Psychologists In Primary Health Care Research Articles

Perceptions towards integrated care through the narrative of practicing social workers and psychologists in PHC: a cross-case analysis

PurposeIn a collective effort to build a patient-centered and coordinated health care system, social workers and psychologists are being progressively introduced to primary health care (PHC) settings worldwide. The present study aims to explore the current status of integration through the narrative of social workers and psychologists in PHC settings in Kazakhstan.Design/methodology/approachIn this paper purposive snowball sampling was utilized to recruit social workers and psychologists who work, or used to work, in PHC settings since the onset of integration in Nur-Sultan for participation in an in-depth interview. A semistructured interview guide was based on normalization process theory (NPT). Interviews were conducted via video conference, in Russian language, lasted no more than 50 min, and transcribed verbatim. Cross-case analysis of eight cases was performed using NPT constructs.FindingsCross-case analysis included findings from the interviews from five social workers and three psychologists. Four major constructs of implementation process from NPT were reflected in the findings: coherence (believes integration improves patient care, functions within integrated care), cognitive participation (individual changes to role performance, mechanisms of work), collective action (status of support from stakeholders, cooperation within a multidisciplinary team) and reflective monitoring (existing mechanisms for monitoring the integration).Research limitations/implicationsDespite organizational integration, there is a lack of successful clinical integration of social workers and psychologists in PHC settings of Kazakhstan, which is manifested by a lack of understanding of responsibilities and functions of these mental health care specialists. Consensus was reached by all participants that both social workers and psychologists are valuable assets in a multidisciplinary team.Originality/valueThe present study contributes to the current knowledge of integrated PHC service delivery by addressing the status of integrated care in Kazakhstan from interviews with key stakeholders in social work and mental health. Moving forward, improvements are needed to (1) establish the monitoring mechanism to evaluate the status of integration, (2) enhance effective collaboration within multidisciplinary teams in PHC settings and (3) increase awareness among medical workers and community members on mental health issues and the available support offered by social workers and psychologists to promote quality of life in a holistic, integrated manner.

Referral Challenges in the Mental Health Program in the Primary Health Care System: A Qualitative Study

Background. One of the main activities that plays a significant role in the prevalence of mental illnesses is the issue of referral, and according to the evidence, the lack of proper implementation of the referral system is one of the obvious weaknesses of the primary health care (PHC) system. Therefore, this study aimed to investigate the challenges of referring mental health clients in the PHC system, and the weaknesses in this process were examined from the perspective of mental health experts in health centers. Methods. The present study is a conventional qualitative content analysis. Data were collected through semi-structured interviews with primary health care psychologists. Fifteen people were selected through purposive sampling. After transcription of the interviews, the data were analyzed based on the Graneheim and Landman model. Results. Two themes and twelve categories were acquired through the present study. The theme of intra-centered referential challenges included categories such as weaknesses in health care providers screening and low referrals, clients' lack of trust in health care providers, clients' lack of cooperation, physicians' poor cooperation, and Barriers to clients' desire to visit a psychologist. Outer-centered referential challenges also included a shortage of referral centers, lack of transparency in referrals, lack of direct referrals, poor follow-up, barriers for clients to go to a higher level, and Barriers to clients’ referral to the institute. Conclusion. The findings of the present study show that poor intra-sectoral and inter-sectoral communication is one of the main challenges that has disrupted the referral process in the field of mental health in the primary health care system. It seems that many challenges such as lack of designated referral centers, poor follow-up due to lack of referral feedback, clients' financial inability to refer to a higher level, etc. can be improved by strengthening cross-sectoral communications such as two-way communication with support organizations and psychiatric and psychotherapy centers.

Caring for Children and Youth with Ongoing Mental Health Problems: Perspectives of Family Physicians, Nurse Practitioners, Social Workers and Psychologists in Primary Health Care

Few studies have examined a diversity of professionals’ perspectives in providing children’s mental health (CMH) care, particularly for ongoing-complex problems. Based on interviews with 16 primary healthcare (PHC) providers, care for ongoing-complex CMH problems depended on provider interest and scope of practice. Most providers felt PHC is where ongoing-complex CMH problems should be cared for, where providers can emphasize advocacy, coordination, and ongoing monitoring; few felt able to provide this type of care. A comprehensive approach for incorporating PHC with specialized MH services is needed. Defining a care coordinator would be a clear step toward improving collaboration and care.

