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Practice Keynote: A Report on National Practice and Advocacy issues. Carol D. Goodheart, Ed.D. Princeton, New Jersey Email: carol@drcarolgoodheart.com Website: http://www.drcarolgoodheart.com. What is Counseling Psychology Practice?. Generating & using knowledge for change

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practice keynote a report on national practice and advocacy issues

Practice Keynote:A Report on National Practice and Advocacy issues

Carol D. Goodheart, Ed.D.

Princeton, New Jersey

Email: carol@drcarolgoodheart.com

Website: http://www.drcarolgoodheart.com

what is counseling psychology practice
What is Counseling Psychology Practice?
  • Generating & using knowledge for change
  • Psychology = Ultimate translational science
  • Practitioners translate, synthesize, select, combine, integrate, & tailor science for public good
  • Practitioners provide diverse services, in diverse settings, for diverse populations & organizations
  • Practice = ALL applications of psychology’s scientific foundation
where is cp practice
Where is CP Practice
  • Health care and non-health care
  • Institutional settings
    • University & College counseling centers
    • Veterans Administration facilities
    • Community health & mental health centers
  • Independent settings
    • Solo and group practices, consulting firms
  • Policy and administration
core cp principles infuse practice
Core CP Principles Infuse Practice
  • Health & adaptation, building upon strengths
  • Developmental perspective/life span approach
  • Social and cultural context
  • Brief interventions, as appropriate
  • Healthy work relationships, behavior &role fulfillment

Gelso, C.J., & Fretz, B.F. (1986). Introduction to Counseling Psychology. New York: Wiley

a bit of history
A Bit of History
  • Advocated for mental health & health services
  • Advocated for Freedom of ‘Choice laws & reimbursement
  • Advocated for inclusion in Medicare
  • Flourished as mental health profession
  • Now enlarging frame: behavior experts, health profession, integration of mind/body, RxP, parity
health care marketplace in u s
Health Care Marketplace in U.S.
  • Costs
    • 5.9% GNP in 1965; 13.9% 1993; 16% 2007; 20% 2010
  • Market Driven, Free-Enterprise Health Care
    • Competition For Cost and Quality
    • Accountability movement: managed care, restrictive EBT lists, outcomes review, CDHPs
  • Publicly-Funded Health Care Changes
    • Cuts in Funding
    • Privatization
    • P4P
worrisome turmoil
Worrisome Turmoil
  • Impact on healthcare practitioners: stagnant incomes, reimbursement cuts, longer work hours
  • Gone in CMHCs; disappearing on panels (50% SWs, 25% psychiatrists, 25% psychologists
  • Leaving the VA
  • ECPs: where to turn with debt and prospects
the good news
The Good News
  • Practitioners have changed the way they practice, offer new services, & negotiate with panels for needed mh services
  • Plenty of room outside of health care
  • Successful ones are quiet
  • Organizational pushback: APA, APAPO, SPTPAs provide information, tools, strategies, & advocacy
areas for advocacy
Areas for Advocacy
  • Prescriptive authority
  • Restore Medicare MH reimbursement cuts
  • Acknowledge E & M services in Medicare
  • Enact strengthened Mental Health Parity bill
  • Health Information Technologylegislation

(records privacy protection)

  • Fund the Mentally Ill Offenderlaw
  • EBPP
  • Pay for Performance
apa policy evidence based practice
APA Policy: Evidence-Based Practice
  • IOM defines evidence based practice as: ‘the integration of the best research evidence with clinical expertise and patient values.’
  • APA defines EBPP as: ‘the integration of the best available research evidence with clinical expertise in the context of patient characteristics, culture, and preferences.’

