Commentary: Healthcare reform and psychology's workforce: preparing for the future of pediatric psychology

Interprofessionality

Preventable medical errors (PME) is the third leading cause of death in the United States with an incidence range of 210,000 to 400,000 deaths per year and an estimated cost of $19.5 billion to $958 billion per year. Despite advances in patient safety, PME persists across the nation. An unmarked extremity, a soft sponge, medication dose, poor communication, etc. are possible precursors of PME that may lead to death. Preventable medical errors such as wrong-patient or wrong-site surgery, botched transplants, and death from myocardial infarction or septic shock following a discharge from the emergency department are frequently reported. According to the Institute of Medicine, most PME in the healthcare system are caused by poor team collaboration and care coordination, particularly when patient care was provided by independent providers. Therefore, the healthcare workforce must work within interprofessional teams for safe, cost-effective, and quality care delivery significant to sustainable healthcare reform.

Psychologists and Pediatricians in the Primary Care Sandbox: Communication is Key to Cooperative Play

Recent literature, public policy, and funding opportunities call attention to the need for better increased integration of health and mental health care services in primary care settings so as to best meet the needs of children and families. There are many benefits to such integration, but pediatric primary care providers (PCPs) face multiple barriers to identifying and managing patients with mental health difficulties. One way to address this problem is through the integration of psychologists into primary care settings who can collaborate with PCPs to provide integrated behavioral health care to youth and families. However, there are challenges to collaboration, which include differences in training, professional cultures, and expectations held by professionals from various disciplines. Effective communication is a key component in supporting interprofessional collaboration between primary care providers and psychologists working in primary care settings. This paper reviews aspects of pediatric medicine culture, critical components of communication, and strategies to improve communication. Three case examples are presented in which some of these challenges have been successfully addressed. Implications and future directions are discussed.

Spending on Hospital Care and Pediatric Psychology Service Use Among Adolescents and Young Adults With Cancer

Objective

To examine the relationship between need-based pediatric psychology service use and spending on hospital care among adolescents and young adults (AYAs) with cancer.

Methods

Billing data were obtained from 48 AYAs with cancer receiving need-based pediatric psychology services and a comparison cohort of 48 AYAs with cancer not receiving services. A factorial analysis of covariance examined group differences in spending for hospital care. Pending significant findings, a multivariate analysis of covariance was planned to examine the relationship between need-based pediatric psychology service use and spending for inpatient admissions, emergency department (ED) visits, and outpatient visits.

Results

Spending for hospital care was higher among AYAs receiving need-based pediatric psychology services than in the comparison cohort (p < .001, ωPartial2 = .11). Group differences were driven by significantly higher spending for inpatient admissions and ED visits among AYAs receiving need-based pediatric psychology services.

Conclusions

The behavioral and psychosocial difficulties warranting need-based pediatric psychology services may predict higher health care spending.

Earlier Pediatric Psychology Consultation Predicts Lower Stem Cell Transplantation Hospital Costs

Objective

The purpose of this study was to examine the hypothesis that earlier time to psychology consultation would predict lower costs for the initial stem cell transplant (SCT) hospitalization among patients receiving care at a children's hospital.

Methods

A retrospective medical record review identified 75 patients (ages 0-32 years) with one or more visits by a licensed clinical psychologist during the initial SCT hospitalization from 2010 to 2014. Demographic and clinical variables were obtained from the electronic medical record and hospitalization costs were obtained from patient billing records. A generalized linear model with a gamma distribution and log link function was used to estimate the relationship between time to psychology consultation and cost for the initial SCT hospitalization while controlling for demographic, clinical, and utilization factors.

Results

After controlling for age at SCT, gender, race, insurance status, diagnosis, SCT type, length of stay, and number of psychology visits, earlier time to psychology consultation predicted lower costs for the initial SCT hospitalization (χ2 = 6.83, p = .01). When the effects of covariates were held constant, every day increase in the time to psychology consultation was associated with a 0.3% increase in SCT hospitalization costs (β = 0.003, SE = 0.001).

Conclusions

Results suggest that facilitating consultations with a pediatric psychologist early in the initial SCT hospitalization may reduce costs for patients undergoing SCT at children's hospitals. Future research is needed to determine the optimal timing of psychology consultation and quantify the economic impact of psychological services.

