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  • Transcript

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

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