Consulting

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  • Consulting

    1. 1. <ul><ul><li>Clinical Practice Patterns </li></ul></ul>
    2. 2. <ul><li>All PracticeNet Enrollees </li></ul><ul><li>General Demographics and Early Career Psychologists </li></ul>
    3. 3. All PracticeNet Enrollees (n=536) <ul><li>55% Female, 44% Male </li></ul><ul><ul><li>Early career: 64.2% Female, 35.8% Male </li></ul></ul><ul><li>Average age 50.8 years, Range 25-79 </li></ul><ul><ul><li>Early career: Average age 40.74, median age 38, range 29-66 </li></ul></ul><ul><li>94.4% White </li></ul><ul><ul><li>2.4% Hispanic/Latino, 0.9%Asian, 0.8% Multiracial, 0.6% Native American/ Indian, 0.6% African American </li></ul></ul><ul><ul><li>Early career: 92.6% White, 6 people of color (2 Hispanic/Latino, 2 Indian, 1 Asian, 1 Multiracial) </li></ul></ul>
    4. 4. All PracticeNet Enrollees, cont. <ul><li>Years of service </li></ul><ul><ul><li>Average 17.8 years, range 1-55 years </li></ul></ul><ul><li>Degrees </li></ul><ul><li>78.4% hold PhDs, 13.6% hold PsyDs, 2.2% hold EdDs, 3.6% hold Masters, 2.2% other </li></ul><ul><ul><li>Early career: 74.1% PhD, 23.5% PsyD, 2.5% EdD* </li></ul></ul><ul><li>Degree Fields </li></ul><ul><li>65.5% clinical, 19.7% counseling, 4.3% school, 10.5% other </li></ul><ul><ul><li>Early career: 74.1% clinical, 23.5% counseling, 2.5% school, 2.5% other* </li></ul></ul>
    5. 5. Practice Settings of Enrollees <ul><li>Primary Employment Setting* </li></ul><ul><li>47% private practice only, 19% organizational settings only, 34% both settings </li></ul><ul><li>Early career psychologists </li></ul><ul><li>33% private practice only, 38% organizational settings only, 29% both settings </li></ul>
    6. 6. Hours Worked Per Week <ul><li>Average of 38.8 hours worked per week </li></ul><ul><li>Average of 25 hours of direct health services, range 3-55 </li></ul><ul><ul><li>Early career: Average of 22 hours of direct health services are provided across settings, range 5-45* </li></ul></ul><ul><li>Average of 30 hours per week in private practice </li></ul><ul><ul><li>Early career: 24.3 hours* </li></ul></ul><ul><li>Average of 27 hours per week in organizational settings </li></ul><ul><ul><li>Early career: Average of 35.6 hours* </li></ul></ul>
    7. 7. <ul><li>Psychologist Demographics and Client Diagnoses Across Surveys </li></ul>
    8. 8. Psychologist Demographics Across Surveys 52% Priv prac 16% Org only 32% Both 49% Priv prac 19% Org only 32% Both 48.5%Priv prac 16.5% Org only 35% Both Employment Setting 95% White 94% White 95% White Race Average 51.9 Range 25-79 Average 51.7 Range 25-78 Average 50 Range 24-77 Age 56% Female 54% Female 54% female Gender Summer 03 (n=241) Winter 03 (n=225) Fall 02 (n=291)
    9. 9. DSM-IV Diagnoses Across Surveys 4.5% 8% 6% No dx 5.5% 5% 9% Dx not complete 15.5% 14% 11% Personality dx Mood (42%) Anxiety (17.5%) Adjustment (17%) Mood (37%) Anxiety (19%) Adjustment (12%) Mood (33%) Anxiety (21.6%) Adjustment (11.4%) Predominant diagnoses 90% (of 203) 86% (of 206) 84% (of 264) % Diagnosed Summer ’03 Winter ’03 Fall ’02
    10. 10. <ul><li>Results of Summer ’03 Survey </li></ul>
    11. 11. Clinical Encounter Settings and Services (Summer ’03) <ul><li>Independent/private practice – solo 49% or group 29% </li></ul><ul><li>Organizational health care setting – 16% </li></ul><ul><ul><li>Mental health services setting – 31% </li></ul></ul><ul><ul><ul><li>80% Outpatient, 20% Inpatient </li></ul></ul></ul><ul><ul><li>Primary health care setting – 25% </li></ul></ul><ul><ul><li>Other health care setting - 40% </li></ul></ul><ul><li>Individual therapy or counseling – 78% </li></ul><ul><li>Formal assessment or evaluation – 26% </li></ul><ul><li>Providing educational information and/or materials – 18% </li></ul><ul><li>Medication evaluation/management –3.9% </li></ul>
