In her presidential address during APA’s 2010 Annual Convention, Carol D. Goodheart, EdD, unveiled a plan to enable practicing psychologists to “intervene at a higher level than we can now.”
Today, only half of all people who need psychological care receive it, Goodheart said. Psychology can improve those odds by integrating six key elements of psychological service delivery, said Goodheart. “If we give our practitioners a sound structure, a 21st-century home that provides us with everything we need to do our best work, psychology will flourish and improve the lives of the people we serve.”
The six elements are:
Use of evidenced-based practice. APA defines evidence-based practice as the integration of the best available research with clinical expertise in the context of patient characteristics, culture and preferences. “Evidence-based practice in psychology is our baseline standard for practice,” Goodheart said. EBP has profound implications for practice, training and policy because what is called evidence-based determines what treatment is conducted, what is taught and what is funded, she said.
Reliance on treatment guidelines. Guidelines offer many benefits for practitioners and patients, Goodheart said, because they translate the best scientific evidence into clinical practice, provide a framework for clinical decision-making, offer benchmarks for evaluating treatments, and discourage ineffective or harmful practices. APA is now developing guidelines for psychology practice that will not be a “cookbook” of required steps, Goodheart said, but instead will guide care. For example, in the case of a diabetes patient, current medical guidelines call for annual foot and eye exams, given the likelihood of complications related to vision and circulation. What conclusions can we draw from that? “So we might expect that for our patients with anxiety, recommendations about mastery will be included,” Goodheart said.
Technological advances to improve care. “Advances in technology will be a total game-changer for us within the next decade,” Goodheart said. New resources are offering psychologists a variety of tools for collaborating with other health professionals and gathering information on the best possible treatments. New software is helping psychologists manage their practices, maintain patient records, conduct assessments and track outcomes. Meanwhile, advances in telehealth are enabling practitioners to reach out to patients in rural areas.
A broader look at patient function. Better care can come from looking beyond disease, said Goodheart. Psychologists should also consider patient functioning — how well patients perform in their daily lives. Psychologists can do this with the help of the World Health Organization’s International Classification of Functioning, Disability, and Health, a system of classification that includes how people live with a health condition; classifies health and well-being; and recognizes personal, social and environmental factors affecting people’s day-to-day lives. “ICF can be very beneficial, not only for gauging outcomes, but also to begin to understand differences in functional status and targets for intervention from the very beginning,” Goodheart said. Psychologists were involved in the ICF’s development, “and it fits us better than a medical model in many instances,” she said.
Use of the International Classification of Disease. Psychologists may be able to diagnose their patients in a more clinically useful way by using the World Health Organization’s International Classification of Mental and Behavioral Disorders (ICD-10), currently under revision, said Goodheart. Although most U.S. practitioners rely on the Diagnostic and Statistical Manual-IV, the ICD is the clinical and research standard for the rest of the world. “The ICD revision will better capture the nature of mental health disorders presented in clinical settings in a succinct and efficient manner,” she said. Using the DSM, for example, providers must consider 20 to 35 separate pieces of information in diagnosing a mental disorder. “This degree of complexity is probably unnecessary,” she said. APA is committed to the latest ICD project, which will make that tool even more useful for psychologists.
Better outcomes measures. Psychologists need multiple tools to help them determine whether a treatment is working or whether an intervention needs adjustment. Goodheart has appointed a presidential task force to develop a system that will allow psychologists to compare and choose among a menu of scientifically sound outcomes measures. Such a tool is essential as insurers move from utilization review to outcome review as way to allocate resources, said Goodheart. “The drive for accountability and quality in health and behavioral health care is relentless, [and we] will be required to provide evidence of quality care and cost-effective treatment,” she said.
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