Community Psychology Practice in Health Care

By SCRA Web Admin – November 21, 2010
OfflineSCRA Web Admin

Written by William D. Neigher, David W. Lounsbury, & Rebecca E. Lee

The values of community psychology embrace health and wellbeing, and many settings and ecological perspectives intersect. Just after passage of the most sweeping change in federal health policy in fifty years there is hope for a more inclusive, responsive and cost-effective U.S. healthcare system. In this article, three of us who work in healthcare share a framework for looking at what we do, how we got there, our co-workers and opportunities and challenges. We represent diverse employers: academic medical school, regional hospital network, and university, all with their unique challenges and rewards.

Rebecca E. Lee, Ph.D., University of Houston,

When I was applying for graduate schools, I had a vision that I wanted the theoretical orientation of community psychology, but the applied skill set of behavioral medicine. I was grateful to be accepted to the University of Maryland, Baltimore County program in Human Services Psychology. During my doctoral work, I learned important theory and techniques, and then moved to a post-doctoral fellowship at the Stanford Center for Research in Disease Prevention. Throughout my training, I worked in clinical, medical settings, because most of health preventive research and promotion was clinic-based.

My first "real" job was at the University of Kansas Medical Center. I learned more than I wanted to know about medical education and wrote six grants in my first year, which focused on developing measurement techniques for quantifying neighborhood attributes that impact physical activity, dietary habits and obesity of residents. Despite my great success there, I realized that this was not the right "person- environment fit" for me. I moved to Houston one year later and took the job at the University of Houston (UH).

Most of my work has been focused on understanding social and physical environmental determinants of neighborhoods that contribute to good health. Houston has proven to be an ideal setting for this, providing lots of opportunity to test elements of my Ecologic Model of Physical Activity (EMPA). Community members like the concept of the EMPA, which incorporates neighborhood assessment and feedback, empowerment to overcome historic social injustices that have lead to current health disparities, and the understanding that environmental factors may transcend individual factors, leading to trans-cultural strategies to improve health behaviors and outcomes.

I recently completed a project to test the efficacy of salsa dancing as a strategy to increase physical activity in women of color. After listening to previous participants tell me how much they hated exercising, it was clear that we needed physical activities that were much more fun and engaging and not perceived as exercise. My team and I recruited fifty women (African American and Hispanic or Latina) and randomized them to a cross over design study. We found women loved salsa dancing, were able to achieve sufficient intensity to meet national guidelines, and increased their physical activity during the study. It was a great success, and highlights the innovation in intervention strategies and techniques that can come from partnering with communities for research.

Balance is the biggest challenge I have faced. Partnering with communities reduces traditional controls and increases burden on investigators to find creative solutions to satisfy scientific rigor. Nevertheless, the fruits of finding balance are rich and lead to novel theoretical interpretation, research application and techniques that lead the science and practice of health forward while improving sustainability of good health in the community.

David W. Lounsbury, Ph.D., Albert Einstein College of Medicine of Yeshiva University,

Since completing my degree in community psychology (PhD, Michigan State University, 2002), I have worked in New York City in community-focused cancer research. My current position is with the Albert Einstein College of Medicine of Yeshiva University, located in The Bronx. At Einstein and its major clinical care partner, the Montefiore Medical Center, I am part of a team of four researchers charged with developing the Einstein/Montefiore program in Cancer Prevention and Control Research. Our program builds upon Einstein's existing capacity in basic cancer research and seeks to integrate new work that is grounded in participatory approaches to social and behavioral studies. Prior to joining Einstein, I completed a post-doctoral program in psycho- oncology at Memorial Sloan-Kettering Cancer Center in New York City.

Recent policies and initiatives by the NIH and other major health research grant makers seek to encourage multidisciplinary, community-based projects. In turn, there has been an increasing demand for community psychologists in academic-medical institutions, like Sloan-Kettering and Einstein. I believe that mixing community psychologists with basic scientists is a key strategy for realizing and sustaining improved public health, and that these kinds of initiatives can have longstanding positive impact on population health. Yet, where there are few community psychologists relative to basic researchers, the possibility of becoming overcommitted is high.

