Week 1 – Assignment: Explore Topics of Interest
PSY-5301 V4: Foundations of Health Psychology NCU
My interest in helping others initiated at a young age, actually, at the age of fourteen (14) years old. The first person I gave advice to my maternal aunt (she was in her early 20’s). My advice to her was always related to her love life and financial situation. At that point in my life, I knew that my interest is in the helping profession, such as psychology. Moving forward to the present time, my interest continued, but more related to health and wellness. Living in an underprivileged neighborhood of Bushwick in Brooklyn, New York, I observed the changes of the neighborhood, and giving back to my community has always been a lifelong dream. This area is full of issues such as safety, crime, housing, health related, retail environment. Police monitoring to keep the neighborhoods crime down, while it results in some of the men in this community end up incarcerated. Many single mothers raising children by themselves, relying on getting childcare assistance from the immediate family or close friend, due to the high prices of daycare. All these issues are not going to disappear anytime soon, but with well trained individuals the issues may lessen.
I want to explore the theoretical principles in the field of health psychology to broaden my knowledge, receive formal education, and professionally help individuals that are in need. By having formal education from a known institution, that facilitate students with quality doctoral educators that are the expert in their chosen field in of psychology. At this point in my life, I am focus, and feel that this time I am taken by the hand and guided in the right direction. That approach is very encouraging and adaptable to develop healthy habits like forming proper study patterns and work ethics. After repeating the same pattern repeatedly there is a lesson in there for me to learn. A health psychologist assists individuals uncover answers and with the hope to reach favorable results. Learning theories may design the different types of approaches, which will add to the needed knowledge to help individual cope with present health issue(s).
I see myself serving by contributing to my community of Bushwick in Brooklyn, New York. During these pressing times of the cOVID-19 pandemic, other newly developed strands, like Omicron. The health psychologist is a professional field that is in high demand. I am also interested in the health issues that has been going on within the pass twenty-two (22) years, and little to no changes has improved:
“Bushwick has the borough’s highest number of children on public assistance and its second highest rate of hospitalization for asthma, and the city’s highest rate of childhood lead poisoning. The graduation rate at Bushwick High School is 35 percent, compared with 61 percent for the borough” (Barnes, E.2000).
This is the neighborhood that I hold close and dear to my heart, perhaps, because this was the first neighborhood I was introduced to since 1968 coming from the Dominican Republic with my family. The neighborhood has improved esthetically, but the same issues continue to arise.
Source
Barnes, J 2000, “The Two Daces of Bushwick; A Troubled Brooklyn Neighborhood Is Mending. But It’s Leaders Are Feuding Over the Size of the Gains and What to Do Next.”
The Collaborative Care within the Realms of Psychology
Mental health issues are complex and people with mental disorders take experience a myriad of issues that complicate the process of assessment, intervention, and recovery. Complete recovery from mental illness can take months or even years. During that time, a person requires immense support as they navigate through various departments within the health system. In the mental health system, there is a mismatch between supply and demand because of resource limitations and other historical issues such as stigmatization. As such, a collaborative model is used to enhance service delivery in mental health and the wider health sector by linking primary care with other agencies, as well as resources required by mental health service users. The collaborative care model enables various providers to work together and provide enhanced, safe, and effective care to individuals through an integrated system of intervention and progress monitoring. The purpose of this paper is to analyze how the collaborative care model and integrated care are utilized in the field of health psychology
Integrated Care and Collaborative Care
In collaborative care, the primary care provider works with psychiatric consultants and care managers to develop common goals for an individual, followed by intervention and monitoring of progress. On the other hand, is an organized system of care characterized by collaboration, effective communication, and coordination to make the care approach seamless, efficient, and highly responsive to the needs of service users (Raney, 2015). The collaborative care model approach is highly essential in mental health because it encourages long-term progress monitoring of individuals with mental illnesses, which improves the chances of successful recovery. Recovery for people with mental illness takes time and requires long-term monitoring and support; otherwise, the chances of relapse are high. With the shortage of psychiatrists and other mental health providers, individuals who have mental health issues such as addiction do not receive enough support required to enable successful healing. The CCM model in health psychology seeks to solve the problem of shortage by integrating care so that primary care providers can work with psychiatrists through communication and coordination of care.
