APAHC Grand Rounds | Fall 2018 1

GRAND

ROUNDS

In This Issue Pain and addiction Interprofessional education

Interprofessional approaches to

suicide prevention Membership survey results Immigration mental health APAHC conference preview

Welcome from the APAHC President I couldn’t be happier to be writing this brief column. Thanks to the initiative of our new editor, Lauren Penwell-Waines, one of my favorite professional newsletters is back in production! It’s a remarkable capstone on what’s been a busy and fruitful year for the association. Some of the work we’ve undertaken has been somewhat behind the scenes but still important. The entire APAHC Board helped shepherd a revamping of our Bylaws (the document that outlines our structure and function) and Officers’ Manual (the document that gets into the nitty-gritty of how we do our work). As those projects were completing, two teams led by Brian Isakson and Laura Daniels worked with a web developing firm to completely redo our public and members-only websites (visit: ahcpsychologists.org). Earlier this year, RoseAnne Illes and Michael Meija organized a very well attended, CE-offering webinar on social determinants of mental health for Latino/a immigrants. As of this writing, Wendy Ward is poised to deliver the APAHC talk at APA Convention on inter-professional education. We are also grateful that Ron Brown has assumed leadership of our flagship journal, Journal of Clinical Psychology in Medical Settings. Amy Williams and John Yozwiak are planning a superb APAHC conference in New Orleans next Feb-ruary – you won’t want to miss it! You can keep on top of all APAHC news on Facebook and Twitter, thanks to Joanna (“Joey”) Yost. In addition to this work, we continue to strengthen our connections to larger organizations. We reviewed and endorsed the APA PTSD Clinical Practice Guidelines earlier this year, and through our liaisons Laura Shaffer and Bill Robiner, continue to advocate for psychol-ogy on the AAMC Council of Faculty and Academic Societies (CFAS). But do you know what has me most excited so far this year? In an effort to help get word out about APAHC, we offered a free membership to interested early career professionals and trainees. In the span of a few weeks, we went from just over 200 members to nearly 700! What gets me even more excited is that nearly half of those members are trainees – the future of this organization. Teresa Pan and Leila Islam have been doing a wonderful job communicating with our new members and helping them get engaged. So, all that said, I hope you’ll take a few minutes to read through this issue of the Grand Rounds. It’s a wonderful way to hear what our association and its members are doing. Maybe it will inspire you to make a suggestion or get involved in some way. If so, I hope you’ll let us know what you’re thinking.

Newsletter of the Association of Psychologists in Academic Health Centers Vol. 5, No. 1 Fall 2018

Zeeshan Butt, PhD

APAHC Grand Rounds | Fall 2018 2

work after an injury than a patient who is unsatisfied.

5-7 Patients who

are receiving workers’ compensation have greater frequency and duration of claims, as well as worse surgical outcomes than those not receiving compensation.

8-10 Additionally, pa-

tients’ friends and family can have an impact on coping with pain.

11 A per-

son whose spouse started helping them with household chores and giv-ing them more attention since be-coming injured may not want these positive changes in their relationship to disappear. In general, patients are not aware of the influence their envi-ronment has on their pain, but often can recognize that their friends’ and family’s response to their pain im-pacts how they feel, both physically and emotionally. Psychologists can assess for such environmental fac-tors and educate both patients and family members on how to better respond to chronic pain, thereby in-creasing support, while decreasing enabling behaviors.

Continues on p. 3...

“I don’t know what to do anymore. This pain is ruining my life!” These words, or some version, often are heard in medical settings. While many providers struggle with “how” to treat chronic pain, perhaps the actual issue is “what” to treat, which is a perfect question for a psychologist to help an-swer. Pain is defined as “an unpleas-ant sensory and emotional experience associated with actual or potential tis-sue damage.”

1 Pain then is inherently

a biopsychosocial experience. There-fore, when patients present with chronic pain, it is the provider’s duty to determine the components contrib-uting to the patient’s experience. Un-derstanding that pain is biopsychoso-cial in nature provides guidance when interpreting a patient’s distress in clin-ic. Below are four key areas to consid-er when deciding what to treat for a patient presenting with chronic pain. Physiological/Biological factors. An important aspect of the “bio” in bi-opsychosocial is outlining the differ-ence between acute and chronic pain. The key feature tends to be related to sensitization of the nervous system. With acute pain (i.e., pain lasting less than 3-6 months), the pain is a warn-ing of injury or potential damage. The treatment will focus only on where the tissue damage has occurred, and the pain dissipates as the injury heals. With chronic pain, the pain persists beyond the expected healing time or greater than 3-6 months.

1 The problem

is not with the initially injured area. Rather, for patients with chronic pain, the persistent pain messaging, now a false warning, occurs throughout the nervous system. Chronic pain is char-acterized by sensitization, meaning that the nervous system is more sensi-tive to stimuli manifesting as allodynia and hyperalgesia. Therefore, the treat-ment for chronic pain should focus on calming the nervous system as a whole rather than treating the initial site of the injury. Psychologists’ role in this domain can be to provide psy-choeducation on the difference be-

Reading Distress in Chronic Pain: Teasing Apart Biopsychosocial

Factors and Substance Abuse

tween acute and chronic pain, and engage patients in relaxation tech-niques to help increase control over the sympathetic response. Psychological/Emotional fac-tors. Although psychology is often utilized as a therapeutic “last resort” for chronic pain, psychological factors often are one of the primary factors in the patient’s pain experience. After all, pain is defined as a sensory AND emotional experience. Patients with chronic pain are more likely to experi-ence symptoms of depression and anxiety, and these symptoms affect both the perception of pain and the ability to function.

