|
1.) The Committee recommends that
the statutory authorization of the Advisory
Committee on Interdisciplinary, Community-Based
Linkages be reauthorized.
The Committee continues to: 1) provide
advice and recommendations to the Secretary
concerning policy and program development
and other matters of significance concerning
activities under Section 756, Title VII,
Part D of the PHS Act; and 2) prepare
and submit to the Secretary, the Committee
on Labor and Human Resources of the Senate
and the Committee on Commerce of the House
of Representatives, a report describing
the activities of the Committee, including
findings and recommendations.
The Title VII Interdisciplinary, Community-Based
Training Grant Programs’ focus is unique.
The training assists health professionals
respond to the demands of the evolving
health care system. The Title VII Interdisciplinary,
Community-Based Training Grant Programs
provide an infrastructure for the recruitment,
training, and retention of the Nation’s
health care workforce. The emphasis on
recruiting and training racial/ethnic
minorities and individuals from unserved
and underserved areas is particularly
important, as these individuals are more
likely to provide services to underserved
populations and communities. The Committee
provides an important mechanism for continuous
assessment of the outcomes and effectiveness
of these Title VII Interdisciplinary,
Community-Based Training Grant Programs
and recommends enhancements that will
address the health care needs of the Nation.
2.) The Secretary and Congress should
amend Section 755(b)(3) to read, “Carrying
out demonstration projects in which chiropractors
and physicians collaborate to identify
and provide effective treatment for spinal
and lower-back conditions or planning
and implementing interdisciplinary projects
for chiropractic students in programs
collaborating with other health professions
and at least one allied health profession.”
Although chiropractors are developing
more interdisciplinary practices, implementation
of interdisciplinary training and collaboration
is difficult for chiropractic training
institutions since all are private and
not formally associated with other health
professions institutions. Expanding the
scope of Section 755(b)(3) will facilitate
better integration of chiropractic with
other health care professions. It will
also help to increase the availability
of services in underserved areas. While
at least 25 percent of chiropractors practice
in small towns and rural areas, chiropractic
services are not readily available to
other underserved populations. The proposed
change will also help in the recruitment
of more diverse students to chiropractic
programs, which will ultimately result
in a more diverse chiropractic workforce.
3.) The Committee supports
its previous recommendation to move podiatry
to Section 747. The Committee requests
an additional $1 million to support program
development for podiatric students and
residents to participate in interdisciplinary
education models as part of their education
track.
Due to the relatively small number of
podiatric practitioners, most health professionals
have limited contact with, and as a result
limited knowledge of, podiatric medicine.
Increasing the involvement of podiatric
students and providers in interdisciplinary
training and care can expand provider,
patient, and community knowledge regarding
the benefits of podiatric care.
Through Title VII, Section 747, approximately
480 grants and multi-year contracts totaling
$82 million dollars annually are awarded
in support of various primary care and
family medicine training programs. The
Committee believes that removal from Part
D, Section 755(b)(2) and placement in
Part C, Section 747 (family medicine,
general internal medicine, general pediatrics,
physician assistants, general dentistry,
and pediatric dentistry) will increase
the integration of podiatric training
and education into interdisciplinary primary
care venues. In addition, greater availability
and integration of podiatric care could
have an impact on minority health issues
as minority populations are disproportionately
affected by some conditions, such as diabetes
and HIV/AIDS, which may require podiatric
care.
Podiatric Primary Care Residency Training
Grants should be supported on a continuing
and, if possible, expanded basis. Further
development of podogeriatric cooperative
agreements will allow development of podogeriatric
curricula to train primary care and podiatric
residents. The curricula should focus
on the medically underserved geriatric
population with chronic conditions, such
as diabetes, that limit their mobility
and self-care abilities.
The appropriations directed to allied
health are not adequate to address program
needs and demands. Therefore, current
appropriations to Section 755 should not
be redirected to Section 747 with the
relocation of the podiatric medicine training
programs. A new allocation, in the amount
of $1 million, should be directed to support
program development for podiatric students
and residents to participate in interdisciplinary
training programs.
4.) The Committee supports its previous
recommendation in the Second Report that
states, “Create a new Section 757 (through
removal of Section 755(b)(1)(j)) to support
behavioral mental health for graduate
psychology education (Section 757a), geriatric
psychology education (Section 757b), and
graduate social work education (757c).
The Committee also requests an increase
in appropriations to $7.7 million.”
Behavior and health are inextricably
intertwined. An integrated, interdisciplinary
approach to health care, which includes
mental and behavioral health, is the most
cost effective and efficient health delivery
system, especially for underserved populations.
Social workers should be considered to
be behavioral health care providers and
social services should be included in
interdisciplinary models of care addressing
behavioral health and primary care.
The creation of a new Section 757, which
includes the graduate psychology, geriatric
psychology, and graduate social work education
programs, will strengthen interdisciplinary
education and enable health practitioners
to ensure more effective and efficient
services in support of behavioral mental
health. The new Section 757 will promote
health professions working together to
enhance health promotion, public health
and prevention, interdisciplinary research,
and many other related behavioral health
activities.
In addition to recommending the creation
of Section 757, the Committee has identified
the following actions that will promote
the integration of behavioral health into
the overall health care delivery system.
- Include psychology training in other
HRSA and PHS health projects to strengthen
interdisciplinary collaboration.
- The Advisory Committee on Training
and Primary Care, Medicine and Dentistry
should be renamed to recognize the importance
of behavioral health.
- Psychology should have representation
on the Advisory Committee on Training
in Primary Care Medicine and Dentistry
in the form of at least two members,
to include a psychologist in the graduate
psychology education (GPE) program and
a psychologist involved in primary care
physician training (e.g., pre-doctoral
and residency training projects for
pediatrics, family medicine, and internal
medicine).
- The term “clinical psychologist,”
instead of “health service psychologist,”
should be used.
|
