Académique Documents
Professionnel Documents
Culture Documents
Interprofessional
Competencies in
Professional Psychology
Developing
Interprofessional
Competencies in
Professional Psychology
A Practical Guide
DOI: 10.5643/9781946646170
10 9 8 7 6 5 4 3 2 1
Keywords
Collaboration, Competency-based education, Health care improvement,
Interprofessional care, Interprofessional education, Professional psychology
Contents
Prefaceix
Foreword................................................................................................xi
Acknowledgments................................................................................... xv
Final Thoughts....................................................................................121
References............................................................................................123
Index..................................................................................................135
Preface
Dr. Olga Heath and I first met in May 2013. I had been encouraged
by my Department Head to travel to the East Coast of Canada to learn
more about how educators there were breaking new ground in teaching
health care professionals, and to bring these insights back to my role as
the theme lead for health psychology and behavioral medicine in the
College of Medicine at the University of Manitoba. I was nauseated and
battling jet lag when I arrived at Memorial University on a windy and
rainy Wednesday morning. Despite the circumstances and the differences
in our backgrounds and experiences, in Olga, I immediately recognized
a kindred spirit.
My involvement with IPE began when I was a graduate student at the
University of Saskatchewan. I had spent years traveling, volunteering, and
teaching before committing to a career in clinical psychology, and Iwas
looking for a way to apply the skills I was learning to the needs I saw
around me. When I heard about an interprofessional group of students
working to establish an after-hours, student-run clinic in a core neigh-
borhood, I knew I had found my answer. My experiences at the Student
Wellness Initiative Toward Community Health (SWITCH) clinic fun-
damentally changed my view of what psychological practice should be,
and it continues to inform my work as a clinician in primary care and
outpatient services, and as a teacher, educational lead, interprofessional
mentor, supervisor, and researcher.
Olgas work as the Director of the Centre for Collaborative Health
Professional Education (CCHPE) is genuinely inspiring, and she
accomplishes it by bringing the full breadth and depth of her training as a
psychologist to every aspect of interprofessional curriculum d
evelopment,
implementation, and evaluation. She is a terrific example of the added
value psychologists can bring to IPE, and when she invited me to write
this book with her, I leapt at the opportunity. In these pages, you will
find a roadmap for how to integrate collaborative competencies into
x PREFACE
If (and at this time the if is very large) health care systems are
to change, then the education of health care professionals, in all their
environments, must inevitably start the journey to learn with, from and
about each other, for the purposes of collaboration to improve the qual-
ity of care (WHO, 2010) as soon as possible, or even sooner! This book
FOREWORD
xiii
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
Its 9:15 a.m. and Im 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. Ive just come from clinic rounds, where the cases for the
day were reviewed with the team, which today includes the clinic director,
2nurses, 2 physicians, a nurse-practitioner, an occupational therapy practi-
cum student, social support and community health workers and a traditional
1
Both authors of this book are clinical psychologists working in academic settings
where clinical psychologists are trained, and our work undoubtedly reflects this per-
spective. However, we have chosen to use the term professional psychology because we
believe that these principles have utility not only for clinical psychologists, but also for
other psychologists who provide psychological health services to the public, includ-
ing counseling and school psychologists. We understand that in some countries other
terminology may be preferred (e.g., the use of health service psychology in the United
States; Health Service Psychology Education Collaborative [HSPEC], 2013) but we
have chosen to use the broader term professional psychology here.
2 DEVELOPING INTERPROFESSIONAL COMPETENCIES
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 individu-
als in isolation? How could anyone?
Introduction
Collaboration in health and social careat least at the grassroots levelis
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 desir-
able, but necessary. In this chapter, we will define IPC and discuss current
trends that have contributed to the rise in IPC.
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 250percent. 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 antici-
pated to reach epidemic proportions as the population ages, given almost
30 percent of those aged 85 to 89 are affected (Mose, 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,
4 DEVELOPING INTERPROFESSIONAL COMPETENCIES
2
Individuals accessing psychological services may be referred to in a variety of ways, includ-
ing service user, survivor, person with lived experience, patient, or client, with preferred
nomenclature often determined by the context of care and official bodies (e.g., insti-
tutions or organizations where psychologists work, professional associations). A lthough
we recognize its limitations, in this book we use patient to designate a recipient of
psychological services because this is the preferred term in health care and the word
most commonly used by other professionals with whom we may collaborate (social work
is a notable exception). The interested reader may wish to refer to Covell, M cCorkle,
Weissman, Summerfelt, & Essock (2007) or Simmons, Hawley, Gale, & Sivakumaran
(2010) for a more nuanced discussion of terminology in mental health settings.
WHAT IS INTERPROFESSIONAL CARE (IPC) 5
Lake, Baerg, and Paslawski (2015) identify three features common to all
frequently used definitions of IPC. These are: (1) a process for commu-
nicating 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 C hapter2).
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 pro-
fessional 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 boundar-
ies (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).
6 DEVELOPING INTERPROFESSIONAL COMPETENCIES
Mental health care is undergoing its own revolution. There has been
a global movement to integrate mental and social care providers into pri-
mary 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 pro-
fessional backgrounds. In Canada, the C anadian P
sychiatric Association and
College of Family Physicians of Canada released a joint paper in 2011 on
WHAT IS INTERPROFESSIONAL CARE (IPC) 7
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 etal., 2011); the notion of reversed shared
care has also arisen, where physical health providers (e.g., nurse practitio-
ners, 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, ef-
forts to promote psychologys participation in collaborative health care set-
tings 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.
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 pa-
tient 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 prepara-
tion 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 etal., 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 litera-
ture, 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 etal., 2012; WHO, 2010).
