Skillings wants patients to have the option
to see a psychologist whether they enter the
system for a mental health problem or a
medical problem, be it a heart attack, diabetes
or anything else. His dream is that behavioral
health becomes as ubiquitous within the health
system as Starbucks is everywhere else.
“If you go to the grocery store, Starbucks is
there,” says Skillings. “Is Starbucks the reason
you go? No, but it adds huge value.”
Evaluating transplant patients
Spectrum used to outsource its behavioral
health care. “Then the organization started
looking at the data and saw that integrated
care was superior in terms of outcomes and
cost savings,” says Skillings, who became the
system’s inaugural director of behavioral
medicine in 2012.
He trained as a generalist while earning
his doctorate in clinical psychology at the
University of Toledo. But while he was on
internship at the Jackson Memorial Hospital/
University of Miami Medical School, he fell in
love with integrated care. “You don’t have to
become a specialist right out of the gate,” he
advises. “There’s some benefit to having a broad
range of experience before you get into one of
the integrated-care specialties.”
At Spectrum, Skillings’s original one-day-a-
week work with the transplant team has grown
into a full-fledged specialty, thanks to the
growing demand for organ transplants.
His goal is to gauge whether the patient is
a good candidate for a transplant based on his
or her psychosocial stability and how likely
he or she is to adhere to medical directions.
Transplant patients, for example, need to be
able to comply with as many as 40 medical
tests and appointments before a transplant and
complex medication and lifestyle regimens
afterward. Most transplant programs won’t
give transplants to nicotine users, so would-be
patients must stop smoking and get themselves
in shape. And because Spectrum requires
transplant patients to have someone who can
care for them at home 24/7 for at least a month
after the operation, patients must also have
good social support.
Skillings also evaluates pediatric patients
who need kidney transplants. With living
donors, presurgical evaluations are even more
complex as two different behavioral health
APA offers video series on integrated care
The free videos showcase psychologists’ roles on integrated
care teams and promote the value of the services they offer.
A new series of free online videos from APA shows what psychologists can
contribute to integrated health-care settings.
Available at www.apa.org/health/psychologists-integrated-care.aspx, the
“Psychologists in Integrated Health Care” series features interviews with
psychologists and physicians working together in medical practices around
So far, the series includes four five-minute videos: an introduction to
integrated care plus videos featuring psychologists working in pediatric
primary care, obstetrics and gynecology, and family medicine settings.
A fifth video on how psychologists can help practices deal with “
super-utilizers” — high-risk, high-cost patients with complicated medical,
behavioral and social problems — is in the planning stages.
The videos are aimed at several audiences: psychologists, other health
professionals, students and consumers.
“The videos tell the story of what integrated care is like,” says
psychologist W. Douglas Tynan, PhD, APA’s director of integrated health
While the series features unscripted interviews, several themes have
— Rebecca A. Clay
emerged, says Tynan. Among them is physicians’ positive response to
psychologists’ involvement in integrated care. “They say things like, ‘This
has been a godsend’ or ‘This is one of the best things to ever happen in
this clinic,’” says Tynan. “They all say having psychologists in their settings
makes their work much more efficient because … their time isn’t tied up
doing something someone else can do better.”
The videos also show how integrating psychologists into health-
care settings reduces the stigma often associated with seeking mental
health services, says Tynan. “Patients are much more willing to come see
a psychologist at the primary-care office where they’ve been coming for
years because they trust that physician,” he says.