Professional practices, training, and funding mechanisms: A survey of pediatric primary care psychologists.

Abstract

The integration of mental health services in primary care settings has expanded rapidly in recent years with psychologists being at the forefront of efforts to promote healthy behaviors, reduce disease, and care for behavioral, emotional, and developmental needs to promote overall health and well-being for children and families (Asarnow, Kolko, Miranda, & Kazak, 2017;Stancin & Perrin, 2014). While there are many psychologists working in pediatric primary care (PPC), little is known about the specific activities that these psychologists engage in, the training they receive, or funding mechanisms that support their work. This study sought to address this gap in the literature through a survey of psychologists working in PPC. An anonymous online survey was disseminated to members of professional organizations and listservs who were identified as having interest in PPC. Psychologists (N ϭ 65) currently practicing in PPC completed the survey by reporting on clinical roles and practices, professional training, practice settings, and funding supports in PPC settings. Results indicate that psychologists assume a number of roles in PPC including providing individual and family therapy, conducting screenings for child mental health concerns, and providing consultation to medical colleagues. Many psychologists also provide supervision and offer educational opportunities for those in related fields, such as medicine and social work. Engagement in research activities was identified as a secondary activity. It was reported that a number of clinical activities were not billed for on a regular basis. Additional areas of research will be discussed along with implications for clinical services in PPC.

Pediatric primary care psychologists’ reported level of integration, billing practices, and reimbursement frequency.

“…Procedures were approved by the authors' institutional review boards. Briefly, a survey was created by a group of PPC psychologists through an iterative piloting and refinement process to characterize current PPC practice parameters (for a full description of survey development, see Hoffses et al, 2017). The survey items reported on herein are available as online supplement material.…”

“…Although potentially beneficial, obtaining reimbursement for the full suite of highintegration activities may prove challenging (Mauch, Kautz, & Smith, 2008). For example, most PPC psychologists report providing screening and consultation services, but a minority bill for these services (Hoffses et al, 2017). Talmi and Fazio (2012) proposed utilization of Health and Behavior (H&B) codes to bill for behavioral services provided during routine care in PPC.…”

“…To better understand payment in PPC, this study explored associations between PPC psychologists’ reported billing practices, reimbursement, and integration models. This information was collected as part of a larger study assessing PPC psychologists’ professional practices, training, and funding (Hoffses et al, 2017). A positive correlation between level of integration, utilization of H&B codes, and more frequent reimbursement for consultation services was hypothesized.…”

Utilization of Integrated and Colocated Behavioral Health Models in Pediatric Primary Care

“…14 In pediatric primary care offices in particular, studies indicate that a large percentage of behavioral health providers use both integrated care within a patient's medical visit along with colocated outpatient therapy. 15,16 In general, the most common presenting concerns addressed by behavioral health providers in pediatric primary care settings are child behavioral and mental health problems (eg, anxiety, depression, attention deficit/hyperactivity disorder [ADHD], disruptive behavior), followed by developmental concerns, medical concerns, and parent or family concerns, 15 but less is known about how the specific care models are used to address these different concerns. In one health system utilizing the integrated model, mental health concerns and developmental concerns were also the most common presenting problems, although diagnoses also included medical concerns such as feeding, weight, and asthma.…”

Spotlight on the Integrated Primary Care Special Interest Group.

“…The survey project presented in this issue, Professional Practices, Training, and Funding Mechanisms: A Survey of Pediatric Primary Care Psychologists (Hoffses et al, 2017), exemplifies the spirit of collaboration and productivity fostered through the IPC SIG. The project had its beginning at the IPC SIG meeting at the Society for Pediatric Psychology annual conference in 2015.…”