Pediatric psychology has focused on tertiary care and chronic illness.
By Terry Stancin, PhD, and Lynne Sturm, PhD
Health care reform has provided increasing opportunities for psychologists in primary care settings. Models of “collaborative” or “integrated” care emphasize interdisciplinary patient-care responsibilities that have been shown to improve health outcomes and reduce costs, especially with adults.
However, as a field, pediatric psychology has focused more on tertiary care and chronic illness than on primary care, and so most pediatric psychologists have had limited training or may be unsure about the skills and expertise necessary to function effectively in a primary care context. Moreover, there has not been a general consensus document that articulates the competencies psychologists need to work in primary care medical settings — whether in adult or child settings.
Inter-Organizational Work Group
To address the need for delineating competencies, 2012 APA president, Suzanne Bennett Johnson, convened the Inter-Organizational Work Group on Competencies for Primary Care Psychology Practice consisting of representatives from nine national organizations with a vested interest in collaborative care. Susan McDaniel served as work group chair and the APA Education Directorate, led by Catherine Grus, provided administrative and technical support. Terry Stancin and Lynne Sturm represented APA Division 54 on the Work Group. Also participating were appointed representatives from APA Division 20, Adult Development and Aging; APA Division 38, Health Psychology; Association of Psychologists in Academic Health Centers (APAHC); Collaborative Family Healthcare Association (CFHA); Council of Clinical Health Psychology Training Programs (CCHPTP); Society of Behavioral Medicine (SBM); Society of Teachers of Family Medicine (STFM); and the VA Psychology Training Council (VAPTC).
The work group was charged with developing a document that articulated the competencies fundamental to primary care psychology, with the goal that it would serve as a resource for graduate psychology training programs and current practitioners. In addition, the document was designed to inform policymakers, other health professionals, and the public about the competencies of primary care psychologists.
Preliminary work on this document focused on reviewing the extant literature on primary care psychology competencies and competency models in professional psychology. The work group adopted the framework of the Competency Benchmarks Work Group (Hatcher et al., in press) and split into smaller groups to draft essential components and behavioral anchors for broader competency cluster areas. The entire group reviewed an initial draft document that was then refined in a face-to-face meeting.
The organization boards that sent representatives to the work group, including the SPP Board of Directors, then reviewed the draft document. A final version was completed in Dec. 2012 and a manuscript was prepared for initial dissemination (McDaniel et al. 2012).
The final document outlines six broad competency clusters: science, systems, professionalism, relationships, application, and education. Within each cluster, essential knowledge, skills, and attitudes needed for practicing in primary care settings as well as behavioral examples are provided. The work group endeavored to supplement existing benchmarks for clinical practice by including components that were unique to primary care (as opposed to general competencies).
Clusters Illustrate Document’s Scope
In the Professionalism Cluster, an essential component to the competency pertaining to professional values and attitudes listed is “Values the culture of the primary care setting and conveys an attitude of flexibility.” A behavioral anchor that would demonstrate this essential component is that the primary care psychologist is “Willing to assume or to adapt role activities of consultant, team leader, advocate, case manager, health educator and community liaison.”
In the Application Cluster, as essential component pertaining to interventions is “Effectively uses current evidence-based interventions appropriate for primary care to treat health and mental health-related issues.” A behavioral anchor for this component is: “Implements evidence-based interventions (e.g. CBT, Parent Child Interaction Therapy, Motivational Interviewing, Family Psychoeducation, problem solving therapy).”
The product of this work group was a consensus document intended to inform education, practice, and research in primary care psychology and to be a tool for psychologists working in primary care environments to assess their competence. We note that this document is general and not specific to pediatric primary care, and so there are many adult examples that may have less relevance to pediatric psychologists. It may be helpful to expand the behavioral anchors to include more pediatric applications and examples. Nonetheless, we expect that this document will serve as an important and useful resource for pediatric psychologists with interests in primary care.
Hatcher, R.L., Fouad, N.A., Grus, C.L., Campbell, L.F., McCutcheon, S.R. & Leahy, K.L. (in press). Competency benchmarks: Practical steps toward a culture of competence. Training and Education in Professional Psychology.
McDaniel, S. H. & the APA Interorganizational Workgroup Group. (under review). Competencies for Psychology Practice in Primary Care.