Ann Fam Med. 2022 Apr 1;20(20 Suppl 1):2964. doi: 10.1370/afm.20.s1.2964.
COVID-19 has underscored the need to accelerate behavioral health (BH) integration in primary care, where many patients seek mental health services. Expanding BH integration requires a strong and sustainable BH workforce trained to work in primary care. Psychology internship is a critical period of development when doctorate-level therapists receive supervised clinical experiences with integrated primary care.
To explore the strategies and challenges of teaching psychology trainees to practice BH in primary care.
Qualitative study.
Nine out of 11 psychology internship and postdoctoral fellowship programs across the Washington State that provide integrated primary care training were recruited. Response rate was 82%.
Twelve training leads and supervisors completed semi-structured interviews between December 2020 - March 2021.
Interviews focused on participant experiences with providing educational training and supervision to psychology trainees practicing integrated primary care. Data were analyzed using grounded theory approach.
Four strategies emerged - orient trainees with extensive onboarding to the culture, context, and function of primary care; provide a psychologically safe space for open dialogues that facilitate professional identity development; model the skills needed to collaborate with primary care teams; and create a structured environment for trainees to practice the skills. Training leads and supervisors also reported three challenges - strategies to address trainees' difficulties with acculturating to the culture of primary care; loss of opportunities to shadow and interact with primary care providers due to telemedicine during COVID-19; and limitations of the traditional supervision structure to accommodate the unpredictable and urgent crises experienced by trainees in fast-paced primary care settings.
Future recommendations include early exposure to primary care during psychology graduate training, a hybrid model of fixed and flexible supervision schedules, and intentional efforts to define and balance in-person and remote teaching for different types of training needs.
COVID-19 凸显了在初级保健中加速行为健康 (BH) 整合的必要性，因为许多患者在初级保健中寻求心理健康服务。扩大 BH 整合需要一支强大且可持续的 BH 劳动力，他们接受过在初级保健中工作的培训。心理学实习是一个关键的发展时期，在此期间，博士级治疗师接受与综合初级保健相结合的监督临床经验。
探讨向心理学实习生传授在初级保健中实践 BH 的策略和挑战。
定性研究。
从华盛顿州的 11 个心理学实习和博士后奖学金项目中招募了 9 个提供综合初级保健培训的项目。回复率为 82%。
12 名培训负责人和主管在 2020 年 12 月至 2021 年 3 月期间完成了半结构化访谈。
访谈重点是参与者在向从事综合初级保健的心理学实习生提供教育培训和监督方面的经验。使用扎根理论方法分析数据。
出现了四种策略 - 让大量入职的学员了解初级保健的文化、背景和功能；为促进专业身份发展的开放对话提供一个心理安全的空间；为与初级保健团队合作所需的技能建模；为学员练习技能创造一个结构化的环境。培训负责人和主管还报告了三个挑战 - 解决学员适应初级保健文化困难的策略；由于 COVID-19 期间的远程医疗，与初级保健提供者进行观察和互动的机会减少；以及传统监督结构的局限性，无法适应学员在快节奏初级保健环境中遇到的不可预测和紧急危机。
未来的建议包括在心理学研究生培训中尽早接触初级保健、固定和灵活监督时间表的混合模式，以及有意努力定义和平衡不同类型培训需求的面对面和远程教学。
