The general public has recently made demands for continuity of care in psychological services from outpatient settings to inpatient facilities and back. These demands plus three economic and structural modifications within our nations' health-care arena, including the incursion of for-profit health-care corporations into the health delivery industry, the 1985 JCAH decision to include nonphysician providers on hospital medical staffs, and the 1990 California Supreme Court Decision (CAPP v. Rank) ensuring full medical staff participation by California psychologists, have opened the doors to the independent practice of psychology in hospitals, rehabilitation centers, nursing homes, and day treatment facilities. This article presents current professional realities for psychologists in hospitals and health-care settings and reviews the work of the American Psychological Association in support of hospital independent practice.Professional psychology is steadily being drawn into the maelstrom of the crisis in American health care. Today our nation spends more on health care than any other nation in the world, and we are the only industrialized nation, other than South Africa, to have not enacted a comprehensive national health-care program (Mitchell;. Recently, both the Bush Administration and the U.S. Congress have entered into the beginning stages of a truly national debate regarding what type of program would most effectively meet the needs of our nation (DeLeon, Wedding, Wakefield, & VandenBos, 1992). With the report by the Administration that even though current healthcare expenditures already represent approximately 13% of our Gross Domestic Product (GDP)-up from less than 6% only 3
Psychologists are taking the lead to ensure that consumers have full access to behavioral science knowledge in America's hospitals. This article recaps the development of psychology's position in hospitals and explores the variety of current and prospective roles of psychologists in inpatient health care.
th the changing health care market, there is an inmary care physicians and other medical providers. Particularly in rural areas, primary care physicians are usually the first medical professionals to encounter patients' behavioral health problems (Rakel, 1995).Unfortunately, psychologists practice in offices that are often isolated from primary care health care providers, and therefore behavioral health problems often go undiagnosed or untreated (Bray & Rogers, 1995;Higgins, 1994;Kroenke & Mangelsdorff, 1989). Many psychologists have little or no training in working with primary care physicians and are not educated about this aspect of the health care system (Bray, 1996;Enright, Resnick, DeLeon, Sciara, & Tanney, 1990).The Linkages Project-a demonstration project that trained W creased need for psychologists to collaborate with pri-The Linkages Project was supported by the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration Contract 92MF05154001D, to the American Psychological Association. Thanks are extended to Gil Hill and Marquette Turner for their help with the project and to the professionals for taking time from their busy practices to participate in the project.
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