The collaborative care model (CCM) is utilized in the field of health psychology to enhance health outcomes for individuals with complex mental health cases. According to Phelps and James (2017), sometimes the primary care providers encounter complex cases, for example, bipolar, that requires the input of psychiatry to ascertain accurate diagnosis and effective intervention. Furthermore, individuals with mental health issues often present with comorbid situations such as depression and alcohol addiction, further complicating the process. Hence, it is not plausible to handle such cases with a single clinician (Ee et al., 2020). The CCM model ensures that a consultant psychiatrist collaborates with the primary care provider so that he/she can contribute their expertise in complex cases to ensure the accuracy of diagnosis and treatment effectiveness. In the CCM model, psychiatrists play a critical role in educating primary care providers on diagnosis and intervention for various mental health conditions (Carlo et al., 2021). For example, psychiatrists can show primary care providers how to diagnose bipolar by recognizing that cases of the condition fall on a spectrum that runs from unipolar to bipolar. Moreover, psychiatrists can also create clinical approaches in primary care that enable providers to diagnose various mental health conditions, especially the ones that present with similar symptoms, for example, bipolar and depression (Phelps & James, 2017).
Apart from primary care, a collaborative care model has also been implemented in community centres to enhance the coordination and integration of care across communities. Community health centres serve many patients with mental health conditions; hence benefit from care coordination to locate resources and other necessary elements needed to provide care to the service users. According to LaBelle et al. (2016), the implementation of CCM at the community level enables access to treatment by many people because of wider geographical coverage. Additionally, the CCM at the community level enhances the engagement of marginalized populations and other underserved communities, ensuring that they access mental and behavioral care services (LaBelle et al., 2016). The collaborative care model in health centres also ensures that there is coordination and open communication between medical providers and behavioral health practitioners, which not only translates to positive health outcomes for patients but also a stigma reduction. Stigma remains a significant issue in behavioral health, negatively impacting people’s decision to seek help and support for their mental health and behavioral problems.
The collaborative care model in health psychology is an evidence-based approach based on the integration of care. According to Ee et al. (2020), CCM incorporates a personalized stepwise care approach that uses targeted intervention. The model is personalized because of its ability to evaluate the unique individual needs of a person. Further integration occurs with the involvement of a case manager who monitors the progress and outcomes, as well as the systematic process of follow-up that enables providers to participate in the monitoring of service users to ensure they receive effective care (Raney, 2015). For example, people who are receiving addiction treatment require monitoring because of the complex nature of the treatment and the high probability of relapse. One of the approaches to achieving collaboration and integration in health and psychology is co-locating mental health specialists and primary care providers (Stergiopoulos et al., 2015). The co-locating strategy is essential for monitoring the progress of a patient by the primary care provider and behavioral health practitioner among other healthcare personnel involved in the case.
Role of Health Psychologist in Collaborative Care Model
The CCM allows multiple providers to work together in providing care to an individual. A health psychologist is among the practitioners tasked with caring for individuals under the CCM. The role of a health psychologist is to ensure that the collaborative team addresses the physiological, behavioral, and psychosocial needs of a patient for positive health outcomes including good welfare and well-being. As such, psychologists have various duties to ensure the well-being of individuals who receive care. For example, integrated care psychologists participate in the care transition from a medical setting to a psychiatric setting (Rugkåsa et al., 2020). In this case, the health psychologist ensures that there are no barriers to effective transition that can impact providers and patients by causing frustration and lack of motivation. The health psychologist plays a critical role in ensuring that systemic, provider and patient factors are managed to create a smooth transition. The health psychologist manages the emotional well-being of the patient and by doing so, also takes a burden off the medical provider within the integrated care system.
The second role of health psychologists in the medical and mental health collaborative care model is to follow through on issues impacting patients such as depression and anxiety (Lara et al., 2018). These conditions are common with a patient diagnosed with chronic illnesses, terminal illnesses, and acute life-threatening conditions and might negatively impact the process of treatment and healing if not addressed. Health psychologists are concerned with the well-being of individuals; hence, facilitate intervention in such cases to restore normal health and maintain good health and well-being. Under this role, health psychologists work in various settings to promote health and well-being in various patient populations. For example, they work with paediatrics in pediatric primary care to ensure that patients from this population who require mental health care have easy access to search services. Other areas where health psychologists work include geriatric care, family medicine, and obstetrics and gynaecology.
Apart from improving patients’ health, psychologists involved in the collaborative care model also focus on enhancing provider satisfaction by buffering them from emotional fatigue and burnout that affect the motivation and productivity of providers. Health psychologists promote an understanding of emotional well-being and its relationship with job satisfaction and performance. Thus, they provide interventions and preventive measures that address or counter a range of issues that cause burnout and emotional fatigue among the providers. An example is self-care activities, which allow providers to practice self-compassion, associated with great emotional outcomes and motivation. Studies have shown that integrated care involving psychologists not only saves money and improves patient outcomes, but also reduces rates of burnout among healthcare providers.
The other role of health psychologists is to make health services cost-effective and accessible to various patient populations. The health psychologist plays this role by drawing the connection between sociocultural factors and health outcomes. As such, they provide essential knowledge, especially to non-mental health care providers on the evidence-based psychotherapies that improve the outcome for patients while reducing the cost of care. For example, they train the primary care providers on how to conduct a targeted and brief assessment and provide interventions for conditions that are narrow in scope, brief, and require fewer sessions than the traditional interventions in psychotherapy settings. Having the knowledge to address common but less complicated mental health issues ensures easy access to providers and cost-effective care as psychiatrists are difficult to pin down and also expensive.
