Developing Interprofessional Competencies in Professional Psychology

Olga Heath, Maxine Holmqvist

• Publisher: Momentum Press
• Year: 2017
• Print ISBN: 9781946646163
• eBook ISBN: 9781946646170
• Topic: Medicine
• Subtopic: Nutrition, Dietics & Bariatrics

Interprofessional collaboration is an expectation for practicing psychologists, yet few psychologists are trained in collaboration competencies. Drawing from the literature, this book presents a model for incorporating interprofessional education (IPE) into graduate training programs and continuing education for professional psychology. There are separate chapters for each stage of professional development focused on different learning environments, including classroom settings, practica and internship, and postregistration psychology practice, with specific activities for use with students and supervisees or in practice. Each chapter has corresponding suggestions for learner assessment and program evaluation, making this an indispensable resource for training programs, supervisors, and practicing psychologists.

CHAPTER 1

What Is Interprofessional Care (IPC), and Why Is It Important in Professional¹ Psychology?

“Alone we can do so little; together we can do so much.”

—Helen Keller

It’s 9:15 a.m. and I’m just sitting down in an office I share on a rotating basis with a dietician, foot care specialist and social support counselor. This primary care clinic is located in an Aboriginal Health & Wellness Centre that includes a head start daycare, a school, an art gallery, educational support and respite for parents of young children, counselors for those going through the Indian Residential School claims process and a restaurant serving locally sourced and traditional foods. I’ve just come from clinic rounds, where the cases for the day were reviewed with the team, which today includes the clinic director, 2 nurses, 2 physicians, a nurse-practitioner, an occupational therapy practicum student, social support and community health workers and a traditional healer. On my schedule for today: a 54-year old man with poorly controlled diabetes and depression, a 20-year old woman struggling with panic attacks and nightmares following a home invasion and assault, a 41-year old woman with chronic pain and Irritable Bowel Syndrome who was recently discharged from hospital following a suicide attempt and a 36-year old man currently in a wheelchair who is struggling with adjusting to his diagnosis of progressive Multiple Sclerosis. As the nurse stops by to let me know my first person has arrived, she mentions that his recent bloodwork shows that his A1c (blood sugar level) is dangerously high; however, he has been non-compliant with his medications in the past. She wonders if I can feel out whether he would be willing to try insulin therapy again and asks if I know anything about needle phobias. I feel a tremendous wave of gratitude for this hard-working and dedicated team. How on earth could I provide quality care to these individuals in isolation? How could anyone?

—quote from primary care consulting psychologist

Introduction

Collaboration in health and social care—at least at the grassroots level—is nothing new, and references to the need for psychologists to work with other disciplines can be found in the academic literature at least as far back as the 1950s (e.g., MacFarlane, 1950). What does seem to have changed in recent years, however, is both the accumulation of evidence in favor of collaborative care, and the recognition by governments and other key stakeholders that interprofessional care (IPC) is not only desirable, but necessary. In this chapter, we will define IPC and discuss current trends that have contributed to the rise in IPC.

Our Changing World

It is no coincidence that the call for collaborative care has gained so much momentum at this particular point in history; health care is going through a transformative process of change. Up until the early 20th century, the most significant threats to global health were widely acknowledged to be infectious and parasitic diseases, which disproportionately affected infants and young children. Advances in sanitation, food production, technology, and antibiotics and other drugs added decades to the human life span by reducing childhood mortality and enabling individuals to live for many years with illnesses that previously would have been fatal. Now, in the second decade of the 21st century, noncommunicable and chronic diseases, particularly heart disease, stroke, and diabetes, impose the greatest burden on global health, accounting for more than 60% of deaths and 48% of healthy life years lost (World Economic Forum, 2011). Chronic diseases are highly impacted at every stage by potentially modifiable behavioral factors; in fact, the World Health Organization (WHO) estimates that at least 80 percent of heart disease, stroke, and type II diabetes and 40 percent of cancers could be prevented through adoption of a healthy diet, adequate physical activity, and avoidance of tobacco products (WHO, 2005). The world is also facing an unprecedented demographic milestone, with people over the age of 65 projected to outnumber children under age 5 for the first time in recorded history within a few years (WHO, 2011). This trend is expected to accelerate globally between now and 2050, with the number of older adults in developed countries projected to increase by 71 percent and the number of older adults in developing countries expected to increase more than 250 percent. Health status scores decline with age, while disability rates and per capita expenditures on health care increase (WHO, 2011); thus, an aging population requires a health care system that can respond both to increasing demand and significantly increased complexity.

