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Clinical Practice Patterns (Summer 2003)


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Clinical Practice Patterns (Summer 2003)

  1. 1. <ul><ul><li>Clinical Practice Patterns </li></ul></ul>
  2. 2. Suggested Citation <ul><li>American Psychological Association Practice Directorate. (2003). PracticeNet survey: Clinical practice patterns. Retrieved Month, Day, Year from: </li></ul>
  3. 3. PracticeNet Methodology <ul><li>PracticeNet uses real time behavior sampling (RTBS), via an internet survey system designed to capture “in the moment” clinician behavior </li></ul><ul><li>Information for this report from the survey administered July 21-31, 2003 </li></ul><ul><li>Total valid responses N= 241 </li></ul><ul><li>(approximately 65% response rate) </li></ul><ul><ul><li>Providing direct clinical services to an individual within 72 hours of randomly selected time and date n= 203 </li></ul></ul>
  4. 4. <ul><li>Results of Summer ’03 Survey </li></ul><ul><li>Clinical Practice Patterns </li></ul>
  5. 5. Clinical Encounter Settings and Services (Summer ’03) <ul><li>Settings Where Targeted Service Occurred </li></ul><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>Clinical Activities During Targeted Service Hour (not mutually exclusive) </li></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>
  6. 6. Primary Source of Payment (n=185) 27% of self-pay clients have insurance but are not using it
  7. 7. 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>
  8. 8. Client Demographics <ul><li>Gender </li></ul><ul><ul><li>61% Female </li></ul></ul><ul><ul><li>39% Male </li></ul></ul><ul><li>Average age 38, Range 5 - 79 </li></ul><ul><li>Race/Ethnicity </li></ul><ul><ul><li>5% Hispanic </li></ul></ul><ul><ul><ul><li>85% White </li></ul></ul></ul><ul><ul><ul><li>5% Black/African American </li></ul></ul></ul><ul><ul><ul><li>2.5% American Indian </li></ul></ul></ul><ul><li>Marital Status (of adults) </li></ul><ul><ul><li>34% Married </li></ul></ul><ul><ul><li>41% Never married </li></ul></ul><ul><ul><li>19% Divorced </li></ul></ul>
  9. 9. Psychologist Demographics <ul><li>56% female, Average age of 51.9 years, 95% White </li></ul><ul><li>9 respondents were people of color </li></ul><ul><ul><li>2 Hispanic/ Latino, 2 Asian ancestry, 2 African American, 2 Multicultural ancestry, 1 American Indian </li></ul></ul><ul><li>Psychologists of color did not differ from White psychologists in terms of gender distribution, age, average number of treatment sessions, theoretical orientation, treatment setting, client age or client gender, DSM diagnosis </li></ul><ul><li>75% of clients of psychologists of color were also ethnic minority (50% were of the same ethnic background as the psychologist) while only 11% of White Psychologists’ clients were people of color </li></ul>
  10. 10. 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>
  11. 11. 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>35% of clients had been referred for a medication evaluation by the psychologist </li></ul><ul><ul><li>Of those, 71% of clients receive medications </li></ul></ul><ul><ul><ul><li>80% of those individuals receive their medications from a psychiatrist </li></ul></ul></ul>
  12. 12. Most Problematic Life Domains (%)
  13. 13. <ul><li>Theoretical Orientation and Clinical Interventions </li></ul>
  14. 14. 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>
  15. 15. 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>
  16. 16. Clinical Interventions Employed in Session 22% 78% 124 Guide, direct or re-focus client 33% 78.6% 125 Gather information 29.6% 84.9% 135 Validate, label, release affect 46.5% 85.5% 136 Relate thoughts and affect 48% 86.8% 138 Identify or challenge thoughts Important focus of session % n =
  17. 17. Rank Order of Differential Use of Interventions Employed in Session by Theoretical Orientation 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
  18. 18. 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>
  19. 19. <ul><li>Spirituality and Psychotherapy </li></ul>
  20. 20. Spirituality and Psychotherapy <ul><li>Over half of psychologists had discussed spiritual matters with their client </li></ul><ul><li>37% had discussed spiritual matters in the specific session reported on in the survey </li></ul>
  21. 21. Spirituality and Psychotherapy, cont. 4 clients (3%) 26% of clients 37% of clients 1/3 of clients Part of the problem Both problem and solution Contributed to the solution Unrelated to the client’s problem or solution Spiritual matters were…
  22. 22.