2 Pain catastrophiz-

ing is a prime example of how psy-chological factors can impact coping with pain. Pain catastrophizing is a cognitive-affective response to antici-pated or actual pain comprised of helplessness, magnification, and ru-mination. It is associated with worse outcomes, heightened pain sensitivi-ty, and impaired functioning.

3,4 Beth

Darnall, a pain psychologist at Stan-ford University, uses the following analogy to explain pain catastrophiz-ing in the context of chronic pain---through sensitization, the body’s nervous system is on fire, and pain catastrophizing is the gasoline. Psy-chologists can assess patients for psychological correlates of pain, but also successfully treat catastrophiz-ing and other psychological factors through cognitive-behavioral inter-ventions, while also teaching our phy-sician colleagues how to identify these potential concerns. Social/Environmental factors. One area that often is overlooked in the physician’s office is the impact of social and environmental factors on chronic pain. When evaluating poten-tial exacerbating factors, secondary gain is necessary to consider, as these sometimes invisible incentives can change a patient’s response to pain. For example, patients who en-joy their job and find it fulfilling are significantly more likely to return to

Alison M. Vargovich, PhD

APAHC Grand Rounds | Fall 2018 3

Substance abuse. Lastly, the importance of assessing for risk and substance abuse is incredibly important in our current climate. With substance use disorders (SUDs) and overdose death rates continually in-creasing across the country, we have a responsibility to treat our patient’s distress while keeping them safe. Up to 48% of patients with chronic pain have a current SUD, with a lifetime prevalence of 16-74%, which is higher than the general population’s lifetime prevalence of 16.7%.

12,13 Additionally, patients with chronic pain and a history of a SUD

are significantly more likely to be prescribed an opioid.14

This situation is an example in which the distress the pa-tient is bringing to the room may have been misread or not fully addressed. It is our responsibility as providers to conduct a thorough history, record review, and substance use assessment to avoid putting our patients at risk for more problems. Psychologists are well-suited to assist with risk assessment for potential substance abuse and cur-rent substance abuse issues, as well as engage patients in treatment for these concerns.

More than likely, what to treat involves multiple disciplines and providers. Some patients may need more treatment in one domain than another, but ultimately if the distress is incorrectly interpreted we risk mismanaging our patients, putting them at risk for more problems, and inadequately addressing their chronic pain. Psychologists are well-suited to determine what to treat and provide interventions to address the distress.

References

1. IASP Task Force on Taxonomy. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. Seattle: IASP Press; 1994.

2. Lumley MA, Cohen JL, et al. Pain and emotion: A biopsychosocial review of recent research. J Clin Psychol 2011;67:942-968. 3. Quartana PJ, Campbell CM, Edwards RR. Pain catastrophizing: a critical review. Expert Rev Neurother 2009;9:745-58. 4. Weissman-Fogel I, Sprecher E, Pud D. Effects of catastrophizing on pain perception and pain modulation. Exp Brain Res

2008;186:79-85. 5. Williams RA, Pruitt SD, et al. The contribution of job satisfaction to the transition from acute to chronic low back pain. Arch

Phys Med Rehabil 1998;79:366-74. 6. Ratinaud MC, Chamoux A, et al. Job satisfaction evaluation in low back pain: A literature review and tools appraisal. Ann Phys

Rehabil Med 2013;56:465-81. 7. Hayden JA, Chou R, et al. Systematic reviews of low back pain prognosis had variable methods and results—Guidance for

future prognosis reviews. J Clin Epidemiol 2009;62:781-96. 8. Loeser JD, Henderlite SE, Conrad DA. Incentive effects of workers' compensation benefits: a literature synthesis. Med Care

Res Rev 1995;52:34-59. 9. Harris I, Mulford J, et al. Association between compensation status and outcome after surgery: A meta-analysis. JAMA

2005;293:1644-52. 10. Cheriyan T, Harris B, et al. Association between compensation status and outcomes in spine surgery: A meta-analysis of 31

studies. Spine J 2015;15:2564-73.

11. Raichle KA, Romano JM, Jensen MP. Partner responses to patient pain and well behaviors and their relationship to patient pain behavior, functioning, and depression. Pain 2011;152:82-8.

12. Polatin PB, Kinney RK, et al. Psychiatric illness and chronic low-back pain: The mind and the spine—which goes first? Spine. 1993;18:66-71.

13. Brown RL, Patterson JJ, et al. Substance use among patients with chronic back pain. J Fam Pract. 1996;43:152-160. 14. Breckenridge J, Clark JD. Patient characteristics associated with opioid versus nonsteroidal anti-inflammatory drug manage-

ment of chronic low back pain. J Pain. 2003;4:344-350.

Distress in Chronic Pain (continued from p.2)

Facts in Brief

Over 30% of Americans experience chronic or acute pain, more than diabetes, heart disease,

and cancer combined. (Institute of Medicine, 2011)

Adults with low back pain experience higher rates of psychological distress than adults without

pain. (National Centers for Health Statistics, 2006)

Almost 2 million Americans abused or were dependent on opioid pain medication in 2013.

