08 Jan 2018

Practicing Telehealth: The Ethical and Legal Ways to Treat your Patients From Afar

How can psychologists navigate the telehealth arena in a world where consumer options for electronic type health services are increasing? What factors must psychologists consider when providing telepsychological services to patients and supervisees?

Legal and psychology experts discuss the ins and outs of telepsychology. Presenters review:

· Legal and ethical aspects of providing telehealth services
· Obstacles and solutions of interjurisdictional telepsychology practice
· APA Guidelines for the Practice of Telepsychology
· ASPPB's Psychology Interjurisdictional Compact (PSYPACT) Initiative

Panelists:

Alex Siegel, JD, PhD
Director of Professional Affairs
Association of State & Provincial Psychology Boards (ASPPB)

Deborah C. Baker, JD
Director, Legal & Regulatory Policy American Psychological Association Practice Organization (APAPO)

This webinar was produced by the Practice Organization, advocating for psychologists on reimbursement issues. The Practice Organization is a legally separate companion organization to APA.

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19 Sep 2017

Practice Management Insights Booklet

Practice Management Insights Booklet

Too few psychology training programs offer guidance on the nuts and bolts of opening and running a practice, such as how to find office space, choose an electronic records system and protect against malpractice claims. “Practice Management Insights” seeks to fill those knowledge gaps by giving psychology practitioners the support they need to provide high-quality services in today’s increasingly competitive marketplace.

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11 Jul 2017

Let’s Talk Money, monitorLIVE Event Explores Professional and Personal Financial Wellness

Even though mental health practitioners often cover a wide variety of difficult subjects in their work, money can be an especially challenging topic to broach. So much so, that sessions can begin and end without even addressing fees or payment schedules with clients. Financial wellness is tied to mental health, and we need to learn to talk about it, according to clinical psychologist Mary Gresham, PhD, who recently addressed a group of psychologists gathered in Atlanta, Ga., for APA’s second local networking event, monitorLIVE. monitorLIVE events connect psychology professionals and thought leaders so they can learn about and discuss issues that impact and elevate the discipline.

Dr. Gresham noted that mental health practitioners have models of good marriages and good communication to teach to clients, but they may lack good models of financial wellness. Most leave money matters to finance professionals, even though mental health practitioners should be the ones applying therapy to the field, she said. While financial planners may take a class in coaching, they haven’t studied behavior, relationships, or any of the other deeper issues related to financial wellness. This, Dr. Gresham believes, is where psychologists can step in and effectively address those issues.

One way to begin addressing financial wellness with clients is through the use of schema—a cognitive framework that can help in the understanding of the concept. Doing so will allow you to interpret implicit and explicit beliefs about money and how they can impact individuals’ lives.

Dr. Gresham explained that money beliefs begin early, at about age three or four. She provided an example—a child thinking money grows in one’s pocket. Practitioners can address these misnomers in the context of behavioral finance, developed by the work of Daniel Kahneman and the late Amos Tversky, which examines how individuals make errors in their thought process around money, like believing money grows on trees or, in Dr. Gresham’s example, in a pocket. Behavioral finance explores how rational or irrational one can be about money matters, such as choosing to take one dollar today to immediately satisfy your desire for money, or taking $1.10 next year, which is actually a 10 percent increase, but might not feel like it.

Dr. Gresham went on to say that schema development depends on cultural beliefs, like thinking rich people are bad and poor people are good (or vice versa), or believing that if you work hard, money will come to you. These beliefs affect us, but they are simplistic, and we need to develop them to make them more sophisticated. This necessary development can happen through research on the cultural differences having to do with money, like the particular rules and customs about money that exist within the families of first-generation immigrants,such as not paying interest on a loan, and how those rules differ from cultural norms here in the United States, where borrowers might not like it, but interest is acceptable.

Another area in behavioral finance Dr. Gresham discussed with the audience is financial trauma. Even though many people suffer from financial trauma, whether they’ve lost everything in bad investments, or because of a spouse’s spending habits, there is not enough research on how to assist people with those experiences. “How do you help people come back from financial trauma and rebuild their lives? We need that research,” she said.

During her conversation, Dr. Gresham also touched on gender issues around money, such as women having lower financial levels of literacy than men and the lack of encouragement of women to enter the financial planning field.

She also noted that practitioners must examine money issues in their own lives, pointing out the costs associated with getting an education in the field and the need to understand what it means to be a self-employed business person by learning to communicate fees and by researching market rates, insurance rates, and retirement plans. Dr. Gresham suggested APA’s Division 42 and the book, “Handbook of Private Practice: Keys to Success for Mental Health Practitioners.”

Keep an eye out for future monitorLIVE events coming to a city near you.

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06 Jul 2017

Improving Practice Delivery Series

Improving Practice Delivery Series

From the solo practice to the large group practice, whether for profit or not-for-profit, the concepts presented in this series can help strengthen the organization in which services are delivered. *This series is eligible for CE credit. Earn 1 CE credit for each session.