In addition to these two trends, mental illnesses are increasingly being recognized as a significant public health problem. According to the WHO (2004), 1 in 4 people worldwide will suffer from mental and/or behavioral disorders at some point during the course of their lives. Unipolar depression is among the largest single causes of disability worldwide (World Economic Forum, 2011), while dementia is anticipated to reach epidemic proportions as the population ages, given almost 30 percent of those aged 85 to 89 are affected (Moïse, Schwarzinger, & Um, 2004). In 2012, the World Health Assembly adopted a resolution to develop a coordinated action plan for 2013 to 2020 (WHO, 2013a) to help address the immense burden of mental illness. That document highlights the fact that individuals with mental illness are at increased risk of developing a range of physical health problems (including cancer, heart disease, and human immunodeficiency virus/acquired immune deficiency syndrome [HIV/AIDS]) and have an excess mortality rate two to three times higher than that in the general population (De Hert et al., 2011). Conversely, individuals with chronic health conditions such as diabetes, cancer, and Parkinson’s disease are at greatly increased risk of developing a mental disorder. The tremendous overlap between chronic disease and mental illness is further complicated by the fact that certain medications used to treat common conditions (e.g., heart disease) are known to potentially have psychological consequences (e.g., anxiety, insomnia).

In order to offer our patients² the best possible care, professional psychologists must be prepared to navigate a system where our work is intricately and unavoidably interdependent with that of other professionals and care providers. The need for IPC has never been greater.

What Is IPC and Why Is It Important?

Although many definitions of IPC exist, we like the one offered by the WHO in 2010 because it incorporates several key concepts related to IPC. Let’s consider each of these in turn.

Interprofessional care occurs when multiple health workers from different professional backgrounds provide comprehensive health services by working with patients, their families, caregivers and communities to deliver the highest quality of care across settings (WHO, 2010).

IPC Involves Health Workers from Different Professional Backgrounds Coming Together

Lake, Baerg, and Paslawski (2015) identify three features common to all frequently used definitions of IPC. These are: (1) a process for communicating and making decisions, (2) shared goals, and (3) synergy (i.e., the whole is greater than the sum of its parts). These definitions all suggest that while physical proximity or colocation (e.g., having a psychologist in the same primary care office as a physician) is often necessary, it is certainly not sufficient to ensure genuinely collaborative care.

In the course of their professional work, psychologists will often be called upon to collaborate with individuals in sectors other than health care (e.g., education, justice) and with individuals who are not formally members of professions (e.g., case managers). The same principles and competencies that allow for effective collaboration between professionals apply in these situations, although the context will be somewhat different (for further discussion of interprofessional competencies, see Chapter 2). Collaboration can occur in a variety of ways, and many different terms are used to describe working together. In particular, confusion around the use of prefixes and suffixes is common (see Text Box 1.1).

IPC Is Comprehensive

The need for collaboration increases with the complexity of the patient, problem, or task. Multiple perspectives allow us to address complexity more fully, as each member of the team brings a different set of “lenses” (i.e., experiences and knowledge) to the case. It follows that not all professional endeavors require collaboration. Indeed, part of what must be learned is an understanding of when it is important to collaborate, and with whom. Within health care, IPC “is essential when patient needs and problems are multiple, complex and/or overlap professional boundaries” (Heinemann, Schmitt, Farrell, & Brallier, 1999). As we have already noted, there is ample reason to believe that the patients we serve have increasingly complex needs and IPC has become commonplace for many kinds of health care teams that routinely include psychologists, including pain management, rehabilitation, and developmental disabilities, as well as in private practice (e.g., Mendelberg, 2014).

Text Box 1.1

Use of Prefixes/Suffixes

Discipline vs. profession

A discipline is a distinct academic field of study, while a profession is a line of work requiring specialized knowledge and formal preparation (Oandasan & Reeves, 2005). Professions typically have codes of ethics and conduct, and have some formal system of accountability to society and/or regulation (e.g., licensing, registration). The term interprofessional is used more in health care due to the fact that there may be multiple disciplines within one profession (e.g., genetics, psychiatry, and internal medicine are all different medical disciplines), whereas interdisciplinary is more common in academic settings.