Training Pediatric Psychologists for Perinatal Behavioral Health Services in a Pediatric Hospital

Although pediatric hospitals specialize in providing care to children and adolescents, at The Children's Hospital of Philadelphia (CHOP), our team has been providing behavioral health services for two unique parent populations-parents with a child in the Newborn Infant Intensive Care Unit and pregnant women carrying fetuses with specific birth defects and receiving prenatal care in the Center for Fetal Diagnosis and Treatment. A new training program was developed to expand the scope of pediatric psychologists' practice to include perinatal behavioral health services, specifically for these two unique parent populations served at CHOP. The program includes direct service provision for adult mental health concerns, as well as education and support to help families cope with the existing medical conditions. This article describes the training program and its implementation as a model of training for other pediatric hospitals. The roles of psychologists embedded in these units and hospital privileges are discussed.

Quality Improvement in Health Care: The Role of Psychologists and Psychology

Quality Improvement (QI) is a health care interprofessional team activity wherein psychology as a field and individual psychologists in health care settings can and should adopt a more robust presence. The current article makes the argument for why psychology's participation in QI is good for health care, is good for our profession, and is the right thing to do for the patients and families we serve. It reviews the varied ways individual psychologists and our profession can integrate quality processes and improve health care through: (1) our approach to our daily work; (2) our roles on health care teams and involvement in organizational initiatives; (3) opportunities for teaching and scholarship; and (4) system redesign and advocacy within our health care organizations and health care environment.

Society of Pediatric Psychology Workforce Survey: Factors Related to Compensation of Pediatric Psychologists

Objective

To summarize compensation results from the 2015 Society of Pediatric Psychology (SPP) Workforce Survey and identify factors related to compensation of pediatric psychologists.

Methods

All full members of SPP ( n  = 1,314) received the online Workforce Survey; 404 (32%) were returned with usable data. The survey assessed salary, benefits, and other income sources. The relationship between demographic and employment-related factors and overall compensation was explored.

Results

Academic rank, level of administrative responsibility, and cost of living index of employment location were associated with compensation. Compensation did not vary by gender; however, women were disproportionately represented at the assistant and associate professor level.

Conclusions

Compensation of pediatric psychologists is related to multiple factors. Longitudinal administration of the Workforce Survey is needed to determine changes in compensation and career advancement for this profession over time. Strategies to increase the response rate of future Workforce Surveys are discussed.

Society of Pediatric Psychology Workforce Survey: Development of Survey Methods, Sample Characteristics, and Lessons Learned

There are few detailed workforce studies of specialty fields within professional psychology, and none have been reported for pediatric psychology since 2006. Availability of such data could facilitate more-informed decision making by students and trainees, psychologists pursuing employment opportunities, and psychologists involved in employment or compensation negotiations. This article describes the work of a task force of the American Psychological Association (APA) Division 54 (Society of Pediatric Psychology) in the design, construction, pretesting, distribution, and data management for the Society of Pediatric Psychology (SPP) Workforce Survey. The 18-member task force was established to design and implement a workforce survey that balanced needs for breadth, clarity, brevity, and protection of confidentiality. The survey solicits information about demographic characteristics; training, licensure and certifications; employment settings, responsibilities, and productivity metrics; compensation; and employment satisfaction. A survey link was distributed via e-mail to full members of the SPP in June 2015. A total of 404 members (32.3% return rate) completed the survey. This article focuses on the development, methodology, and respondent characteristics for this 1st administration of the workforce survey. Separate articles will report detailed analyses of the survey results such as compensation and work satisfaction. Future distributions of the survey will enable compilation of a longitudinal database to track changes in the profession. SPP members and others may propose additional analyses of these data. This work may provide guidance to other groups of specialized psychologists who may wish to implement similar initiatives.

Targeting Health Behaviors to Reduce Health Care Costs in Pediatric Psychology: Descriptive Review and Recommendations

OBJECTIVE

Recent efforts to enhance the quality of health care in the United States while reducing costs have resulted in an increased emphasis on cost containment and the introduction of new payment plans. The purpose of this review is to summarize the impact of pediatric health behavior change interventions on health care costs.

METHODS

A review of PubMed, PsycINFO, and PEDE databases identified 15 articles describing the economic outcomes of pediatric health behavior change interventions. Data describing the intervention, health outcome, and economic outcome were extracted.

RESULTS

All interventions targeting cigarette smoking (n = 3) or the prevention of a chronic medical condition (n = 5) were predicted to avert hundreds of dollars in health care costs per patient. Five of the seven interventions targeting self-management were associated with reductions in health care costs.