Institute of Medicine (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

APA policy statement: http://www.apa.org/practice/ebpstatement.pdf

APA Task Force on Evidence-Based Practice (2006). Evidence-based practice in psychology. American Psychologist, 61, 271-285

words matter
Words Matter
  • EBBP has profound implications for practice, training, and policy.
  • What is designated as “evidence-based” will determine, in large part, what treatment is conducted, what is taught, what is funded.
  • EBPs are ripe for misuse and abuse
  • Time to advocate, lest others unilaterally decide for us

Norcross, J. EBPP: Implications for practice, training, and policy. APA Convention symposium, August, 2005.

working assumptions
Working Assumptions
  • Call for accountability is here to stay: Health professions will need to demonstrate the safety & efficacy of services
  • Solid position: Psychology has been a leader in demonstrating efficacy & in conducting outcome research
  • Demands for evidence will escalate: No amount of kvetching, howling, or resolutions will alter it
  • External demands arise from efforts to improve health AND to restrict services/decrease expenditures: It’s about effectiveness & money

Norcross, J. EBPP: Implications for practice, training, and policy. APA Convention symposium, August, 2005.

evidence based often used rarely defined
“Evidence Based”: Often Used, Rarely Defined
  • Many uses of the term “evidence based” can be found in federal and state legislation
  • Frequently referenced in policy documents
  • The term is defined by referencing to other documents, resulting in circuitous definitions OR narrow definitions resulting in lists of treatments
  • Policy makers like it but don’t always seem to know what it means!

Bufka, L. “Evidence Based” in legislation and policies. State Leadership Conf, 2007

apa s strategies for ebpp
APA’s Strategies for EBPP
  • Develop coalitions with other professional and consumer groups
  • Advocate that good clinical practice values clinical expertise and the individual patient and is not about the mere application of treatment protocols
  • Ensure that psychology is “at the table”

Bufka, L. SLC, 2007

pay for performance initiatives
Pay for Performance Initiatives
  • Differential payments for similar services
  • Bonuses based on:
    • Outcomes
    • Following protocols
    • Meeting reporting benchmarks (HEDIS)
    • Data information systems
    • Focus on the aggregate

Eisman, E.(2006). Pay for performance and outcomes.SLC, Washington, D.C.

metrics to assess quality outcomes of care
Metrics to Assess Quality & Outcomes of Care
  • Feasibility
  • Relevance
  • Scientific quality
    • Reliable
    • Valid
  • Auditable
  • Actionable

Doucette, A. By the numbers: Outcome metrics-pay for performance. SLC 2007

targeting performance measurement outcome efforts
Targeting Performance Measurement – Outcome Efforts

Potential factors to measure for outcomes:

  • Distress – symptoms and function
  • Common factors – e.g. alliance
  • Motivation- stage of change
  • Retention in care
  • Satisfaction
  • Adherence to treatment plan

Doucette, A. By the numbers: Outcome metrics-pay for performance. SLC 2007

p4p potential problems
P4P Potential Problems
  • Care providers focus on doing what is needed to attain incentive
  • Potential negative effect on teamwork & collaboration
  • Incentive payout may be greater than anticipated & result in increasing the standards and benchmarks to merit incentives
  • As performance improves it may become more difficult to sustain P4P over time
  • Potential to select patients who will likely do well

Doucette, A. By the numbers: Outcome metrics-pay for performance. SLC, 2007

what to do be alert
What to Do? Be Alert
  • Attend to the motivation behind the legislation
  • Watch for “Evidence based” showing up in terms of treatment and measures
    • Examples are in Worker’s Compensation, rate setting, health administration
  • Be active
    • when proposed legislation directly relates to medical care & specifies physician involvement- psychology must advocate at outset that our practice approaches are sufficiently represented
    • Use the APA definition of EBPP and documents

Bufka, L. “Evidence Based” in legislation and policies. SLC, 2007

new initiatives for psychology practice
New Initiatives for Psychology Practice
  • TF on the Future of Psychology Practice
    • Proposed new policies for APA on integrative care
    • Practice Summit 2009
  • APA & APAPO
    • New Executive Director, Katherine Nordal
  • APAPO
    • New Center for Professional Development, coming soon