The four 90-minute programs focus on:

How to Create and Implement a Vision for Your Practice

Learn about creating an over-arching vision for your practice and how to use it to guide both clinical and practice/administrative decisions.

Managing Staff and Organizations in Support of Practice Excellence

Learn how to promote excellence in service delivery via employment contracts, policies and procedures, and mentoring to advance staff development.

Expanding the Scope of Your Practice to Address the Needs of the Community

Keep your practice relevant by positioning it to meet the changing needs of the community you serve.

Practice Health Metrics

Keep your practice thriving and growing by tracking your basic metrics (accounts receivables, referral patterns, productivity, etc.), thus assuring the overall health of the practice for the future.

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27 Jun 2017

Work-life Balance Still a Struggle for Most Psychologists

Work-life Balance Still a Struggle for Most Psychologists

When Pamela Hays, PhD, began her psychology career, she tried to do it all: clinical work, writing, research and teaching. But she couldn't sustain it. After a decade of going full tilt, she developed neck problems and carpal tunnel syndrome so severe she had to start using a voice-activated computer system.

"I was driven," she says. "But I drove myself into health problems I couldn't ignore anymore."

Hays, now a clinical psychologist practicing in Soldotna, Alaska, might be an extreme case. Or maybe not. Work-life balance is something that many psychologists struggle with.

The unfortunate irony is that psychologists know better than anyone the importance of making time for self-care. "We talk about it a lot with patients, but we don't practice what we preach," says Chelsi Day, PsyD, a behavioral health provider at Windrose Health Network in Indianapolis.

Psychologists might even have a false sense of invulnerability, says John F. Christensen, PhD, a psychologist in Corbett, Oregon, and past co-chair of the APA Advisory Committee on Colleague Assistance (ACCA). "We study burnout and think that applies to the people we're trying to help," he says. "In fact, health is on a continuum, with well-being at one end and burnout at the other. And most of us, during a professional career, slide back and forth on that continuum depending on what's going on in our lives."

Finding balance, however, is easier said than done. "The sin of the early 21st century is being nonproductive," Christensen says. "We're conditioned by our culture to equate value with productivity."

Of course, as psychologists well know, no one is as productive as they can be when they are exhausted and overworked. Burnout is a legitimate phenomenon, marked by feelings of emotional exhaustion, depersonalization and a diminished sense of accomplishment. "When we move into burnout, we get impatient, we treat others as objects, and we start treating ourselves as task-processing machines," Christensen says. "Our empathy tank has run dry."

For psychologists in clinical practice, neglecting well-being can even impair professional competence, making the matter an ethical concern. As Erica H. Wise, PhD, a psychologist at the University of North Carolina at Chapel Hill and current co-chair of the ACCA, argues in a recent article, it's much harder to stay competent when you're burned out. "Competence … is an essential ethical obligation and provides a critical link between ethics and self-care," Wise and her colleagues conclude (Professional Psychology: Research and Practice, 2012).

Practical balance

Unfortunately, there's no one-size-fits-all strategy for achieving personal-professional equilibrium. Stressors and obligations are different for everyone, and they also change over the course of an individual's life. "It is important for psychologists to stay attuned to these issues throughout their professional life span, since personal and work-related stressors tend to shift over time," Wise says. "Work-life balance isn't a once-and-done thing."

Some people start by establishing a career with some balance built in. Day, a sport psychologist, recently decided not to pursue an opportunity that she described as a dream job — building a counseling and sport psychology center at a Big 10 school. Although the opportunity thrilled her, after she factored in the long commute, the fact that she'd be on call 24 hours a day and her desire for personal and family time, the job didn't sound quite so dreamy. "Work-life balance is important to me," she says. "I don't want to burn out in 10 years."

After working herself into physical health problems, Hays left academia and moved back to her home state of Alaska to start a clinical practice. She joined a yoga class and a book group, started spending more time with family, and wrote the 2014 book "Creating Well-Being: Four Steps to a Happier, Healthier Life."

But finding balance doesn't necessarily mean you have to change jobs (or move to Alaska). You can start by taking a critical look at your commitments.

Wise recommends doing either formal or informal self-care assessments, which can remind you of your goals and help you figure out which daily activities energize you — and which feel like a slog. "From that, you have critical information that you can factor into your choices about your personal and professional activities," she says.

Jim Davies, PhD, a faculty member at Carleton University in Ottawa, says that for him and many of his colleagues, a lot of work commitments are self-imposed. "They are projects we are passionate about and take on whether we have the time to commit to them or not," he says. "We're too busy because we're overcommitted, not because our jobs are too onerous."

Davies uses a rigid strategy to balance personal and professional time. Every morning, he fills in a detailed spreadsheet with activities for each half hour of his waking day. "Crucially, I also schedule in my breaks," he says — including lunch, coffee breaks and even daily naps. "For me, prioritizing life means putting it in the schedule like all the other important things."

