Services, a Florida state program for children from low-income
At present, most integrated services are funded in the
traditional fee-for-service manner, says Delamater. But not
all are. For example, the state of Florida prepays the Mailman
Center for psychological services provided through the
Children’s Medical Services contract. Various types of prepaid
and bundled-services models are being piloted across the
Payment model aside, “What stays the same is that you have
on-the-spot consultation with the psychologist, and that’s the
beauty of the integrated team,” says Delamater. “Because if you
refer people out, they often don’t follow through. Having us
there in the clinic, we’re normalized and the stigma goes away.
And it gives us the opportunity to screen and be preventive.”
What also stay the same, says Delamater, are the skills needed to
deliver services collaboratively. As he related in a presentation
at APA’s 2012 Annual Convention, he’s found that for
psychologists to work well on such teams, they need to:
• Understand disease. The psychologist needs to know
more than a disease’s physiological effects — he or she needs
to be fluent in tests, labs and values, says Delamater. “You
need to really speak the language of that illness,” he says.
“Because if you don’t, you lose credibility, and nobody will
go to you. No. 1 is having the confidence of patients and your
• Be visible and responsive. Psychologists need to be in the
clinic walking the halls, not sitting in the office waiting for their
phones to ring, says Delamater. That way, he says, people get
accustomed to your input and miss it if you’re not around. “It’s
also important to attend team meetings where everyone reviews
the patients being seen,” he says. “You need that face time so
everybody recognizes what you bring.”
• Communicate concisely. Physicians and other providers
are busy with clinical demands, so they need you to quickly
describe the problem. “If we write a 10-page report, they
will not read that report,” Delamater says. “They just want
conclusions and recommendations. Tell it simply and get to
the punch line.” He also suggests psychologists share notes with
other providers in the same electronic charts, at least to the
extent that this does not threaten confidentiality of sensitive
• Teach and train. With their disciplinary knowledge of
what makes teams work, psychologists can help teams resolve
conflicts and coach team leaders, says Delamater. They can
also advance other team members’ understanding of what
behavioral health providers contribute by sharing articles
and research findings and offering seminars for other health
professionals, he says.
• Promote informal bonding. As psychologists know,
informal interpersonal relations are the social glue of teams, so
it’s well worth making time for small talk, lunches, happy hours
and other relationship-building activities, says Delamater.
• Respect their team members. “You don’t tell each other
what to do. You inform and ask what each other’s opinions
are,” says Larry Mauksch, MEd, past chair of the Collaborative
Family Health Care Association, co-editor of the APA journal
Families, Systems, & Health, and a senior lecturer in the
University of Washington’s department of family medicine.
“You share concerns, ask questions. You brainstorm to problem-
solve when you come across difficult situations. So there’s a
sense of shared responsibility that takes over. And the guild
mentality, the silo kind of functioning, goes away.”
Khatri says this is how treatment delivery works at Cherokee
Health Systems, where she and colleagues catch and treat the
range of behavioral health issues — including depression,
anxiety and substance use — that may underlie many physical
maladies. “The fact is we’re much better able to meet treatment
goals when we work on functioning teams as opposed to alone
in silos,” she says. n
Bridget Murray Law is a writer in Silver Spring, Md.
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