CONCLUSIONS

Pediatric health behavior change interventions may be a valuable component of efforts to improve population health while reducing health care costs.

An Exploration of Behavioral Health Productivity and Billing Practices Within Pediatric Primary Care

Objectives To provide descriptive information on behavioral health (BH) productivity and billing practices within a pediatric primary care setting. Methods This retrospective investigation reviewed 30 months of electronic medical records and financial data. Results The percent of BH provider time spent in direct patient care (productivity) was 35.28% overall, with a slightly higher quarterly average (M  =  36.42%; SD  =  6.46%). In the 646.75 hr BH providers spent in the primary care setting, $52,050.00 was charged for BH services delivered ($80.48 hourly average). Conclusions BH productivity and billing within pediatric primary care were suboptimal and likely multifactorially derived. To promote integrated primary care sustainability, the authors recommend three future aims: improve BH productivity, demonstrate the value-added contributions of BH services within primary care, and advocate for BH-supporting health care reform.

Quality of Life Changes and Health Care Charges Among Youth With Epilepsy

OBJECTIVE

To examine differences in health care charges following a pediatric epilepsy diagnosis based on changes in health-related quality of life (HRQOL).

METHODS

Billing records were obtained for 171 youth [M (SD) age = 8.9 (4.1) years] newly diagnosed with epilepsy. Differences in health care charges among HRQOL groups (stable low, declining, improving, or stable high as determined by PedsQL(™) scores at diagnosis and 12 months after diagnosis) were examined.

RESULTS

Patients with persistently low or declining HRQOL incurred higher total health care charges in the year following diagnosis (g = .49, g = .81) than patients with stable high HRQOL after controlling for epilepsy etiology, seizure occurrence, and insurance type. These relationships remained consistent after excluding health care charges for behavioral medicine or neuropsychology services (g = .49, g = .80).

CONCLUSIONS

Monitoring HRQOL over time may identify youth with epilepsy at particular risk for higher health care charges.

Healthcare Reform and Preparing the Future Clinical Child and Adolescent Psychology Workforce

The healthcare environment is undergoing important changes for both patients and providers, in part due to the Patient Protection and Affordable Care Act (ACA). Ultimately the healthcare delivery system will function very differently by the end of this decade. These changes will have important implications for the education, training, scientific inquiry, and practice of clinical child and adolescent psychologists. In this article we provide a brief description of the fundamental features of the ACA, with a specific focus on critical components of the act that have important, specific implications for clinical child and adolescents psychologists. We then provide recommendations to help position our field to thrive in the evolving healthcare environment to help facilitate further awareness and promote discussion of both challenges and opportunities that face our field in this evolving health care environment.

Commentary: demonstrating cost-effectiveness in pediatric psychology

OBJECTIVE

Changes in the health care system and payment plans will likely require pediatric psychologists to illustrate the impact of their services. Cost-effectiveness analyses are one method of demonstrating the potential economic benefits of our services but are rarely used by pediatric psychologists.

METHOD

A hypothetical cost-effectiveness analysis was conducted, comparing the costs and outcomes between a behavioral adherence intervention and no intervention for youth with acute lymphoblastic leukemia.

RESULTS

Results illustrate how pediatric psychologists can use cost-effectiveness analyses to demonstrate the economic impact of their work.

CONCLUSIONS

Efforts to conduct economic analyses could allow pediatric psychologists to advocate for their services. Implications and future directions are discussed.

Recommendations for training in pediatric psychology: defining core competencies across training levels

OBJECTIVE

As a field, pediatric psychology has focused considerable efforts on the education and training of students and practitioners. Alongside a broader movement toward competency attainment in professional psychology and within the health professions, the Society of Pediatric Psychology commissioned a Task Force to establish core competencies in pediatric psychology and address the need for contemporary training recommendations. 

METHODS

 The Task Force adapted the framework proposed by the Competency Benchmarks Work Group on preparing psychologists for health service practice and defined competencies applicable across training levels ranging from initial practicum training to entry into the professional workforce in pediatric psychology. 

RESULTS

 Competencies within 6 cluster areas, including science, professionalism, interpersonal, application, education, and systems, and 1 crosscutting cluster, crosscutting knowledge competencies in pediatric psychology, are presented in this report. 

CONCLUSIONS

 Recommendations for the use of, and the further refinement of, these suggested competencies are discussed.