(SAMHSA, 2014)

APAHC Grand Rounds | Fall 2018 4

There are two interrelated movements shaping academ-

ic health centers (AHCs) across the nation: collaborative

team-based care and interprofessional education (IPE).

These movements were both catalyzed when the Triple Aim

concept was coined by the Institute for Healthcare Improve-

ment and the healthcare system was charged with three

goals: to improve population health, to improve the experi-

ence of care for patients and families, and to reduce per

capita cost.1 This emphasis not just on treating the ill who

present in clinics but also on promoting health in the popu-

lation, all in a cost effective manner, was an important refo-

cusing of our health system. Soon after, the World Health

Organization defined collaborative care as occurring “when

multiple health workers from different professional back-

grounds provide comprehensive services by working with

patients, their families, carers and communities to deliver

the highest quality of care across settings” (p.13)2. As such,

collaborative care was then seen as an avenue for meeting

the Triple Aim. The Patient Protection and Affordable Care

Act reinforced the trend toward integrated, team-based care

by supporting healthcare homes and led to the considera-

tion of interprofessional team-based, collaborative care as a

way to provide comprehensive care to patients and their

families3,4

. Four core competency domains (with 9 to 15

specific skills in each) were determined to be the foundation

of effective team functioning in clinical environments5, edu-

cational efforts6, and research teams.

7 Thus, these core

competencies apply to the missions of AHCs and involve

the understanding of professional roles (including overlap

and distinctions), shared values of mutual respect and col-

laborative decision-making, clear and positive communica-

tion among all team members and the patient/family, and

effective team dynamics (including clinical process and flow

as well as positive approaches to differences of opinion).

To prepare for the transition to collaborative care, AHCs

have been working to develop evidence-based programs

dedicated to student skill development in the four core com-

petency domains of high quality interprofessional team-

based care that keeps patients and their needs first.8,9

Ac-

creditation policies for many of the

national health care professional

associations have now incorpo-

rated IPE as a required curriculum

element including both Medicine

and Psychology.10

Delivery of quality care to provide comprehensive health

care services for patients and their families is challenging

and complex. Fostering collaborative, integrated care and

evidence-based IPE experiences that implicate specific skill

acquisition in addition to didactic learning is key.11,12

Specifi-

cally, research supports the idea that IPE experiences

(where learners from two or more professions learn about,

from, and with each other) enhance the quality of clinical

collaborations and team-based care in both faculty and stu-

dents 4,9,13-15

, reduce safety events,16

and positively impact

patient- and family- engagement and satisfaction in the care

environment.17

Psychologists working in AHCs could play a role in IPE

that would potentially impact the landscape of collaborative

care in the future. First, psychologists could encourage psy-

chology trainees at different levels to become involved in

IPE events at their institution. This would foster the inclu-

sion of psychologists into the cognitive framework that pro-

fessional students are developing in IPE of what a collabo-

rative care team looks like. This framework would drive ex-

pectations when students reach the “real life” clinical envi-

ronment and create a demand for increased psychology

involvement. Second, psychologists could become facilita-

tors of IPE events. They have expertise in the four core

competency domain skill sets; namely, developing a culture

of mutual respect and shared values, communication skills

among team members and the patient/family, understand-

ing and negotiating role overlap and role distinctions among

professions, and team dynamics and process. Creating ac-

tive learning experiences that enhance these skills are al-

ready familiar to psychologists (such as role play, small

group discussion, observation with feedback, etc). It is im-

portant to point out that a role as creator or facilitator of IPE

events (or even an IPE Curriculum Director role) adds value

to psychologists and the field of psychology in AHCs. Fur-

ther, development of evaluation tools to assess the quality

and utility of the programming as well as pre/post

knowledge and skill acquisition for students is needed.18

Research in this field is in its infancy with less known

about the impact on service quality, patient satisfaction, and

cost effectiveness when students join the existing workforce

post-graduation. Psychologists’ research skills are invalua-

ble in this regard and critical for identifying key components

of IPE events that most impact learning and skill develop-

ment, documenting the translation of these skills from the

learning environment to the practice environment, and

Continues on page 5... Wendy Ward, PhD, ABPP

Wendy Ward, PhD, ABPP

Interprofessional Education and Collaborative Team-Based Care:

Twin Forces Shaping the Culture and Focus of Academic Health Centers

APAHC Grand Rounds | Fall 2018 5

IPE and Collaborative Team-Based Care (continued from p.4)

tracking the impact of IPE over the long term on key Triple Aim ob-jects like patient satisfaction, population health, and cost-effectiveness of care. Finally, psychologists could promote IPE events for physicians and oth-er health care professions faculty, designed to enhance the four core compe-tency domain skill sets in the current work force as they move toward collabo-rative, team-based care.

Sociopolitical forces have influenced the movement toward collabora-tive team-based care in academic health centers which provides a need for trained professionals who can work effectively together to treat patients and improve population health, all in a cost-effective manner. Interprofessional education learning experiences are designed to promote skills in student and faculty learners that prepare them for effective team-based care. These inter-related movements provide an opportunity for psychologists to become more involved and shape the future of our health system to one that includes psy-chology as a discipline.

APAHC

9th National

Conference!

Join us for the 9th National Confer-

ence of APAHC, February 7-9, 2019,

at Le Meridien in New Orleans, LA.

