New Models of Care for Psychology in Canada's Health Services

By Graff, Lesley A.; Kaoukis, George et al. | Canadian Psychology, August 2012 | Go to article overview

New Models of Care for Psychology in Canada's Health Services


Graff, Lesley A., Kaoukis, George, Vincent, Norah, Piotrowski, Andrea, Ediger, Jason, Canadian Psychology


Psychological services in health care have expanded beyond traditional areas of mental health to the full spectrum of health disorders, as research has increasingly shown the importance of psychological processes in health outcomes. Behavioural and psychological factors can contribute to the onset, course, or severity of many chronic diseases, and psychology has much to offer with clinically and cost-effective interventions. Good principles of care, involving appropriate assessment, evidence-based interventions, and close collaboration with other health care providers, are vital for effective chronic disease management, but can be difficult to realise given issues of timely access, patient volumes, and availability of psychological services in publicly funded health care. This article provides an overview of psychological interventions in diverse areas of health psychology, with examples of innovative Canadian clinical service delivery models, particularly focussing on integrated screening and treatment for cardiac patients, computerized delivery of insomnia treatment, screening and brief intervention prior to joint replacement surgery, and on-site psychological consultation for family physicians. The case examples, developed and implemented in Winnipeg, Manitoba, demonstrate components for consideration when redesigning psychological service models, such as more systematic approaches to identifying patient needs, stepped levels of care that increase intensity of service relative to need, integration into systems already handling large patient volumes, innovative use of technology, and location of psychological resources "in situ" for timely, brief access. Although still in early stages of development and evaluation, these models show promise for improved access and enhanced ability to deliver psychological service to relevant patient volumes.

Keywords: psychology services, public health care, stepped interventions, online treatment

The understanding of disease and the role of psychological processes has evolved in recent decades with the explosion of research in fields such as psychoneuroimmunology. The biopsychosocial model of illness has flourished as a more biomedically based model has failed to fully explain differences in disease course and outcomes (Baum & Posluszny, 1999). In addition, health care services have been burdened by care related to chronic disease. That is, the discovery of antibiotics in the early 20th century and improvements in diet and living conditions have revolutionized treatment and prevention of infectious diseases and have led to a shiñ in emphasis to chronic illness, rehabilitation, and quality of life (Ray, 2004; U.S. Department of Health and Human Services, 2000). There has been growing recognition of the major influence of behavioural and psychological factors in the onset, course, and severity of many of the most common chronic diseases (Gonder-Frederick, Cox, & Ritterband, 2002; Graff et al., 2006; Kiecolt-Glaser, Mcguire, Robles, & Glaser, 2002; Yusef et al., 2004). As well, behavioural factors have been identified as the primary causes of half of all cancers resulting in deaths in developed countries (Adami, Day, Trichopoulos, & Willett, 2001; Colditz, DeJong, Hunter, Trichopoulos, & Willett, 1996). There is strong evidence that psychological interventions can improve symptoms and quality of life and decrease distress and health care utilization across a range of health conditions including heart disease, diabetes, arthritis, and chronic pain (Hunsley, 2002). Going one step further, prevention efforts based on lifestyle interventions for individuals with elevated disease risk have shown promise (Diabetes Prevention Program Research Group, 2002, 2009).

Psychological services in health care have expanded beyond traditional areas of mental health to the full spectrum of health disorders, as research has increasingly shown the importance of psychological processes in health outcomes. …

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