Environments for Implementing Collaborative Care Model
One of the environments that would benefit from the collaborative care model is the community health centres. Community health centers provide care targeted at meeting the specific needs of the community. Community health services are closer to the people, and thus, they enhance health access to individuals, especially those who are marginalized or vulnerable. Moreso, community health centers have a better understanding of the local culture; hence, they incorporate cultural sensitivity into the services they provide to the locals. Community health centres are under-resourced and often experience a shortage of experts such as psychiatrists. The collaborative care model allows community health centers to work with other providers to increase access to expert services for the populations that they serve (Raney, 2015). Health psychologists can play an important role in this case by advocating for policies that address the negative social determinants of health to improve outcomes for the communities.
The second setting that would be ideal for implementing a collaborative care model is pediatric primary care. Pediatric primary care is a setting that provides a range of health and behavioral care to children and adolescents. According to Burkhart et al. (2020), providing integrated pediatric care allows for identifying children who are at risk of mental health conditions or at risk of developing mental and behavioral issues. Such an approach supports early intervention and prevention to promote health outcomes for the pediatric population. A study investigating the outcomes of an integrated and collaborative care model in the pediatric population reports increased access to behavioral support services, satisfaction with care, and treatment engagement for better patient outcomes. The policy considerations that would be required include policies addressing the changes in the scope of practice for primary care providers and other members of the collaborative framework to ensure that it covers a comprehensive care approach to a range of issues impacting children and their families (Wissow et al., 2021).
Conclusion
The collaborative care model and integrated care have been implemented in various settings in the medical environment to improve health outcomes for populations. The collaborative care model is used by providers to coordinate care, provide appropriate interventions, and allow monitoring of patients’ progress and recovery journey. The health psychologist is at the center of the integrated care and collaborative care relationship as he/she ensures access to cost-effective services while also managing the emotional issues among providers and patients that might have a poor impact on health. For example, health psychologists participate in care transition to ensure an efficient and smooth process and buffer providers and patients from frustrations and lack of motivation. Various settings in medical and mental healthcare can benefit from the collaborative care model such as community health centers and pediatric primary care.
References
Burkhart, K., Asogwa, K., Muzaffar, N., & Gabriel, M. (2020). Pediatric Integrated Care Models: A Systematic Review. Clinical Pediatric, 59(2):148-153. https://doi.10.1177/0009922819890004.
Carlo, A., Barnett, B., & Unützer, J. (2021). Harnessing Collaborative Care to Meet Mental Health Demands in the Era of COVID-19. JAMA Psychiatry, 78(4):355–356. doi:10.1001/jamapsychiatry.2020.3216.
Ee, C., Lake, J., & Firth, J. (2020). An integrative collaborative care model for people with mental illness and physical comorbidities. International Journal of Mental Health System, 14, 83. https://doi.org/10.1186/s13033-020-00410-6.
LaBelle, C., Han, S., Bergeron, A., & Samet, J. (2016). Office-Based Opioid Treatment with Buprenorphine (OBOT-B): Statewide Implementation of the Massachusetts Collaborative Care Model in Community Health Centers. Journal of Subst Abuse Treat, 60:6-13. https://doi.10.1016/j.jsat.2015.06.010. Epub 2015 Jun 26.
Lara, M., Stepleman, L. P.-W., & Valvano, A. (2018). Integrated care psychologists and their role in patient transition from medical to psychiatric specialty care settings: a conceptual model. Health Psychology and Behavioral Medicine, 3:1, 154. 10.1080/21642850.2015.1063059.
Phelps, J., & James, J. (2017). Psychiatric consultation in the collaborative care model: The “bipolar sieve” effect. Med Hypotheses, 105:10-16. https://doi.10.1016/j.mehy.2017.06.017.
Raney, L. E. (2015). Integrated care: Working at the interface of primary care and behavioral health. American Psychiatric Publishing, Inc.
Rugkåsa, J., Tveit, O., & Berteig, J. (2020). Collaborative care for mental health: a qualitative study of the experiences of patients and health professionals. BMC Health Service Research, 20, 844. https://doi.org/10.1186/s12913-020-05691-8.
Stergiopoulos, V., Schuler, A., & Nisenbaum, R. (2015). The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study. BMC Health Service Research, 15, 348. https://doi.org/10.1186/s12913-015-1014-x.
Wissow, L., Platt, R., & Sarvet, B. (2021). Policy Recommendations to Promote Integrated Mental Health Care for Children and Youth. Academy of Pediatrics, 21(3):401-407. doi: 10.1016/j.acap.2020.08.014.