Integrated care psychologists and their role in patient transition from medical to psychiatric specialty care settings: a conceptual model

Abstract

Psychologists' participation within integrated primary and specialty medical care settings continues to expand and the benefits to patients, caregivers, and multidisciplinary healthcare teams are well described in the literature. However, specialty psychiatric care referrals are still necessary, particularly for patients with severe and persistent mental illness or other individuals whose psychiatric illness requires treatment of an intensity and duration that is often not practical in integrated care settings, and/or those not improving based on interventions available in the context of their medical care. A complex and interacting set of systemic, provider, and patient barriers can make the transition from integrated care to specialty psychiatric care arduous, resulting in decreased patient motivation for care, frustration by referring providers, and delayed or failed attempts to transition the patients to a level of care better suited to their needs. Integrated care psychologists have an opportunity to facilitate this transition when necessary as part of their work with patients, although guidance is lacking regarding an evidenced-based conceptual approach for their role in doing so. To this end, the purpose of this article is to describe the ACCESS model, a conceptual framework and set of evidenced-based strategies that evolved through years of “trial and error” within several integrated care clinics to facilitate successful transitions into psychiatric care when needed. The aim of each component in the ACCESS model, research evidence for suggested interventions within each component, and examples of clinical implementation are presented. Implications and limitations of the model's applicability across integrated care settings and within different patient populations are discussed. Formal evaluation is needed to assess the relationship between psychologists' use of ACCESS strategies and engagement and retention in specialized psychiatric care, psychiatric symptom severity, patient satisfaction with care, and health outcomes.

Keywords:

• integrated care
• care continuity
• health psychology
• collaborative care
• referral