The conference theme will be Psy-

chology on the Cutting Edge: Cele-

brating Psychologists’ Roles, Contri-

butions, and Diversity in Academic

Health Centers.

References 1. Berwick DM, Nolan TW, Whittington J. The Triple Aim: Care, health, and cost. Health

Affairs, 2008; 27: 759-769.

2. World Health Organization. Constitution of the World Health Organization, 1946.

3. Abu-Rish E, Kim S, et al. Current trends in interprofessional education of health sciences

students: A literature review. J Interprof Care, 2012; 26: 444-51.

4. Thistlethwaite J., Moran M. Learning outcomes for interprofessional education (IPE):

Literature review and synthesis. J Interprof Care, 2010; 24: 503-13

5. Interprofessional Education Collaborative Expert Panel. Core competencies for interpro-fessional collaborative practice: Report of an expert panel. 2011. Washington, D.C.: Interprofessional Education Collaborative.

6. Center for the Advancement of Interprofessional Education. Interprofessional educa-tion—A definition. 1997. London: CAIPE Bulletin 13.

7. Bennett LM, Gadlin H, et al. Collaboration and team science: A field guide. https://ccrod.cancer.gov/confluence/download/attachments/47284665/teamscience_fieldguide.pdf

8. Reeves S, Goldman J, et al. A scoping review to improve conceptual clarity of interpro-fessional interventions. J Interprof Care, 2011; 25: 167-74.

9. Thistlethwaite J. Interprofessional education: a review of context, learning, and the re-search agenda. Med Educ, 2012; 46: 58-70.

10. American Psychological Association. APA Joins Interprofessional Education Collabora-tive. http://www.apa.org/news/press/releases/2016/02/interprofessional-education.aspx

11. Cameron S, Rutherford I, et al. Debating the use of work-based learning and interpro-fessional education in promotion collaborative practice in primary care: A discussion paper. Qual Prim Care, 2012; 20: 211-7.

12. Thompson C. Do interprofessional education and problem-based learning work

together? Clin Teach, 2010; 7: 197-201.

13.Reeves S, Perrier L, et al. Education: Effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev, 2013; 28: CD002213.

14. Gillan C, Lovrics E, et al. The evaluation of learner outcomes in interprofessional con-tinuing education: A literature review and an analysis of survey instruments. Med Teach, 2011; 33: 461-70.

15. Reeves S, Goldman J, et al. Synthesis systematic review evidence of interprofessional education. J Allied Health, 2010; 39: 198-203.

16. Nagelkerk J, Peterson T, et al. Patient safety culture transformation in a children’s

hospital: An interprofessional approach. J Interprof Care, 2014; 28: 358-64.

17. Reeves S, Zwarenstein M, et al. The effectiveness of interprofessional education: Key findings from a new systematic review. J of Interprof Care, 2010; 24: 230-41.

18. Oates M, Davidson M. A critical appraisal of instruments to measure outcomes of inter

professional education. Med Educ, 2014; 49: 386-98.

Submit proposals for research

posters by Oct. 1 to apahc.association@gmail.com

Early Career Bootcamp applications

are due Oct. 15

Mid-Career Bootcamp applications

are due Nov. 4

Go to ahcpsychologists.org/ to reg-ister for the conference

Early bird registration closes

Jan. 1.

APAHC Grand Rounds | Fall 2018 6

Suicide

Stats

Nearly 45,000

Americans died

by suicide in

2016.

54% of people

who died by

suicide did not

have a known

mental health

condition.

People without

a known mental

health diagno-

sis were more

likely to be

male and to die

by firearm.

CDC, 2018

Suicide is a leading cause of death in the United States among both adolescent and adult popula-tions.1 Concerningly, even in the face of increased awareness and prevention efforts, suicide attempts are increasing. Most individuals who die by suicide have contact with medical providers in the month prior to death,2 illustrating an opportunity for life-saving interventions to occur. This is particularly rele-vant for providers within primary care (PC), as Ameri-cans receive most of their health and behavioral health care in PC settings. Indeed, PC providers are more likely than other providers to interact with sui-cide decedents in the months leading up to death.2 Risk assessment and management of suicidal pa-tients are key components of care in specialist mental health services, but these issues are relatively unex-plored in PC services. Accessibility and familiarity make PC an ideal setting for suicide prevention; how-ever, these environments must be prepared to re-spond to the presentation of risk. This requires the presence of trained clinicians with the capability to identify and treat individuals experiencing varying levels of risk for suicide. Risk Detection The first steps in a comprehensive suicide preven-tion program in PC settings involve well-developed suicide screening and assessment practices. PC pro-viders can implement targeted screening programs focused on at-risk populations (e.g., patients with positive depression or substance misuse screens) or universal suicide screening protocols, with universal screening protocols identifying significantly more sui-cidal patients.3 Regardless of the screening strategy employed, empirically supported screening tools should be implemented in PC settings to improve identification of at-risk patients while ensuring ade-quate predictive value.4 Several brief suicide screen-ing measures have been developed for PC and other medical settings including the Ask Suicide-Screening Questions (ASQ) Toolkit,5 the Risk of Suicide Ques-tionnaire,6 the suicidal ideation item of the PHQ-9,7 along with other tools that directly assess suicidal ideation and warning signs. Ultimately, identifying patients at risk for suicide is necessary but not suffi-cient for prevention efforts. Once a patient has been identified as at-risk, appropriate treatment provisions must be offered. Risk Management Interventions focused directly on suicide, such as stabilization during acute crises,8 may be more effec-tive in reducing suicidal behaviors than interventions focused on depression, hopelessness, substance use or other factors related to suicide risk.9 Additionally, suicide safety plans, in which the patient and provider collaboratively develop an individualized plan to uti-lize during a suicidal crisis, can also assist with man-aging suicidality.10 These plans proactively identify suicidal triggers, intra- and interpersonal coping re-sources, supportive resources (e.g., suicide crisis hotlines or chatlines), reasons for living, and safe storage of lethal means. PC providers can also attend