    12. 12. Primary Source of Payment (n=185) 27% of self-pay clients have insurance but are not using it
    13. 13. Reasons for Self Pay (n=27) <ul><li>No insurance </li></ul><ul><li>Preferred provider not covered </li></ul><ul><li>Concerns about privacy or stigma </li></ul><ul><li>Coverage too limited (either benefits already used up or benefits are too minimal to bother using) </li></ul><ul><li>Other (forensic evaluation, “choice”) </li></ul><ul><li>Insurance status unknown </li></ul>
    14. 14. Client Demographics <ul><li>Gender </li></ul><ul><ul><li>56% Female </li></ul></ul><ul><ul><li>44% Male </li></ul></ul><ul><li>Average age 36, Range 2 - 92 </li></ul><ul><li>Race/Ethnicity </li></ul><ul><ul><li>5% Hispanic </li></ul></ul><ul><ul><ul><li>82% White </li></ul></ul></ul><ul><ul><ul><li>5% Black/African American </li></ul></ul></ul><ul><ul><ul><li>3% Multiracial </li></ul></ul></ul><ul><li>Marital Status </li></ul><ul><ul><li>25% Married </li></ul></ul><ul><ul><li>53% Never married </li></ul></ul><ul><ul><li>15% Divorced </li></ul></ul>
    15. 15. Referral Source <ul><li>Other Professional (52.2%) </li></ul><ul><ul><li>Primary Care Physician (23.6%) </li></ul></ul><ul><ul><li>Psychiatrist (17.9%) </li></ul></ul><ul><ul><li>Other mental health professional (39.6%) </li></ul></ul><ul><ul><li>Other health care provider (18.9%) </li></ul></ul><ul><li>Self (26.1%) </li></ul><ul><li>Friend (7.4%) </li></ul><ul><li>Legal system (5.9%) and Family (5.9%) </li></ul><ul><li>School (2.5%) </li></ul>
    16. 16. Comparisons: Early Career and More Established <ul><li>No differences between groups in terms of gender, race or type of degree </li></ul><ul><li>Significant differences between groups in terms of practice setting (early career psychologists more likely to be employed in organizational settings) </li></ul><ul><li>Of those who do private practice, early career psychologists do fewer hours </li></ul><ul><li>Of those who work in organizational settings, early career psychologists work more hours </li></ul><ul><li>No differences in average total hours worked but early career psychologists average fewer hours of direct client care </li></ul>
    17. 17. Correlates of Treatment Length <ul><li>Treatment setting (private practice) </li></ul><ul><li>Capacity to pay for treatment (self pay and indemnity insurance) </li></ul><ul><li>Greater number of treatment goals </li></ul><ul><li>White race </li></ul><ul><li>Psychologist theoretical orientation (psychodynamic and combination) </li></ul><ul><li>Diagnosis (depression v adjustment disorder, especially) </li></ul><ul><li>Age of client (older clients had more sessions) </li></ul>
    18. 18. Psychopharmacology and Psychotherapy <ul><li>Over half (54.2%) of clients are receiving psychotropic medications </li></ul><ul><li>Psychopharmacology and psychotherapy were equally likely to have begun first </li></ul><ul><li>Most clients (70%) see a psychiatrist for medications although 24% receive medications from a primary care physician </li></ul><ul><li>Only 20% of psychologists had no contact with the prescriber, 60% of psychologists have exchanged written reports with the prescriber or have had ongoing telephone conversations </li></ul><ul><li>71% of clients referred by psychologist for medication evaluation receive medications, 80% receive them from a psychiatrist </li></ul>
    19. 19. Problematic Life Domains
    20. 20. <ul><li>Theoretical Orientation and Clinical Interventions </li></ul>
