Evaluation of Integrated Psychological Services in a University-Based Primary Care Clinic

Abstract

Primary care is increasingly moving toward integration of psychological services; however few studies have been conducted to test the efficacy of such an integrated approach. This paper presents a program evaluation of psychological services provided by doctoral trainees in clinical and counseling psychology within a primary care clinic at an urban academic medical center. It includes: (1) a description of the program, including types of patients served, their presenting problems, and treatments administered and; (2) evidence of the impact of behavioral health services on primary care patients' emotional adjustment and progress on behavioral goals. Intake and follow-up measures of depression, anxiety, smoking, insomnia, chronic pain, and weight loss were collected on 452 adult patients (mean age = 52; 59 % African-American; 35 % uninsured) who were provided brief interventions (mean visits = 2.2) over a 16-month period. Although conclusions are limited by the lack of a control or comparison group, preliminary findings indicate that the integrated behavioral health services provided were effective. Implications and future directions are discussed.

The Impact of Integrated Psychological Services in a Safety Net Primary Care Clinic on Medical Utilization

“…Resident physicians, who provide patient care under the guidance of faculty attending physicians, see patients for a broad range of medical services. In December 2008, the primary care psychology program was instituted at the ACC; a full description of its operation can be found elsewhere (Sadock et al., ). Services are provided according to an IBH model wherein physicians and doctoral clinical and counseling psychology trainees collaborate to optimize patient care.…”

“…Interventions provided for these conditions vary, but all of them are based on empirically supported treatments (see Table ). A recent analysis of the effectiveness of this same primary care psychology program demonstrated significant reductions in patient scores on depression and anxiety measures, in addition to positive weight loss and smoking outcomes (Sadock et al., ).…”

“… a Taken from Evaluation of Integrated Psychological Services in a University‐Based Primary Care Clinic, by E. Sadock, S.M. Auerbach, B. Rybarczyk, A. Aggarwal, . Journal of Clinical Psychology in Medical Settings , 1, 19–32.…”

“…The integration of psychological services into primary care offices has been shown to improve patient outcomes such as depression, anxiety, smoking cessation, and weight loss (Sadock, Auerbach, Rybarczyk, & Aggarwal, ). The integrated behavioral health (IBH) model improves access to care in multiple ways including closing the referral gap found in lower income populations (Reno Conference on the Integration of Behavioral Health in Primary Care, ; Cummings, O'Donohue, & Cummings, ), reducing mental health disparities seen in underserved minority ethnic groups in the United States (Bridges et al, ) and providing treatment opportunities for the estimated 60% of patients whose primary medical complaint has a significant behavioral component (Sobel, ).…”

Initial and Follow‐Up Evaluations of Integrated Psychological Services for Anxiety and Depression in a Safety Net Primary Care Clinic

“…Similarly, only two studies have demonstrated the durability of treatment effects beyond the initial treatment period (Davis et al., ; Ray‐Sannerud et al., ), and neither study took place in a safety net primary care setting. Though integrating behavioral health into clinics that provide care to underserved populations is widely acknowledged as vital for filling the income gap in access to behavioral health services, only four studies thus far have been conducted in a safety net setting (Bryan et al., ; Corso et al., ; McFeature & Pierce, ; Sadock et al., ).…”