to suicidal patients by assisting them with accessing specialized mental health treatment and coordinating transitions between providers, given that most pa-tients do not follow-up on referrals for suicide related treatment.8 Further, providing written messages ex-pressing care and interest in their patients’ well-being can significantly reduce suicidal behaviors among vulnerable populations,11 and could perhaps increase service utilization. However, suicide specific interven-tions delivered by PC physicians may vary in effec-tiveness,8 highlighting the necessity of psychologists in this setting as well as improved training efforts. Clinical Training A critical barrier impeding effective suicide preven-tion services within PC settings is the lack of ade-quate training. Many physicians receive no specific training related to the assessment and treatment of suicidal individuals during their education,12 with only a few states requiring this type of training.13 This is alarming when considering that among PC physi-cians, training improves self-perceived competence in addressing suicidality, which has been found to di-rectly influence willingness to assess for and treat suicidal individuals.14 Thus, psychologists may find themselves tasked with evaluating the willingness of PC team members to respond to suicide risk and providing training as needed. Additionally, there are formal suicide prevention training resources intended for broad clinical audiences including Question, Per-suade, Refer, Train: Suicide Triage, Safety Planning Intervention for Suicide Prevention, and Recognizing and Responding to Suicide Risk in Primary Care among others. Moreover, trainings on lethal means assessment such as Counseling on Access to Lethal Means are available. These may be particularly use-ful investments of time as reduction of access to le-thal means, in the absence of any psychological inter-vention, is found to effectively decrease suicides.15 Conclusion Psychologists often serve as critical suicide pre-vention resources within PC settings, by providing team members with the knowledge needed to identify signs of suicidality and the confidence required to enable responsive, and effective, action. They may also encourage the utilization of resources to support the development of suicide screening programs, as-sessment selection, and provider trainings offered by national organizations such as the Suicide Prevention Resource Center, the American Foundation for Sui-cide Prevention, and the National Institute of Mental Health. Ultimately, psychologists are vital to enhanc-ing suicide prevention practices within PC settings through their roles as consultants, interdisciplinary team members, and leaders of program implementa-tion and enhancement efforts.

(References on p. 11)

Suicide Prevention in Primary Care Settings Lori Holleran, PhD, MPH, and Alison Athey, MA

L: Alison Athey, MA R: Lori Holleran, PhD, MPH

APAHC Grand Rounds | Fall 2018 7

CFAS Corner Bill Robiner, PhD, and

Laura Shaffer, PhD,

APAHC CFAS Reps

Have you ever wondered what that news-

letter is that Dr. Shaffer forwards you from

the AAMC every week? Per the CFAS

website, “CFAS News reports on the

comings and goings of major figures at

medical schools and teaching hospitals,

the trends and trendsetters influencing

the field, and news and happenings in

biomedical research, medical education,

and patient care.” A quick perusal each

week is a helpful way to better understand

academic healthcare and the multiple mis-

sions of the institutions where AHC psy-

chologists work. It offers a synopsis of

critical issues in the news that are on the

minds of deans, department heads, and

faculty at medical schools around the

country as well as that concern leaders of

diverse health professional disciplines and

organizations.

In addition to its brief summaries, CFAS

News presents links to more in-depth infor-

mation about many of the stories. It also

acquaints readers with structural changes

in medical schools and throughout

healthcare. This information helps readers

to become better informed about current

events in academic healthcare, the

healthcare system, and a range of factors

that affect education, research, and

healthcare. The more psychologists un-

derstand these matters, the greater their

ability to speak the same language and

understand the concerns and thinking of

their medical colleagues. Reading it can

provide psychologists both a broader na-

tional perspective and, at times, an insider

view of their workplaces and the opportuni-

ties available to them.

As a bonus, the AAMC staff member who

writes CFAS News has a wry sense of

humor, so it is usually worth a scroll to the

end to see what entertaining article he has

found!

Serina Neumann, PhD, Janet Fishel, PhD, Laura Shaffer, PhD, Carol Painter, PhD, and Amy Williams, PhD, at the Spring 2018 CFAS Meeting

Selected Results of the 2017 APAHC Member

Survey and APAHC’s Responsiveness to Feedback

Wendy Ward, PhD, Elizabeth Cash, PhD, Laura Daniels, PhD, &

Bill Robiner, Ph,D

APAHC has a history of conducting membership surveys in an effort to solicit feedback regarding the association’s activities and membership benefits. Further, APAHC is interested in surveying members on current trends and hot topics of interest to psychologists working in academic health centers. Toward that end, a survey was distributed to all student and full members of APAHC in fall 2017. This was APAHC’s third membership survey, designed to target cur-rent issues relevant to psychologists working in AHCs as well as satisfaction with member benefits and services. Specific questions by content area were created to assess needs in the areas of: (a) demographics; (b) current trends in the field; (c) roles in education; (d) leadership roles and perceived skill devel-opment needs; (e) professional wellness and sources of stress; and (f) level of satisfaction with existing membership services. This brief report will focus on responses related to membership benefits only.