At Einstein, the professional environment is truly multidisciplinary and collaborative. Faculty and staff work together to secure research grants and to teach in the Medical College and in the Schools of Psychology, Social work, and Public Health. I work with epidemiologists, oncologists, primary care physicians, and oncologists as well as sociologists, geneticists, psychiatrists, biostatisticians and informatics experts.

While a multidisciplinary, collaborative approach is fundamental to good community psychology research, navigating these various disciplines - simply building up a basic vocabulary for effective communication - in a medical institution is an on-going challenge. At places like Einstein, the coin of the realm is the randomized control trial or large observational studies in epidemiology, neither of which is particularly well suited to research modalities that focus and engage communities. I have found that more traditionally trained medical faculty resist perspectives, research questions, and designs that step away from reliance on traditional research. Still, at places like Einstein, there is authentic interest in developing new skills and capacities to work together to carry out richer, more impactful health science. The trick is to stay committed to this vision and to be mindful of the real level of work required to succeed in collaborative health research.

William D. Neigher, Ph.D., Atlantic Health,

I've spent most of my career working in hospital-based settings, although I went to graduate school in social psychology, planned a career as an academic, and taught undergraduates after I got my doctorate. But I was teaching about areas I had no experience in, and thought I should get some. My first position was as director of research and evaluation for a hospital-based community mental health center (CMHC) supported by Federal funding. Emory Cowen and his work changed my career. While replicating his Primary Mental Health Project in an inner-city public school system I saw the value proposition for prevention, community-based intervention, and evaluation research. Although program evaluation was part of the CMHC mandate, it was not generally practiced in community hospitals. I moved into a more stable position in hospital planning, adding program development to my evaluation responsibilities. My sponsoring institutions ever since have been both faith-based and secular healthcare systems.

I now direct strategic planning for Atlantic Health, one of Fortune's "100 best companies to work for," a multi- provider health care system serving northern NJ. We are affiliated with the Mount Sinai School of Medicine and The Mount Sinai Hospital. My core job responsibilities include strategic planning, market share analysis, utilization forecasting, regulatory compliance, program development and business plans, community needs assessment, and data base development. I work with the President/CEO, Board of Trustees, medical staff, allied health personnel, legal services and community agencies. I help our organization set and review its vision, mission and values, the pathways to get there, and measure success.

For the last year and a half I lead a strategic planning process involving physicians, nurses, managers, and overseen by a lay strategic planning committee. We set a vision for the decade ahead to be recognized among the nation's best healthcare systems. But in adding these four words to our mission statement we have the potential to dramatically change our organization and our patient experience: "...within a healing culture." By pursuing the field of integrative medicine we make the psychological and spiritual aspects of treatment symmetrical with our medical and surgical interventions. As we teach "cultural competence" we recognize that every patient and their family bring their own values and heritage to the healing process, and our providers need sensitivity to their needs and expectations.

Results are mixed: growth is tempered by a difficult economy where many postpone needed elective and even emergent procedures because of lack of insurance coverage. We are challenged by cutbacks in state-funded programs in behavioral health and charity care subsidy, and fewer safety net alternatives. Balancing cost, quality and access is difficult. With uncertain reimbursement facing our hospitals, outpatient programs, and physicians the challenge of guiding our future is complex. At the same time, an enhanced role and coverage for prevention, including psychological services has great potential. And the promise of insurance coverage for 32 million people will provide new opportunities and challenges.

Summing Up

All three of us are challenged to "fit in" to complex organizations, competing value systems, and finding methodological compromises. We intervene at different ecological and systems perspectives-Rebecca with understanding health determinants within neighborhoods, David in cancer prevention and control programs, and Bill at the institutional levels of vision, mission and values. In common are many of the guiding principles of community psychology: participant conceptualization, prevention and promotion, multilevel analysis and action, creating locally useful products, and a commitment to strengthening the settings in which we work [Elias, SCRA President's Blog, 2010.]

There are exciting opportunities for community psychologists in healthcare- at the provider level, government planning and regulatory agencies, consulting firms, pharmaceutical companies, insurance plans, and policy organizations. Our "value proposition" [TCP, Spring 2009] makes us a good fit. Be prepared to use all of your skills and a great deal of patience as you deal with organizations and professionals who both share and contrast with the values that guide our profession.

Summer 2010 - The Community Psychologist


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November 21, 2010
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Practice column for The Community Psychologist (TCP)

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