Promoting Quality: Graduate Psychology Education (GPE) Trainees at a Community Health Center

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1 Promoting Quality: Graduate Psychology Education (GPE) Trainees at a Community Health Center Ana J. Bridges Assistant Professor Director, GPE Program Department of Psychological Science University of Arkansas Debbie Gomez Clinical Psychology Graduate Student GPE Trainee Department of Psychological Science University of Arkansas Kathy Grisham Executive Director Community Clinic

2 GPE Crew

3 UA GPE Training Goals Increase # of psychology trainees who pursue careers related to health disparities Foster a professional identity and base knowledge that increases comprehensive, culturally competent, quality mental health care Provide clinical training to meet the needs of medically underserved communities Improve behavioral health of NWA medically underserved residents

4 UA GPE Training Components

5 Didactic Training: * Diversity course * Medical consultation course * EBPP/IBHC seminar * Monthly colloquia

6 Research Training: * Program evaluation * Health disparities * Clinical populations * Treatment outcome * Mentoring Undergraduate Health & Diversity Fellows

7 Clinical Training: 1 year clerkship in a Federally Qualified Health Center

8 Outreach/Immersion: * Behavioral health workshops and newspaper articles * Immersion and cultural training at Ponce Medical School, Puerto Rico

9

10 Public Health Perspective Impact = Effectiveness x % Population Reached Individual health perspective: Maximize effectiveness Public health perspective: Maximize the impact An intervention for depression that is 80% effective but only reaches 5% of the population will have less of an impact than an intervention that is 50% effective but reaches 40% of the population. Impact =.8 x.05 =.04 Impact =.5 x.4 =.20

11 Self-Rating Data- Trainees GPE Trainee Self-Assessed Competencies Culturally sensitive therapy Working in IBH setting Medical consultation Evidence based practice 1st 2nd 3rd 4th Competency

12 Patient Demographics: Age Female (N = 238) Male (N = 121) Child (< 12) Youth (12-17) Adult (18-54) Older adult

13 Patient Demographics: Race/Ethnicity & Preferred Language 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Male (N = 121) Female (N = 238) African American Hispanic White Other English Spanish

14 Common Diagnoses 45.00% 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Mood Anxiety Adjustment Childhood D/O Male (N = 121) Female (N = 238)

15 Common Interventions 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% Psychoed Beh Act Reinforce sched PMR/Breathing Exposure Male (N = 121) Female (N = 238)

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17 IBHC Patients are Moderately Distressed 5 Global Distress Score English (N = 74) Global Distress Spanish (N = 44)

18 Patients Are Very Satisfied with IBHC Provider 5 Therapeutic Alliance English (N = 74) Spanish (N = 45)

19 IBHC Services are Effective Cohen s d =.62 (medium) 5 Global Distress Scores Pre Post

20 IBHC Services are Effective Cohen s d =.62 (medium) Traditional therapies: average Cohen s d of.80 (medium to large effect size) We are getting 75% of the therapeutic effect of a 20- visit treatment in 1.5 visits

21 How GPE Has Impacted My Training

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26 Outreach and Immersion Opportunities

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28 Impact of Trainees on Patients: Case Vignettes

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31 Value of Psychologists in Community Health Centers

32 NEW Mandates for Community Health Centers Like many healthcare agencies, we are changing our practice to accommodate expectations under the ACA. Team approach to care (patient centered medical homes) Reimbursement will be based on patient outcomes, quality measures (A1c, comorbidity) Electronic medical records ( meaningful use ) Our dilemma: How to produce the best clinical outcome for the patient in the most cost-effective manner

33 Community Clinic s Patient Demographics Latino/a 58% Marshallese 5.5% Below 200% FPL 89% Uninsured 37% Medicaid 49% Children 57% Language other than English 51% 25,021 patients in 2011

34 Barriers to Seeking Care 2010, Ana J. Bridges, Ph.D. Training Intergraded Behavioral Health Care Psychologists in Medically Underserved Communities

35 Where Care is Accessed 2010, Ana J. Bridges, Ph.D. Training Intergraded Behavioral Health Care Psychologists in Medically Underserved Communities

36 Partnership between Psychologists and CHCs Positive, measurable outcomes My 3 rd trip to DC on behalf of APA/ the GPE program Value of psychologists in Community Clinic CHCs nationally will be increasing services from 15 million to 30 million patients Community Clinic has seen a 78% increase in patients served in the last 3 years CHC advocacy efforts

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