Most respondents were female (70%), White (80%), and non-Hispanic (93%). Respondents were mostly Full Members (76%) with PhDs (85%). Many members had learned about APAHC from colleagues (41%) or supervisors (19%). Respondents reflect the continuum of the career spectrum: 0-5 years in the field (28%); 6-10 years (17%); 20 years or more (29%); and > 20 years/mid-career (24%). Respondents were primarily non-tenure track (78%), with about half on the Clinical-Educator track (46%). The distribution of academic rank spanned Assistant Professor (39%), Associate Professor (23%), and Full Pro-fessor (17%). Respondents reported working principally in Medical School (45%), Hospital (24%), and outpatient medical care clinic settings (21%).

Continues on page 8...

APAHC Grand Rounds | Fall 2018 8

Membership Survey (continued from p.7)

Overall satisfaction with specific Member Benefits was rated positively: extremely satisfied (12%), very satisfied (44%), or somewhat satisfied (25%). Most members indicated they intended to renew membership (55% Definitely; 29% Very Like-ly). Among the 21 benefits sampled, the most highly rated benefits of APAHC membership included rein-forcing members’ identities as AHC psychologists, the organization’s advocacy on behalf of AHC psy-chologists, the organization’s help in keeping abreast of developments in AHCs, APAHC’s journal JCPMS, the APAHC listserv, and networking and training opportunities. These and the other ad-vantages that membership confers contribute to APAHC’s vital role in the professional lives of its members.

The APAHC Board reviewed in detail the responses to questions related to member benefits. General comments suggested growing membership and enhancing the diversity of the association. Fur-ther, exploring additional ways to network and pro-mote professional development between confer-ences (e.g., webinars) was suggested. Enhancing opportunities in research, networking, and mentor-ship was encouraged. Survey results spurred the Board to spearhead several initiatives to address member concerns.

A complete redesign of the existing website was undertaken. A more user-friendly design emerged, resulting in a more dynamic website that more effectively conveys the missions of APAHC and facilitates membership application and renewal (ahcpsychologists.org/). Revisions to the editorial process for the Journal of Clinical Psychology in Medical Settings have also been completed. Ronald Brown, PhD, was elected as Editor-In-Chief for a five-year term. Dr. Brown has restructured the work of four Associate Editors (Andrea Bradford, PhD, Liz Cash, PhD, James Paulson, PhD, and John Wryo-beck, PhD) serving one-year terms. To facilitate jour-nal efficiency, Associate Editors’ process manu-scripts within three days of receipt, and reviewers are allotted 28 days to complete their assignments. Initiatives to expand the content of the journal are also under development. Several special issues are currently in the planning phases; announcements highlighting those topics will be made in the coming months.

The next APAHC biennial conference is scheduled to take place February 7-9, 2019, at Le Méridien New Orleans in Louisiana. Conference planning has focused heavily on responses from the

Member Survey as well as on feedback from the last conference. Based on respondent comments, ex-panded conference offerings are being planned to include programming on pediatrics, women in aca-demic healthcare, late career transitions, hospital and staff privileging of psychologists, breakout ses-sions to facilitate networking, as well as increasing conference planning involvement among junior APAHC members. APA Self-Study and Site Visitor training, as well as the APA Division 38 Spring Board Meeting also will be held in conjunction with the con-ference.

As results of the membership survey were discussed by the APAHC Board, initiatives to reach out to potential new members and retain existing members also were considered. Our goal was to re-tain existing members through the implementation of ongoing quality improvement efforts for existing member benefits and to consider new benefits as well. A recent new membership recruitment program was initiated and designed to provide early career psychologists and trainees a year of free member-ship to APAHC in the hopes that new members will find value in ways many of our current members cit-ed in the survey responses. As a result of this initia-tive membership grew by more than 200% (from 207 active members on Feb 15 to 671 active members on April 2). Another goal was that new members might identify ways they can become more involved in APAHC and add their perspectives and contribute in ways that further enhances the membership expe-rience (e.g. participation on APAHC committees, webinars, journal reviewers, conference attendance). Efforts related to this latter aspiration are in develop-ment, and the membership committee anticipates providing more information and updates in this re-gard to membership in the future.

The APAHC Membership Survey provides insights into characteristics of its membership and crystallized some of the most valuable elements of being a member. This brief report focused on re-sponses related to membership benefits only. Three workgroups are currently analyzing and writing up remaining results (psychologists’ roles in education in AHCs, professional wellness and sources of stress for psychologists in AHCs, and the diverse leadership roles that psychologists’ serve in AHCs). The feedback from members via survey responses is much appreciated by the Board and is driving ongo-ing efforts to improve member benefits and to better understand the issues and needs central to the ex-perience of psychologists working in academic health centers and other medical settings.