“Inter” vs. “multi”

The use of the prefix “inter” denotes a greater degree of integration than that of the prefix “multi”. The use of “multi-” implies that team members work independently (i.e., in parallel or sequentially) toward a common purpose. In contrast, the use of the prefix “inter-” suggests a high degree of synthesis and team reflection. Thus, interprofessional care is characterized by features such as joint goal setting and the development of shared care plans, reflecting the explicit and intentional coordination of services and shared leadership.

Mental health care is undergoing its own revolution. There has been a global movement to integrate mental and social care providers into primary care clinics as one means of increasing access to these services, while improving outcomes in a variety of domains (WHO, 2008). In the United Kingdom, the National Health Service (NHS) rolled out the Improving Access to Psychological Therapies (IAPT) program in 2008 (http://www.iapt.nhs.uk/) with the aim of dramatically increasing access to evidence-based psychological therapies. Psychologists were, and remain, pivotal in developing and evaluating the IAPT program and also play a key role in training and supervising frontline clinicians, who may have a variety of professional backgrounds. In Canada, the Canadian Psychiatric Association and College of Family Physicians of Canada released a joint paper in 2011 on collaborative mental health care that promotes the idea of “shared care,” where mental health providers are integrated into family practice through shared care teams (Kates et al., 2011); the notion of “reversed shared care” has also arisen, where physical health providers (e.g., nurse practitioners, family doctors) are brought into mental health settings (e.g., Ungar, Goldman, & Marcus, 2013). In Australia, a similar “Better Access” initiative was launched in 2006 as part of the National Action Plan on Mental Health (Council of Australian Governments, 2006), while in the United States, efforts to promote psychology’s participation in collaborative health care settings were bolstered by the passing of the Affordable Care Act (ACA). The ACA requires that essential health benefits include mental health, preventive and wellness services, and chronic disease management in addition to more biomedically focused interventions and services. At the time of writing, the future of the ACA is uncertain; however, we believe it is likely that many of the incentives for interprofessional practice will remain in place.

IPC Can Improve the Safety, Quality, and Cost-Effectiveness of Care

For the past two decades, attention has increasingly focused on the issue of preventable medical errors. According to the WHO, in developed countries worldwide, the approximate likelihood that a hospitalized patient will be the victim of a medical error is 10 percent (WHO, 2014). Research has shown that the majority of errors are not due to lapses of skill, but rather failures of communication. In fact, inadequate preparation of health professionals for working in interprofessional teams has been implicated in a range of negative outcomes in addition to patient safety issues, including lower levels of provider and patient satisfaction, low workforce retention, system inefficiencies resulting in higher costs, and suboptimal community engagement (Epstein, 2014; Institute Of Medicine, 2003; WHO, 2010; Zwarenstein et al., 2009).

While assessing the effectiveness of IPC is a complex undertaking, important progress has been made, and effective IPC has been linked to a range of positive outcomes across a variety of settings (see Text Box 1.2 for a summary, with illustrative examples). For an overview of this literature, the reader may want to consult one of the many summary papers that have been written for this purpose (e.g., Barrett, Curran, Glynn, & Godwin, 2007; Suter et al., 2012; WHO, 2010).

Text Box 1.2

Benefits of IPC

• Increases patient self-confidence, role functioning, and involvement in care (Taylor, Oberle, Crutcher, & Norton, 2005; Pirkis et al., 2004)

• Lowers costs (Fuller et al., 2011)

• Improves access to services for underserved communities (Pinto, Wall, Yu, Penido, & Schmidt, 2012)

• Improves patient safety and qua...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• Preface
• Foreword
• Acknowledgments
• Chapter 1 What Is Interprofessional Care (IPC), and Why Is It Important in Professional Psychology?
• Chapter 2 What Are Interprofessional Competencies?
• Chapter 3 Barriers and Enablers to Including IPE in Psychology Training Programs
• Chapter 4 A Model for Interprofessional Education, Collaborative Competency Assessment, and Program Evaluation in Professional Psychology
• Chapter 5 Interprofessional Education in Professional Psychology Training: Classroom Settings
• Chapter 6 Interprofessional Education in Professional Psychology Training: Practica and Internship
• Chapter 7 Interprofessional Education in Professional Psychology: Post-registration
• Final Thoughts
• References
• Index