Guidelines For Psychological Practice In Health Care Delivery Systems

American Psychological Association

Psychologists practice in an increasingly diverse range of health care delivery systems (HCDS). This diversification is due to widening recognition of psychology as a health profession (Belar, 2002; Brown, Freeman, Brown, Belar, Hersch, & Hornyak, 2002), of the unique skills of psychologists, and of the value of psychological services for health and wellbeing. It is also due to rapidly evolving systems in which health care is being delivered (American Psychological Association (APA), 2009). At the same time, psychologists’ roles within these settings are expanding, and multidisciplinary collaboration within health care is becoming commonplace. The following guidelines are intended to assist psychologists, other health care providers, administrators in health care delivery systems, and the public to conceptualize the roles and responsibilities of psychologists in these diverse contexts.

These guidelines are informed by the Ethical Principles of Psychologists and Code of Conduct (“APA Ethics Codes”)1 (APA, 2002a, 2010) and the Record Keeping Guidelines (APA, 2007). These guidelines address psychologists’ roles and responsibilities related to service provision and clinical care, including teaching and administrative duties. There are additional obligations related to conducting research in health care delivery systems that will not be included here; guidance in this area can be found in the APA Ethics Code (APA Ethics Code 8.0 through 8.15). In accordance with ethical standards, the practice of psychology in health care delivery systems is based on established scientific and professional knowledge (APA Ethics Code 2.04).

These guidelines may also be used to inform rule making and decision making in health care delivery systems about the roles of psychologists that are commensurate with their training and licensure. Federal and state laws, (including those governing service delivery, payment arrangements and business structures), standards of accrediting bodies (e.g., Joint Commission, 2009), and institutional bylaws are also relevant to these rules and decisions. These guidelines build upon earlier guidelines regarding hospital privileges, credentialing and bylaws specific to hospital settings (APA Board of Professional Affairs, Task Force on Hospital Privileges, 1991) and draw on the issues highlighted in an additional APA document regarding practicing psychology in hospitals from that same time period (APA Practice Organization (APAPO), 1998).

There are a wide variety of systems for health care delivery, including, but not limited to, primary care and integrative care facilities, tertiary care hospitals, rehabilitation centers, nursing homes, outpatient surgery centers, and substance abuse treatment centers. Similarly, there are a wide variety of patient populations with whom psychologists work within these systems (e.g., pediatric, geriatric, acutely versus chronically ill, those being treated for mental health or medical conditions, those from diverse cultures and socioeconomic groups, etc.) There
are also different entry points for psychologists to deliver professional services for both direct and indirect patient care within health care delivery systems, ranging from being employed by the organization to being independent practitioners with either contractual arrangements or following their patients as they enter a health care delivery system. In all cases, psychologists have special expertise in communication, behavioral issues, patient decision making, human interaction and systems that is relevant to the full spectrum of health and mental health issues and settings; these guidelines apply to that full spectrum. It is recognized that there is rapid growth in the use of technology (in areas such as telehealth) with unique considerations for practice that are beyond the scope of these guidelines. Ethical and legal standards for the practice of psychology pertain to the full range of health care delivery systems, and to every professional psychological role within such systems, unless otherwise specified.

The term “guidelines” refers to statements that suggest or recommend specific professional behavior, endeavors, or conduct for psychologists. Guidelines differ from “standards” in that standards are mandatory and may be accompanied by an enforcement mechanism. Thus, guidelines are aspirational in intent. They are intended to facilitate the continued systematic development of the profession and to help ensure a high level of professional practice by psychologists. Guidelines are not intended to be mandatory or exhaustive and may not be applicable to every professional and clinical situation. They are not definitive and they are not intended to take precedence over the judgment of psychologists.

The following glossary of terms found in these guidelines may be helpful. For the purpose of these guidelines, “psychologists” are considered “health service providers” (APA, 1996), having been duly trained and experienced in the delivery of preventive, assessment, diagnostic and therapeutic intervention services related to the psychological and physical health of consumers, based on: 1) having completed scientific and professional training resulting in a doctoral degree in psychology; 2) having completd an internship and supervised experience in health care settings; and 3) having been licensed as psychologists at the independent practice level.

We use the term “patient” to refer to the child, adolescent, adult, older adult, couple, family, group, organization, community, or other population receiving psychological services in health care delivery systems. However, we recognize that in many situations there are important and valid reasons for using such terms as “client” or “person” in place of “patient” to describe the recipient of services. Finally, we use the term “multidisciplinary” throughout the guidelines but recognize that in some instances psychologists may actually be working in a “transdisciplinary” context where holistic care is being provided that crosses disciplinary boundaries.

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