APAHC Grand Rounds | Fall 2018 9

Immigration mental health:

Policy as a social determinant

There were 56.5 million Latinos in the U.S. in 2015, comprising 17.6% of the population, and 34% of this group was foreign-born. In February, we presented a webinar on behalf of the APAHC Committee on Diversity and Disparities entitled Social Determinants of Mental Health for Latino/a Immigrants: Implications for Clini-cal Practice. In the webinar, we explored social deter-minants of mental health specific to Latino/a/x immigrant populations, using the CAMINO framework

1 as a guide to

these social determinants. We also identified relevant clinical factors and potential resources for mental health providers. In this article, we briefly discuss key points from the webinar and reflect on the webinar’s focus in light of recent events.

Social determinants of mental health include dif-ferences in social, economic, and environmental circum-stances and policies which impact the conditions in which people live and the services they can access. We posit that a focus on social determinants is important to clinical work with the U.S. immigrant population for two reasons. First, immigrants (particularly those of low socio-economic status) may be disproportionately exposed to adverse social, economic, and environmental circumstances both in the country they have left and in the country to which they migrated. Second, there are social determinants of health specific to the process and experience of migration and of living as an immigrant in the U.S.

The CAMINO framework provides a useful mne-monic for clinical assessment with Latino immigrant popu-lations

1. CAMINO is the Spanish word for path, and the

letters of CAMINO stand for Community & Family Sup-port, Acculturative Stress, Migration History, Idioms of Distress and Resilience, Native Language and Prefer-ences, and Origin. A focus on these domains provides an entry point into a number of social determinants impacting the health of immigrant Latinos in the US; for example, understanding the migration history of a Latino/a client can provide a window into the social context that may have impacted an individual and their family before, dur-ing, and after migration. The experience of planned mi-gration from a politically stable country is very different from the experience of fleeing an unstable and dangerous environment. By the same token, arrival in the US as a member of a group that is welcomed may facilitate adjust-ment and well-being, while arriving as a member of a group that is disparaged and marginalized may have ad-verse effects on mental health via the impact of accultura-tive stress, discrimination, and barriers to opportunity. The CAMINO framework also brings balance to the provider’s view of their Latino immigrant patients by delving into spe-cific sources of strength and resilience such as communi-ty and family support, and by highlighting the use of idi-oms of resilience (such as Si, se puede/”Yes, we can” and No hay mal que por bien no venga, which is like the English phrase “Every cloud has a silver lining”).

A focus on the social context of immigrant mental health has taken on greater urgency at the time of this writing, given the separation of over two thousand children, including babies and toddlers, from their families due to a “zero tol-erance” policy applied to undocumented immi-grants crossing outside of official U.S. check-points. The American Psychological Associa-tion, along with many other professional asso-ciations, has issued official statements empha-sizing the devastating long-term effects that may be caused to children needlessly traumatized by separation from their parents

2. Yet, despite widespread condemna-

tion, reunification of these children with their families has not happened quickly, and news reports have highlighted parents being deported without their young children, lack of records linking children to the identity of their parents, and an onerous verification process for parents and chil-dren to be reunified.

3 Attention to this crisis has also

brought awareness to the myriad other ways that mental and physical health can be impacted via the current immi-gration system – from the impact of deportation of parents on child mental health to the safety risks that ensue when immigrants fear calling police to report crimes.

4

As psychologists in academic health centers, we serve diverse populations across the country and are part of a healthcare workforce in which nearly 17% of profes-sionals are immigrants.

5 We must be active in under-

standing the impact of our country’s immigration system and policies on mental health. We must recognize how a climate of fear erodes the well-being of immigrant popula-tions, including by making it less likely that immigrants will seek care in health centers or call for crisis services when needed.

6-8 And beyond bringing this awareness into our

care of individual patients, we should consider what col-lective actions can be taken to improve the social condi-tions impacting immigrant populations in the US. For ex-ample, via our professional associations, medical institu-tions, and individual efforts, we can ensure that empirical evidence and clinical insights continue to inform advoca-cy; and we can identify actions at the local level that can make our communities and medical systems safe and welcoming to immigrants. This crisis brings into sharp relief the reality that it is not enough to be aware of social determinants and integrate them into our clinical practice with individual patients; if we are to practice population health as medical center psychologists, then we must al-so commit to bringing systemic solutions to bear upon systemic problems.

(References on p.11)