    21. 21. Theoretical Orientation <ul><li>General theoretical orientation (n= 177) </li></ul><ul><ul><li>Psychodynamic 17% </li></ul></ul><ul><ul><li>Cognitive behavioral 28% </li></ul></ul><ul><ul><li>Combination 45% </li></ul></ul><ul><li>Orientation specific to this session (n=177) </li></ul><ul><ul><li>Psychodynamic 15% </li></ul></ul><ul><ul><li>Cognitive behavioral 35% </li></ul></ul><ul><ul><li>Combination 42% </li></ul></ul><ul><li>General and specific theoretical orientation were correlated .58 (p < .01) </li></ul>
    22. 22. Clinical Interventions <ul><li>Virtually all therapists reported doing the following two things in session: </li></ul><ul><li>Discuss current stressors relevant to client’s problem (196/200 psychologists) </li></ul><ul><li>Discuss interpersonal relationships or relationship patterns or themes (192/200) </li></ul>
    23. 23. Clinical Interventions <ul><ul><li>Clinical Interventions Employed in Session </li></ul></ul>% n = 78% 124 Guide, direct or re-focus client 78.6% 125 Gather information 84.9% 135 Validate, label, release affect 85.5% 136 Relate thoughts and affect 86.8% 138 Identify or challenge thoughts
    24. 24. Interventions Employed in Session 2.5 2.5 1 Repeated dysfn 2.5 2.5 1 Reactions tx 1.5 1.5 3 Homework 2 1 3 Teach skills 2 1 3 Enc activities 2.5 2.5 1 Child experienc 1.5 1.5 3 Set agenda 2 1 3 Encourage q’s 2 1 3 Educate client Combination CBT Psychodynamic Strategy
    25. 25. Specific Clinical Interventions <ul><li>Early career psychologists were more likely to discuss past treatment problems and gains </li></ul><ul><li>Early career psychologists were less likely to provide feedback regarding therapist’s understanding of presenting problems or direction of treatment </li></ul><ul><li>Early career psychologists were less likely to discuss client’s communication patterns </li></ul>
    26. 26. www.apapracticenet.net
    27. 27. Early Career Psychologists, Summer ’03 (n=32) <ul><li>59.4% female, 40.6% male </li></ul><ul><li>93.8% white, 1 American Indian, 1 Multiracial </li></ul><ul><li>Average age 42.3 years, range 31-63 </li></ul><ul><li>Degree </li></ul><ul><li>81.3% PhD, 15.6% PsyD, 3.1% EdD </li></ul><ul><li>Degree field </li></ul><ul><li>62.5% clinical, 31.3% counseling, 3.1% school, 3.1% other </li></ul>
    28. 28. Spirituality and Psychotherapy <ul><li>Psychologists had discussed spirituality with 56% of clients (n=113) </li></ul><ul><li>Spirituality was identified as a source of strength and coping for 35% of these clients </li></ul><ul><li>Spirituality was a source of distress for 6% of these clients and psychologists reported that spiritual matters directly contributed to the presenting problems for 4 individuals </li></ul><ul><li>70% of these clients had expressed a belief in God, a higher power, deity or “other” </li></ul>
    29. 29. Participating Psychologist Demographics- Summer ‘03 <ul><ul><li>56% Female </li></ul></ul><ul><ul><li>44% Male </li></ul></ul><ul><ul><li>Average age 51.9, Range 25-79 </li></ul></ul><ul><ul><li>9 people of color </li></ul></ul><ul><ul><ul><li>2 Hispanic/ Latino, 2 Asian, 2 African American, 2 multiracial, 1 American Indian </li></ul></ul></ul><ul><ul><li>95% White </li></ul></ul><ul><ul><li>Primary Employment Setting </li></ul></ul><ul><ul><li>125 private practice ONLY </li></ul></ul><ul><ul><li>39 organizational setting ONLY </li></ul></ul><ul><ul><li>77 divide practice time between both settings </li></ul></ul>
    30. 30. Participating Psychologist Demographics- Winter ‘03 <ul><ul><li>54% Female </li></ul></ul><ul><ul><li>46% Male </li></ul></ul><ul><ul><li>Average age 51.7, Range 25-78 </li></ul></ul><ul><ul><li>2% Hispanic </li></ul></ul><ul><ul><li>3% Other people of color </li></ul></ul><ul><ul><li>94% White </li></ul></ul><ul><ul><li>Primary Employment Setting </li></ul></ul><ul><ul><li>111 private practice ONLY </li></ul></ul><ul><ul><li>42 organizational setting ONLY </li></ul></ul><ul><ul><li>72 divide practice time between private and organizational settings </li></ul></ul>