Clinical psychologists in primary mental health care in Norway - what to do?

Abstract Background The past 20 years Norwegian health authorities have put significant effort into increasing the number of clinical psychologists in primary health care. By 2020, all Norwegian municipalities are required by law to have clinical psychologists available. In 2018, only about half of the 422 municipalities had fulfilled this requirement, and the number of vacant positions is growing. The purpose of this study was to investigate the usefulness of clinical psychologists in a primary care setting as perceived from primary mental health care leaders/employees and those who educate clinical psychologists at the universities. Methods We combined the use of open-ended questions in a survey (N = 456) among leaders and employees of primary mental health services in Norway, with data from semi-structured focus group and individual interviews (N = 15) with academic staff at the four universities in Norway that provides education for clinical psychologists. Results The discussion on utilisation and usefulness of clinical psychologists in Norwegian primary care often condensates into weighing time spent on a never-ending demand for individual therapy against time spent on health promotion, prevention and system level work. Traditionally, Norwegian psychologists have received education mostly focusing on treatment methodology and individual therapy most suitable for the specialist services. The curricula are now changing towards more health promotion/prevention in primary care, but still lacks focus on system level approaches like collaboration with and guidance of other professions - which are the qualities asked for from those who hire clinical psychologists in primary mental health care. Conclusions Interdisciplinary collaboration with a wide spectre of professionals and thereby ’working with and through others’ in the health and welfare services, was suggested to be the most efficient way of utilising psychological clinical competence. Key messages The Norwegian clinical psychologists’ education is becoming more primary care friendly. Psychologists in primary care must be part of interdisciplinary teams where they can work with and trough others.

Saúde mental de psicólogos atuantes em serviços de atenção primária à saúde

Este estudo objetivou conhecer e caracterizar o trabalho do psicólogo na atenção primária à saúde e seus efeitos na saúde desses profissionais. Participaram da pesquisa 32 psicólogos que atuam em serviços públicos de atenção à saúde no estado do Espírito Santo. Os participantes responderam a um questionário online composto pelos seguintes instrumentos: JCQ, WHOQOL-bref, SRQ-20; e questões sociodemográficas. Os resultados indicam que o trabalho do psicólogo nesses espaços caracteriza-se enquanto trabalho ativo, no entanto observou-se um nível elevado de adoecimento mental e baixa qualidade de vida dentre os participantes. Além disso destacou-se, na saúde mental dos trabalhadores, uma maior influência da demanda psicológica do trabalho do que do controle. A dimensão controle parece não contribuir positivamente para a saúde dos trabalhadores como previsto no modelo teórico. Por fim, indicam-se estratégias para melhoria do trabalho, com foco na demanda psicológica.

Indonesian experts' perspectives on a curriculum for psychologists working in primary health care in Indonesia

Mental health is a critical issue in Indonesia, since its population ranks among the top five in the world and the prevalence of common mental disorders is 11.6% of the adult population. However, the need to build an effective mental health-care system that is accessible to the whole population has only been recently addressed. The Aceh tsunami in 2004 brought to the forefront an unexpected window of opportunity to build a mental health-care system. Integration of mental health care into primary health care is a key strategy to close the treatment gap for people with mental disorders. Existing integration of psychologists into primary health care is a big step to meet the shortage of mental health-care specialists. As primary mental health care is an emerging field, the perspectives of Indonesian experts on Indonesian mental health care are needed to develop a curriculum for training psychologists to work in primary health care. In this study, data have been collected through semi-structured interviews with 24 Indonesian mental health experts, and three focus group discussions with 26 psychologists. Overall, experts agreed that to be able to work in primary health-care psychologists should have roles and training ranging from clinical to advocacy skills. Participants also agreed that psychologists should work in the community and contribute to primary health care as service providers and that strong collaborations between psychologists and other primary health-care providers are the key; these can be developed partly through referral and by respecting each other's unique strengths.

