Health psychology specialty practice opportunities in a rural community hospital: Practicing local clinical science.

Abstract

There is currently considerable interest in opportunities for collaboration between psychologists and primary care providers, particularly in rural settings. This article is an attempt to expand this discussion by focusing on opportunities for more specialized health psychology practices within tertiary care settings. Two examples are provided of collaborative projects recently implemented in a rural community hospital in southern New Hampshire-1 in the department of surgery, the other in the department of cardiac rehabilitation. The process of developing these practice opportunities is described within the context of the psychologist functioning as a local clinical scientist. The article concludes with a discussion of practical issues, including staffing and funding. BRIAN L. LEWIS received his PhD in counseling psychology from the University of Florida in 1981. He is now manager of the Psychology Department at Pitt County Memorial Hospital. His research interests include psychological training, factors affecting lifestyle change, and health psychology theory. THE WORK DESCRIBED in this article would not have been possible without the active participation of a number of graduate students. I am particularly grateful to Helen Daly and Laurie Guidry for their involvement in the surgery project and to Gail Oswald for her contribution to the cardiac rehabilitation project. I would also like to thank the medical staff at the Chesire Medical Center in Keene, NH, particularly Nancy Crawford, the cardiac rehabilitation program director.

A systematic review of the psychology literature addressing hospital practice.

“…By the 1980s and ‘90s, psychologists were being described as uniquely trained in psychotherapy in a manner that exceeded that of other professions (Enright et al, 1993). Later, with an emerging focus on budget constraints and managed care, came additional discussion of the importance of being skilled in brief psychotherapy treatments (Lewis, 2001) particularly in medical settings (Gotthelf, 2000).…”

“…There is also benefit to examining how clinical training programs can optimize preparation for hospital practice. For many years there have been calls for better training in brief interventions that map well onto hospital practices (Lewis, 2001), as well as a better coverage of relevant administrative, leadership, and evaluation domains. Ongoing guidance is also needed with respect to the organizational structures within which psychology is optimized—with different requirements for general medical, psychiatric, and small or rural contexts.…”

Poor, Rural and Female: Under-Studied, Under-Counseled, More At-Risk

“…Geography, inclement weather, lack of public transportation, and the need for improved communications in rural areas contribute heavily to the difficulties women lace in accessing both health care and mental health services (Murray & Keller, 1991). High rates of underservice by mental health providers in rural areas are related to factors such as inadequate training for working in these settings (Hargrove & Breazeale, 1993), value systems that are radically different from those predominant in rural areas (Human & Wasem, 1991), discrimination in the reimbursement policies of Medicare and private insurance companies (DeLeon et al, 1989), and high rates of professional isolation in rural areas (Murray & Keller).These factors are compounded by a lack of awareness regarding mental health services (APA), the stigma associated with mental illness in rural areas (Scattolon & Stoppard, 1999), and the increased likelihood of dual relationships creating reluctance to enter into helping relationships on the part of clients, both individuals and families, as well as mental health professionals in rural communities (Lewis, 2001;Schank & Skovholt, 1997).…”