Advancing Psychology’s Role in Community Health Centers — April 2010

Promoting the role of psychology in integrated health has been a primary goal of the Education Government Relations Office (GRO) since 1994 in its quest to gain inclusion of psychologists in Federally Qualified Health Centers (FQHC). In addition, Education GRO successfully advocated for a focus on behavioral health, as well as mental health, in the $2.2 billion FHQC Program, which includes community health centers, migrant health centers, health centers for the homeless, and health centers in public housing with over 7,000 sites through out the nation.

The recent passage of the American Reinvestment and Recovery Act (ARRA) has provided a significant boost ($338 million) to the FQHC Program, which doubles the number of health professionals to 6,400 including behavioral and mental health professionals. Many of these positions will be filled by National Health Service Corps (NHSC) Scholars and Loan Repayers. (Psychologists currently participate in the Loan Repayment Program.) Other health professionals will be direct hirers by the health centers.

Initially Education GRO sought to advance the participation of psychologists in the NHSC financial aid programs for health professionals in exchange for service in FQHC that are federally designated health professionals shortage areas. This involved outreach to the Bureau of Primary Health Care, which administers both the FQHC and NHSC programs with an expression of support from a key member of Congress, Senator Daniel Inouye (D-HI). While this advocacy initiative began with the federal agency and a member of Congress, during the past fifteen years there has been continuous advocacy with the federal agency and at different stages with the Congressional authorizing or appropriations committees.  Periodically there has also been outreach to national associations, including the National Association of Community Health Centers (NACHC). The diagram below illustrates the number of stages and different players during this sustained effort.

Gaining Momentum and Inclusion in 2002 Safety Net Legislation

Because of Education GRO efforts, since 1995 psychologists have been participating in the NHSC Loan Repayment Program and working at health care facilities that have been designated as Health Professional Shortage Areas (HPSA).  However, for many years there was a great deal of interest on the part of psychologists but not a great deal of demand from HPSA designated facilities. However, significant gains were made in 2000 when Education GRO secured a $1 million appropriation to establish regional conferences to promote integrated care that included mental and behavioral health for underserved populations throughout the nation. Close on the heels of that success, in 2002 statutory language was accepted in the Safety Net Legislation that gave psychologists and psychology trainees access to all the NHSC financial aid programs.  It also created a focus on mental and behavioral health in the FQHC program. As a result the number of psychologists participating in the NHSC recently doubled to almost 400.
 
Despite gains at the federal level through Congressional action and federal agency policies, it became clear that, although there has been significant progress with the NHSC, much more needed to be done to increase the number of psychologists working in FQHCs. Therefore, Education GRO determined that a push had to be made at the state level where the FQHCs were organized through state-based Primary Care Associations (PCA.)

Advancing Efforts through State Primary Care Associations

In 2007 Nina Levitt, EdD, Associate Executive Director, Education GRO, reached out to the California Psychological Association (CPA), Gilbert Newman, PhD, Immediate Past President of CPA, and its Rural Health Coordinator, Marv Megibow, PhD, regarding a possible effort in California that could serve as a model for other states in the country.  Under Dr. Newman's leadership, the California PCA was approached and although the California PCA had been resistant in the past, its staff expressed a strong interest in working with him and the CPA to get more psychologists hired. They were especially interested in hiring psychologists with prescription drug privileges. In fact, the California PCA had already launched an effort to facilitate an integrated approach to health care that included spearheading an initiative to get the state legislature to remove the regulation that prohibited Medicaid reimbursement for medical and mental health services on the same day. 

In September 2008 during the Fall APA Consolidated Meetings in Washington, DC, the Education GRO and the Practice Directorate Committee on Rural Health (CHC) hosted an all-day meeting on the role of psychologists and trainees in FQHCs. Attending the meeting were Gil Newman, PhD, Wright Institute of Berkeley, CA.  Parinda Kahtri, PhD of the Cherokee Health Systems of  Talbot, TN and Ben Miller, PsyD University of Massachusetts. Drs. Miller and Kathri spoke about successful efforts at integrated health care including psychologists, and Dr. Newman addressed efforts in CA to place psychologists and psychology trainees in Community Health Centers that began in collaboration with Education GRO staff. Other invited guests included Gina Capra, a representative for the US Bureau of Primary Health Care (BPHC) in the Health Resources and Services Administration, and Michael Lardiere of the National Association of Community Health Centers (NACHC).  Both spoke about the FQHC program and the efforts to address the mental and behavioral health needs of the underserved. 

As a result of that meeting, efforts by Education GRO to work with state PCAs for the inclusion of psychologists and psychology trainees in Community Health Centers began in NM, ME and are planned for NH, MT and possibly AR.

Promoting Psychologists Contributions to FQHCs through Health Care Reform Legislation

Due to the passage of the health care reform bill—which includes efforts to boost the provision of health care to underserved populations—it is critical to promote the contributions of psychologists to integrated health care in FQHCs, and in particular community health centers. Because of their expertise in the diagnosis and treatment of mental disorders, as well as behavioral aspects associated with chronic illnesses and other physical conditions, psychologists have a unique role to play, especially given that these are the most common health problems presented at FQHCs.  Consequently, health care reform legislation will provide an opportunity for psychologists to distinguish themselves from psychiatrists and social workers.  Further, as Congress increasingly focuses on prevention, psychologists are also in the best position to participate in those efforts. The involvement of psychologists in integrated health care will not only highlight their expertise in mental and behavioral health assessment and diagnosis, but consultation and team building skills as well. Finally, the Graduate Psychology Education Program, which provides interdisciplinary training for the delivery of services to underserved populations primarily in integrated settings, underscores and demonstrates the importance of psychology and the need for the psychology community to continue to garner Congressional support (funding) for psychology education and training.