Twenty years of the Journal of Clinical Psychology in Medical Settings: we hope you will enjoy the show

The 20th anniversary of the Journal of Clinical Psychology in Medical Settings is celebrated by highlighting the scientist-practitioner philosophy on which it was founded. The goal of the Journal-to provide an outlet for evidence-based approaches to healthcare that underscore the important scientific and clinical contributions of psychology in medical settings-is discussed. The contemporary relevance of this approach is related to the current implementation of the Patient Protection and Affordable Care and its focus on accountability and the development of an interprofessional healthcare workforce; both of which have been foci of the Journal throughout its history and will continue to be so into the future. Several recommendations of future topic areas for the Journal to highlight regarding scientific, practice, policy, and education and training in professional health service psychology are offered. Successfully addressing these topics will support the growth of the field of psychology in the ever evolving healthcare system of the future and continue ensure that the Journal is a key source of professional information in health service psychology.

Reflections on developing collaborative research in pediatric psychology: implications and future directions

OBJECTIVES

Collaborative research with pediatric colleagues has become increasingly important in the professional agenda of pediatric psychology, and there is a continuing need to articulate the challenges of such research. To address this need, this article describes types of collaborative research, reasons for collaboration, collaborative process, challenges, and strategies to facilitate collaborative research.

METHODS

Experiences and lessons learned over the course of a career in collaborative research are described.

RESULTS

Challenges in collaborative research can be overcome by effective strategies of engagement and communication. Useful methods of training researchers in collaborative research include modeling and supervised mentored experiences in research initiated by trainees.

CONCLUSION

Data are needed to identify the characteristics of successful collaborative research, strategies to promote effective research, and methods of training and career development.

Psychology in academic health centers: a true healthcare home

This article is based on the invited presentation by the author at the American Psychological Association's Annual Convention, August 4-7, 2011, upon his receipt of the Joseph D. Matarazzo Award for Distinguished Contributions to Psychology in Academic Health Centers presented by the Association of Psychologists in Academic Health Centers. This article relates the history, roles, and responsibilities of psychologists in academic health centers to the ultimate survival and success of professional psychology. It describes implications of the Patient Protection and Affordable Care Act (ACA) on the institutional practice of psychology including how psychology's place in academic health centers positions the field well for the future of healthcare reform. The article provides several recommendations to help professional psychology prepare for that future of integrated, interprofessional healthcare.

The ripple effect: systems-level interventions to ameliorate pediatric pain

The focus of this brief review is to highlight to the reader some of the 'ripple effects' of broader systems-level healthcare issues and the implications they may have for effective treatment of pediatric chronic pain. Many healthcare providers focus almost exclusively on the patient, but lack the knowledge of how to intervene effectively at systems levels with families, schools and healthcare institutions surrounding the pediatric patient with pain. We provide a case example and consider this issue across three systems that are particularly relevant to pediatric pain management: the outpatient pain clinic, school and inpatient settings. The information presented will improve the healthcare provider's ability to effectively treat pediatric pain through an enhanced understanding of the multiple systems of care that surround children with pain.

Crew resource management and teamwork training in health care: a review of the literature and recommendations for how to leverage such interventions to enhance patient safety

PURPOSE

In an attempt to enhance patient safety, health care facilities are increasingly turning to crew resource management (CRM) and other teamwork training interventions. However, there is still quite a bit about such training interventions that remain unclear. Accordingly, our primary intent herein is to provide some clarity by providing a review of the literature, in hopes of highlighting the current state of the literature as well as identifying the areas that should be addressed by researchers in this field going forward.

DESIGN/METHODOLOGY/APPROACH

We searched various electronic databases and utilized numerous relevant search terms to maximize the likelihood of identifying all empirical research related to the use of CRM training within health care. Additionally, we conducted a manual search of the most relevant journals and also conducted a legacy search to identify even more articles. Furthermore, given that as a research team we have experience with CRM initiatives, we also integrate the lessons learned through this experience.

FINDINGS

Based on our review of the literature, CRM and teamwork training programs generally appear beneficial to individual employees, the groups and teams within such settings, and overall health care organizations.

ORIGINALITY/VALUE

In addition to reviewing the literature that addressed CRM and teamwork training, we also highlight some of the more critical aspects of CRM training programs in order for such initiatives to be as successful as possible. Additionally, we detail various factors that appear essential to sustaining any benefits of CRM over the long haul.