    31. 31. Participating Psychologist Demographics- Fall ‘02 <ul><ul><li>54% Female </li></ul></ul><ul><ul><li>46% Male </li></ul></ul><ul><ul><li>Average age 50, Range 24-77 </li></ul></ul><ul><ul><li>2% Hispanic </li></ul></ul><ul><ul><ul><li>95% White </li></ul></ul></ul><ul><ul><li>Primary Employment Setting </li></ul></ul><ul><ul><li>141 private practice ONLY </li></ul></ul><ul><ul><li>48 organizational setting ONLY </li></ul></ul><ul><ul><li>102 divide practice time between private and organizational settings </li></ul></ul>
    32. 32. DSM-IV Diagnosis <ul><li>90% of clients have been diagnosed </li></ul><ul><ul><li>Predominantly depression/ dysthymia (37%), anxiety (17.5%) and adjustment disorders (16.9%) </li></ul></ul><ul><ul><li>15.5% personality disorder diagnosis </li></ul></ul><ul><li>5.5% diagnosis not yet completed </li></ul><ul><li>4.5% no diagnosis </li></ul>
    33. 33. Primary Axis I Diagnoses of All Clients <ul><li>Diagnosis N= 203 </li></ul><ul><li>Mood Disorders 75 42% </li></ul><ul><ul><li>MDD (n=49), Dysthymia (n=18) </li></ul></ul><ul><li>Anxiety Disorders 31 17.5% </li></ul><ul><ul><li>PTSD (n=12), GAD (n=8) </li></ul></ul><ul><li>Adjustment Disorders 30 17% </li></ul><ul><li>Psychotic Disorders 5 2.8% </li></ul><ul><li>Substance Use Disorders 4 2.3% </li></ul>
    34. 34. Primary Axis I Diagnoses of All Clients, cont. <ul><li>ADD/ADHD 8 4.5% </li></ul><ul><li>Developmental disorder 4 2.3% </li></ul><ul><li>Diagnosis not yet completed 11 5.5% </li></ul><ul><li>No DSM-IV diagnosis assigned 9 4.5% </li></ul>
    35. 35. Primary Axis I Diagnoses of All Clients (winter ’03) <ul><li>Diagnosis N= 206 </li></ul><ul><li>Mood Disorders 76 37% </li></ul><ul><ul><li>MDD (n=37), Dysthymia (n=22) </li></ul></ul><ul><li>Anxiety Disorders 39 19% </li></ul><ul><ul><li>PTSD (n=11), GAD (n=13) </li></ul></ul><ul><li>Adjustment Disorders 24 12% </li></ul><ul><li>Childhood Onset Disorders 13 6.3% </li></ul><ul><li>Psychotic Disorders 9 4.4% </li></ul><ul><li>Substance Use Disorders 4 1.9% </li></ul>
    36. 36. Primary Axis I Diagnoses of All Clients, cont. (winter ’03) <ul><li>Cognitive Disorders 5 2.4% </li></ul><ul><li>Eating Disorders 1 0.5% </li></ul><ul><li>Medical/ Psychological Issues 4 1.9% </li></ul><ul><li>Diagnosis not yet completed 10 4.9% </li></ul><ul><li>No DSM-IV diagnosis assigned 16 7.8% </li></ul>
    37. 37. DSM-IV Diagnosis (fall ’02) <ul><li>84% of clients have been diagnosed </li></ul><ul><ul><li>Predominantly Mood, Anxiety and Adjustment disorders </li></ul></ul><ul><ul><li>n=10 Axis I Primary Substance Abuse disorder </li></ul></ul><ul><ul><li>11% Axis II diagnosis </li></ul></ul><ul><li>9% diagnosis not yet completed </li></ul><ul><li>6% no diagnosis </li></ul><ul><li>1% not assessed </li></ul>
    38. 38. Early Career, Summer ’03, cont. <ul><li>22 individuals do private practice (11 do only private practice), average hours are 21.9, range 1-50 </li></ul><ul><li>21 work in organizational settings (10 work only organizational settings), average hours are 36.48, range 1-55 </li></ul><ul><li>11 work in both settings </li></ul><ul><li>Average of 21.5 hours of direct services, range 5-40 </li></ul>
    39. 39. Comparisons: Early Career and More Established <ul><li>No differences between groups in terms of theoretical orientation in general or endorsed for specific session </li></ul><ul><li>No differences in number of treatment goals endorsed for particular session or for overall treatment </li></ul><ul><li>No differences in types of clinical activities engaged in during session (including therapy, assessment, medication evaluation, providing education and other) </li></ul><ul><li>No differences in payment sources </li></ul>

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