The Patient Protection and Affordable Care Act of 2010 (ACA; P. L. 111-148) is ushering in a new era for the training and education in clinical psychology. Yet, little is known about the potential impact of this healthcare reform on our field moving forward. In our article (Chor, Olin, & Hoagwood, 2014), we describe features of the ACA-funded Mental and Behavioral Health Education and Training Grants (MBHETGs). Through the lens of dissemination and implementation science, we also discuss four paradigm shifts related to the ACA that are critical to our field – evidence-based practices (EBPs), research methodology, interprofessionalism, and quality indicators.
Our field is a dynamic one that evolves with public policy. We – graduate students, predoctoral interns, postdoctoral fellows, clinicians, researchers, policymakers – need to be cognizant of the directions the ACA brings to the forefront. The U.S. mental health system is steering away from a fee-for-service, siloed system to an integrated one within the greater healthcare system. Parity in health and mental health is becoming a reality through primary care integration, patient-centered medical homes, and on the system-level, accountable care organizations. In this context, developing EBPs, studying and demonstrating treatment effectiveness, and coordinating payable, quality care take on completely new meanings. It is hard to imagine who in our field would notbe affected by these macro- and micro-changes in one way or another. These changes come to life in our ongoing study of EBP adoption in the children’s mental health system in New York State. Interviews with directors of mental health agencies and clinics have revealed real-world questions and challenges that should sound eerily familiar to us – How to balance clinician productivity with professional development such as EBP trainings (i.e., unbillable, costly, and time-consuming)? How to adopt and implement EBPs that may be inconsistent with clients’ insurance policies? How to maintain quality care in light of cuts in Medicaid rates? How to develop an organizational infrastructure (e.g., electronic health records, reducing no-show rates) to meet new demands from managed care organizations?
But top-down policy changes also come with new opportunities for our field to innovate and address these changes. Becker, Chorpita, and Daleiden (2014) and Beidas and Manderscheid (2014) offer insightful commentaries and highlight ways in which we can reconceptualize our graduate curricula, development of professional and paraprofessional workforce, consolidation and dissemination of clinical knowledge, efficient and effective training modalities, and alignment with other health disciplines. We encourage readers to ask themselves: What do I know about the ACA as it relates to my profession? How does the ACA affect my clinical work? How should the frontend of clinical psychology (education and training) meet the backend (professional world) more seamlessly in this era of healthcare reform? We hope readers can keep an open mind as they reflect on the individual- and system-level impact of the ACA on our field.
Guest Blogger: Dr. Ka Ho Brian Chor
Dr. Ka Ho Brian Chor is a Research Assistant Professor at the NIMH-funded Center for Implementation-Dissemination of Evidence-Based Practices among States (IDEAS Center; PI: Hoagwood) at the NYU Child Study Center. His research interests are in mental health and child welfare services and policy, and dissemination and implementation of evidence-based practices in state systems.
Becker, K. D., Chorpita, B. F., & Daleiden, E. L. (2014). Coordinating people and knowledge: Efficiency in the context of the Patient Protection and Affordable Care Act. Clinical Psychology: Science and Practice, 21(2), 106-112. doi: 10.1111/cpsp.12062
Beidas, R. S., & Manderscheid, R. W. (2014). A healthy new world: Emergent opportunities for clinical psychologists in the Patient Protection and Affordable Care Act. Clinical Psychology: Science and Practice, 21(2), 113-117. doi: 10.1111/cpsp.12067
Chor, K. H. B., Olin, S. S., & Hoagwood, K. E. (2014). Training and education in clinical psychology in the context of the Patient Protection and Affordable Care Act. Clinical Psychology: Science and Practice, 21(2), 91-105. doi: 10.1111/cpsp.12068