Kiara Alvarez, PhD, & Giuliana McQuirt, PsyD

APAHC Grand Rounds | Fall 2018 10

APAHC Grand Rounds | Fall 2018 11

References for Suicide Prevention in Primary Care Settings 1. Centers for Disease Control and Prevention. Suicide Facts at a Glance 2015. https://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf. 2. Ahmedani BK, Simon GE, et al. Health Care Contacts in the Year Before Suicide Death. J Gen Intern Med. 2014;29:870-877. 3. Boudreaux ED, Camargo CA, et al. Improving Suicide Risk Screening and Detection in the Emergency Department. Am J Pre-vent Med. 2016;50:445-453. 4. Horowitz LM, Ballard ED, Pao M. Suicide screening in schools, primary care and emergency departments. Curr Opin Pediatr. 2009;21:620-627. 5. Horowitz LM, Bridge JA, et al. Ask Suicide-Screening Questions (ASQ). Arch Pediatr Adol Med. 2012;166:1170-1176. 6. Horowitz LM, Wang PS, et al. Detecting Suicide Risk in a Pediatric Emergency Department: Development of a Brief Screening Tool. Pediatr. 2001;107:1133-1137. 7. Simon GE, Rutter CM, et al. Does Response on the PHQ-9 Depression Questionnaire Predict Subsequent Suicide Attempt or Suicide Death? Psychiatr Serv. 2013;64:1195-1202. 8. Milner A, Witt K, et al. The effectiveness of suicide prevention delivered by GPs: A systematic review and meta-analysis. J Af-fect Disord. 2017;210:294-302. 9. Meerwijk EL, Parekh A, et al. Direct versus indirect psychosocial and behavioural interventions to prevent suicide and suicide attempts: a systematic review and meta-analysis. The Lancet Psychiatry. 2016;3:544-554. 10. Jin HM, Khazem LR, Anestis MD. Recent Advances in Means Safety as a Suicide Prevention Strategy. Curr Psychiat Rep. 2016;18, 96. 11. Luxton DD, June JD, Comtois KA. Can postdischarge follow-up contacts prevent suicide and suicidal behavior? A review of the evidence. Crisis. 2013;34:32-41. 12. Sudak D, Roy A, et al. Deficiencies in suicide training in primary care specialties: A survey of training directors. Acad Psychiatr 2007;31:345-349. 13. American Foundation for Suicide Prevention. State Laws: Training for Health Professionals in Suicide Assessment, Treatment, and Management. http://afsp.org/wp-content/uploads/2016 /04/Health-Professional-Training-Issue-Brief.pdf 14. Graham R, Rudd M, Bryan C. Primary care providers’ views regarding assessing and treating suicidal patients. Suicide Threat Behav. 2011;41:614-623. 15. Mann J, Apter A, et al. Suicide prevention strategies: A systematic review. JAMA 2005;294:2064-2074.

References for Immigration mental health: Policy as a social determinant 1. Silva MA, Paris M, Añez LM.CAMINO: Integrating context in the mental health assessment of immigrant Latinos. Prof Psy-

chol Res Prac, 2017; 48: 453. 2. American Psychological Association. Immigration. Retrieved from http://www.apa.org/advocacy/immigration/index.aspx. 3. Shoichet C. Why it’s taking so long for the government to reunite the families it separated. CNN News. (2018, July 9). Re-

trieved from: https://www.cnn.com/2018/07/09/politics/family-separation-reunion-hurdles/index.html. 4. Burnet J. New immigration crackdowns creating ‘chilling’ effect on crime reporting. National Public Radio. (2017, May 25).

Retrieved from: https://www.npr.org/2017/05/25/529513771/new-immigration-crackdowns-creating-chilling-effect-on-crime-reporting

5. Altorjai S, Batalova J. Immigrant health care workers in the United States. Migration Information Source. (2017, June 28). Retrieved from: https://www.migrationpolicy.org/article/immigrant-health-care-workers-united-states

6. Hardy LJ, Getrich CM, et al. A call for further research on the impact of state-level immigration policies on public health. Am J Public Health, 2012; 102: 1250-1253.

7. Martinez O, Wu E, et al. Evaluating the impact of immigration policies on health status among undocumented immigrants: a systematic review. J Immigr Minor Health, 2015; 17: 947-970.

8. Toomey RB, Umaña-Taylor AJ, et al. Impact of Arizona’s SB 1070 immigration law on utilization of health care and public assistance among Mexican-origin adolescent mothers and their mother figures. Am J Public Health, 2014; 104: S28-S34.

Kudos to APAHC members Drs. Serina Neuman, Laura Shaffer, and Amy Williams who presented or facilitated

discussion groups at the 2018 Spring Meeting of the Association of American Medical College’s (AAMC’s) Coun-

cil of Faculty and Academic Societies (CFAS)! Dr. Shaffer was invited to serve on the program committee for

2019 so look for more psychology visibility to come.

APAHC Grand Rounds | Fall 2018 12

Contact Us

Visit our NEW website at

ahcpsychologists.org

It is with great excitement that I write this article to re-launch Grand Rounds.

As I reviewed article proposals for this issue, I was struck by the diverse,

amazing things our members do. Psychologists in academic health centers

are involved in patient care, education, and research related to topics that

are in the news regularly, from the opioid crisis and increasing rates of sui-

cide to immigration mental health to new models of healthcare delivery.

AHC psychologists are finding innovative ways to address these issues and

improve the well-being of individuals, systems, and society. It is fitting, then,

that the theme for the next APAHC conference is Psychology on the Cutting

Edge: Celebrating Psychologists’ Roles, Contributions, and Diversity in Aca-

demic Health Centers. I hope that you will join us for the conference and

connect with leaders in our profession. As our fearless leader, Zeeshan

Butt, encouraged in his article, I also hope that you all will want to get more

involved in the organization. In particular, I welcome members who would

like to join the editorial staff of Grand Rounds and contribute to its growth

and development. Consistent with feedback we received in the membership

survey, Grand Rounds will include a greater diversity of topics and contribu-

tors, with releases planned for the spring and fall each year. I look forward

to receiving article proposals from our membership and sharing all the

amazing things psychologists in academic health centers are doing.

Call for proposals and editorial staff!

Have exciting clinical research that you want to share?

Using innovative teaching methods?

Involved with policy?

Let APAHC members know what you’re doing!

We are seeking submissions of approximately 500—1,000 words for upcoming installments of Grand Rounds. We also are looking for editorial staff to

help publish future issues.

E-mail your proposals to the Editor at apahc.association@gmail.com

by Dec. 1, 2018

Lauren Penwell-Waines, PhD

Letter from the Editor