Psychologists create the ‘home’
in patient-centered medical homes
BY NADINE J. KASLOW, PHD • APA PRESIDENT
I try to practice what I preach. That’s why I recently switched my health
care to a patient-centered medical home team that includes a psychologist.
It’s only been 13 months, but I already have seen a difference. My care is
more psychologically minded and better coordinated, two of the goals that
lawmakers foresaw when they included patient-centered medical homes, or
PCMHs, as part of the Affordable Care Act.
PCMHs are designed to offer comprehensive, patient-centered care that is coordinated and accessible. Members
of PCMH teams are committed to continuous quality
improvement and safety. To optimize these improvements in
care, psychologists must be leaders. After all, psychologists
are the experts in behaviors, a critical priority in this evolving
PCMHs date back to 1967 when the American Academy
of Pediatrics introduced the term as part of its emphasis on
care for children with special needs. In 2008, the National
Committee for Quality Assurance (NCQA) recognized the first
criteria for PCMHs. This year, NCQA updated its standards
to underscore the importance of integrating behavioral and
physical health, providing team-based care and improving
access to services for high-need populations.
Even more significantly, the American Academy of Family
Physicians created the “Joint Principles: Integrating Behavioral
Health Care” to ensure that behavioral health is central to the
PCMH model. This document offers a complementary set of joint
principles to the original document. APA was the first mental
health organization to endorse these complementary principles.
Psychologists can and should play major roles in ensuring that
these criteria are met, for several reasons. Research shows that
most patients seen by primary-care physicians have high rates of
behavioral health problems. Studies also show that when behavioral health needs are met in PCMHs, patients have better health
outcomes and are more satisfied with their care. In addition, the
enhanced care psychologists provide actually lowers costs.
What roles do psychologists play in PCMHs? To name just
a few, psychologists take the lead in outcomes assessment and
improve and oversee screening systems. They facilitate effective
functioning among the patient, the health-care team and the
family. They offer evidence-based interventions and develop
and disseminate treatment protocols for comorbid physical and
behavioral health problems.
Excellent examples of psychologists working within the
PCMH model are seen in the Department of Veterans Affairs
Patient Aligned Care Teams (PACT) primary-care clinics. Other
examples of psychologists’ work in PCMHs appear in articles
beginning on page 38.
To maximize the potential of psychologists as members of
PCMHs, we must act swiftly. Practitioners can partner with col-
leagues from other professions and organizations, be seated at the
critical local and national tables to ensure full inclusion of behav-
ioral health care, be mindful of the ethics in caring for patients as
part of an interdisciplinary team, and assume leadership positions.
Researchers can collaborate in research that examines the
effectiveness and efficiency of PCMHs and study the unique
value added by psychologists.
Educators must ensure that accreditation standards require
training in the requisite competencies, such as interprofessional
collaborative care, Health Service Psychology Education
Collaborative competencies, and Competencies for Psychology
Practice in Primary Care. Educators must also make certain that
didactic and experiential training is sufficient and continually
updated for trainees and professionals alike, obtain appropriate
training themselves, and seek relevant board certification.
Psychologist advocates must shape the future by ensuring that
behavioral health is prioritized in all PCMHs. They must also
recommend an alternate to the physician as a team lead, with a
focus instead on patient-centered collaborative care or health
care or clinician directed team-based care. Advocates must also
support more family-centered care.
As Susan H. McDaniel, PhD, and Colleen T. Fogarty, MD,
asserted in their 2009 article in Professional Psychology: Research
and Practice, psychologists give meaning to the word “home” in
the PCMH model. n