8 DEVELOPING INTERPROFESSIONAL COMPETENCIES
IPC is valued by our patients, our colleagues, our institutions, and our gov-
ernments. In the 1960s and 70s, parents of children with developmental
disabilities requested that service providers work together to provide more
coordinated care (Bamm & Rosenbaum, 2008), and randomized controlled
trials suggest increased patient satisfaction with IPC when compared with
usual care in a range of settings, including prenatal and palliative care (Bir,
Waldenstrom, Brown, & Pannifex, 2003; B rumley etal., 2007). Indeed, IPC
is a fundamental enabler of patient-centered care. Not only does it minimize
the burden on p atients by allowing them to access the expertise of multiple
care providers simultaneously rather than separately, but the range of poten-
tial services that can be offered by teams, relative to single providers, is greatly
expanded, allowing for more patient choice and better matching of skill sets
to patient needs. In the literature on IPC, patients, families, and communities
are increasingly seen as integral members of the team, while interprofessional
education (IPE) opportunities designed to teach providers to collaborate with
one another are beginning to recognize the need to teach collaboration with
patients and to emphasize the patient perspective (e.g., Bridges, D avidson,
Odegard, Maki, & Tomkowiak, 2011), with some programs employing pa-
tients themselves as trainers (e.g., Towle & Godolphin, 2013).
WHAT IS INTERPROFESSIONAL CARE (IPC) 9
Psychologists can bring important, and often unique, skills and knowl-
edge to IPC. Psychologists are trained to listen actively and attend to
nonverbal communication and can provide leadership in evidence-based
practice, research skills, and ethical decision making. In terms of patient
care, in addition to expertise in mental health, psychologists have much
to contribute to health care teams looking to facilitate behavioral change
for those at risk for, or already diagnosed with, chronic disease. An il-
lustrative example is that of nonadherence. Once a chronic disease has
been diagnosed, treatment is critical to limit costly complications and fur-
ther deterioration. The efficacy of these interventions is limited, however,
by very low rates of adherence (approximately 50 percent in developed
countries and even worse in developing countries; WHO, 2003). Under-
standing nonadherence and helping patients to effectively change behav-
ior requires integrating knowledge of, and sensitivity to, environmental
factors, social factors, and individual factors, including physiological,
cognitive, and affective components. Because of their broad base of train-
ing, psychologists are uniquely well-positioned to assess, conceptualize,
and implement evidence-based behavior change programs and to address
mental health issues in a range of settings.
10 DEVELOPING INTERPROFESSIONAL COMPETENCIES
Summary
The writing on the wall is clear. In order to offer excellent quality,
evidence-based psychological services to the public, regardless of setting,
professional psychology graduates must have strong collaborative skills.
But how do we build these competencies in our learners?
In Chapter 2, we will delve into the research literature on IPE and
will outline the competencies required to become effective collaborators.
In Chapter 3, we will explore barriers and enablers to including IPE into
a professional psychology program. This will be expanded in Chapter 4,
where we present a model for integrating IPE into professional psychology
training, and use this to discuss program development, learner assessment,
and evaluation. In Chapters 5 to 7, we go on to provide specific strategies
for developing IPE competencies along the continuum of professional
training (classroom, practica, internship3, and post-registration), with
practical examples.
Interprofessional collaboration is good not only for patients and for
overburdened health care systems, but also for practitioners. Research has
consistently linked IPC with better employee retention, lower rates of
burnout, and greater job satisfaction (e.g., Suter & Deutschlander, 2010).
Personally, both authors have found our interprofessional relationships to
be, at various times, frustrating, exhilarating, challenging, satisfying, and
ultimatelyimmensely rewarding. We invite you to join us on this journey.
3
We have observed that many sites have begun to replace the term internship with
residency. This appears to stem from a desire to communicate interprofessionally that
the level of preparation for these professional psychology trainees is comparable to
that of medical trainees who are referred to as residents. Although we recognize and
applaud this change, because it is not fully integrated into the lexicon of professional
psychology training, we will use the more traditional term internship throughout this
book.
Index
Accreditation of Interprofessional enablers to overcome, 4042
Health Education in practice settings, 3537
(AIPHE), 23 clinical responsibilities to
Affordable Care Act (ACA), 7 incorporate IPE, 37
Agency for Healthcare Research and different clinical placement
Quality (AHRQ), 116 schedules, 37
American Interprofessional Health practice supervisors to assess
Collaborative (AIHC), 115 collaborative competencies,
American Psychological Association 3637
(APA), 13, 62 supervisors are not trained
American Psychological Association in interprofessional
Committee on Accreditation collaboration, 3637
(CoA), 13 team-based practicum during
Andragogy, 47 training, requirement of,
Association of State and Provincial 3536
Psychology Boards (ASPPB), structural barriers, 26
13, 19 Behaviorism, 47
Building Interprofessional
Barriers to IPE, in professional Collaborative Teams (BICT),
psychology, 2542 110111
attitudinal barriers, 26
in classroom settings, 2735 Canadian Interprofessional Health
adequate funding, ensuring, Collaborative (CIHC), 16
3335 Canadian Psychiatric Association, 6
curricula for professional Centre for Collaborative Health
psychology programs, 2829 Professional Education
graduate and undergraduate (CCHPE), 98, 104, 110
training, division between, CIHC National Competency
3032 Framework, 16, 17
learners are not interested Classroom settings, IPE in
in IPE, 35 professional psychology
psychologists training in different training
faculties, not health science, collaborative behaviors, assessment
3233 of, 83
scheduling for IPE, 2930 collaborator competencies,
in continuing IPE (CIPE), 3840 assessing, 8285
collaborative skills in practice developing collaborator
environment, improving, competencies, 6062
3940 existing IPE programming,
professional psychology degree, utilizing and building
having, 3839 upon, 60
136 INDEX
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