PROCESSO GRUPAL E ATUAÇÃO DO PSICÓLOGO NA ATENÇÃOPRIMÁRIA À SAÚDE

Este artigo tem por objetivo discutir a atuação do psicólogo na atenção primária à saúde a partir da proposição de processos grupais alternativos às práticas individualistas. Essas práticas mantêm tradições de hierarquia profissional-usuário e modelos de normatização e medicalização da vida. Inspirados na perspectiva construcionista social, abordamos alguns dos pressupostos que inspiram essa proposta, tais como: (1) processo grupal como alternativa à noção de grupo como uma entidade autocontida, (2) relações colaborativas profissional-usuário com a constante negociação sobre a modalidade de atendimento oferecida e (3) auto-reflexividade para compreensão de seus potenciais e limites. Acreditamos que essa forma de assistência pode inspirar outras práticas grupais que possibilitem consolidar os princípios do Sistema Único de Saúde Brasileiro e que se aproximem do ideal de formação profissional em Psicologia preconizado para o trabalho em políticas públicas de saúde.

El trabajo de los psicólogos en los centros de atención primaria del sistema público de salud en Chile

To define work characteristics of psychologists in public primary health care centers in Chile and the degree to which their functions conform to the standards set by the National Plan on Mental Health and Psychiatry (NPMHP). From December 2003 to November 2004, a cross-sectional, descriptive study was conducted employing a questionnaire sent to a nonrandom sample of 486 professionals working in public primary care centers of Chile's 29 health districts. The total response rate was 34.4% (167 completed questionnaires). The questionnaire gathered general information and demographics; frequency, distribution, and type of activities performed; the mental health issues treated; personal perspectives on the efficiency of care, factors affecting interventions, and the quality of work conditions; and competence level regarding diagnosis and treatment strategies, as well as the educational background needed to fulfill the role of psychologist at the primary health care centers. Descriptive statistics with 95% confidence intervals were calculated for the quantitative data. Content analysis techniques were applied to the responses to open-ended questions. Considerably more time is being devoted to individual consultations and interventions than to group and community promotion and prevention activities. Over 93% of the survey participants were satisfied with their work and valued their peers; however, more than half gave a negative rating to their work conditions and job security. The majority indicated that preparation for the role must include coursework on the health system, specifically the primary health care setting, and topics such as clinical and group psychology, public health policy, and primary health care management and specifics. Most critical to the work were a knowledge of diagnostic tools and classification systems, i.e., the International Classification of Diseases and the Diagnostic and Statistical Manual of Mental Disorders. Contrary to NPMHP recommendations, the primary health care psychologists in Chile's public health care system are dedicating most of their time to individual counseling and therapy, rather than community activities designed to strengthen and promote mental health. In addition, a funding plan that supports NPMHP priorities is needed.

Training Primary Care Psychologists

Primary care psychology is a new area that provides exciting opportunities for the field. This paper discusses the definition of primary care and the role of psychologists in primary health care. Educational programs developed by the author for pre- and postdoctoral training in primary care psychology are described.

Psychology and primary care: Evolving traditions

The involvement of psychology and psychologists in primary health care is based upon patient care needs which suggest that upward of 60% of all visits to primary care physicians' offices are psychological in nature. Psychologists have a strong tradition of providing primary health care to medically ill patients and as long-term members of the health care team. The wide array of cost-effective patient care services provided by psychologists is discussed. Present APA initiatives in primary health care are presented, along with descriptions of the manuscripts in this special issue of theJournal of Clinical Psychology in Medical Settings focusing on primary health care.

Cuban health psychology: A priority is the primary health care system

Abstract Cuban health psychology has experienced a great expansion during the last 25 years, both in the number of psychologists and in range of activities in the field. Today, psychologists are integrated at all levels of the national health system, an achievement which is particularly interesting in that Cuba is a developing country. In a position isolated from trends in international psychology, Cuba has developed a role for psychologists within the field of health which is adapted to its situation as a poor and socialistic country. Priority is given to preventive and community-based psychology within primary health care facilities. Psychologists in primary health care serve a composite client-group, with high priority given to pregnant women and to children. The work of these psychologists covers a wide range of health problems—-physical as well as mental—and focuses upon individuals as bio-psycho-social units. Their responsibilities include health promotion, disease prevention, consultation and treat...