Still, for many people, time management isn't really the problem, says Sandra Lewis, PsyD, a clinical psychologist at Montclair State University in New Jersey and founder of The Living Source, a company that helps clients improve well-being and achieve their goals. "People focus a lot on time management, but I think in terms of personal energy management. If you have enough energy, you make better use of your time," Lewis says. "In the same way we charge our cellphones, we need to charge ourselves."

Yet when we're overextended, even activities that energize us can feel like one more item on an endless to-do list. So Wise suggests taking advantage of smaller moments. You might not have an hour to go to the gym, but you could take a 10-minute lunchtime walk. If you can't fit in a yoga class, take five minutes between appointments to breathe or stretch or meditate. "Find self-care strategies that you can integrate in rather than add on," she says. "Honor the smaller things."

While such strategies are helpful, more needs to be done to change the culture of workplaces from the top down, says Christensen. Too many organizations value busyness and productivity at the expense of their employees' well-being, he says. "Often in this kind of professional workplace, when you're working with other smart, committed people, the way to excel is to overwork."

Christensen has been collaborating with health-care systems in Oregon to measure well-being among clinicians, including physicians and psychologists. He's optimistic that many such organizations are starting to realize that helping employees avoid burnout is not only good for employees, but also for patients and the financial bottom line. That kind of sea change is crucial for making work-life balance more attainable, he says. "The things we as individuals can do will take us only so far."

Meanwhile, Wise argues that instead of focusing only on reducing stress, the field of psychology should do more to promote and maintain well-being broadly. "We need a more positive vision," she says. "As a profession, whether we practice or do research, whether we're being mentors or treating patients, we need to be aware that keeping ourselves healthy is important."

Further reading

  • Hays, P. H. (2014). Creating well-being: Four steps to a happier, healthier life. Washington, DC: American Psychological Association.
  • Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66(7), 579–592. DOI: 10.1037/a0021769
  • Wise, E. H., Hersh, M. A., & Gibson, C. M. (2012). Ethics, self-care and well-being for psychologists: Reenvisioning the stress-distress continuum. Professional Psychology: Research and Practice, 43(5), 487–494. DOI: 10.1037/a0029446

By Kirsten Weir


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20 Jun 2017

Stop Wasting Time: Keys to Great Meetings

Stop Wasting Time: Keys to Great Meetings

Whether it's a gathering of health-care providers, faculty, students or a mix, here's how to make your meetings productive

Meetings that start late, last too long and accomplish little can stress attendees far beyond that lost hour, says Steven Rogelberg, PhD, of the University of North Carolina at Charlotte who studies meeting science. Research shows bad meetings can lead to job dissatisfaction, employee fatigue and what he calls "meeting recovery syndrome"—time spent cooling off after a frustrating meeting, which often includes destructive commiseration with colleagues.

"The next thing you know, the weight of the crappy meeting is higher, and it can spill over into other areas of work," he says.

How can everyone make meetings more effective, even enjoyable? The best gatherings happen when meeting leaders view themselves as stewards of everyone else's valuable time, says Rogelberg. Good stewards plan meetings thoughtfully, manage group dynamics, find out in advance why people want to meet and promote other people's contributions rather than their own.

Here is more wisdom from experts for attendees and leaders on how to meet-up better.

Be on time. Arriving late to meetings undermines productivity from the start—and upper management members are often the worst offenders, says Daniel Post Senning, co-author of "The Etiquette Advantage in Business" and great-great-grandson of manners guru Emily Post. "Often, they believe the rules don't apply to them."

Lateness may cause more than irritation: In a paper under review, Rogelberg and Joseph Allen, PhD, found that when a person showed up less than five minutes late for a meeting, productivity didn't suffer. But when an attendee or leader showed up five to 10 minutes late, "satisfaction, effectiveness and productivity of the meeting dropped dramatically," says Allen, an associate professor of industrial-organizational psychology at the University of Nebraska at Omaha.

Wallace Dixon, PhD, psychology department chair at East Tennessee State University, leads by example by starting and ending his monthly faculty meeting precisely on time. "If you don't, you insult the people who got there on time, reward the people who got there late and convey to everyone their time isn't that important," he says.

Be prepared. Arriving "late, frazzled, with nothing but a leaky coffee cup doesn't leave a good impression," Senning says. Bring something to take notes with and a steady attention span. Complete any assigned reading in advance. "Nothing is worse than showing up to the meeting and finding that no one has read the documents that [you sent, and] you then have to explain to everyone what they should have read," says Allen.

Make your phone (mostly) invisible. Despite the leave-the-device-at-the-door practice made popular by President Obama and Amazon, in most settings it is considered OK to bring your smartphone to meetings if you keep your attention on the speaker, says Senning. He recommends telling people in advance if you plan to use your phone to take notes or images of PowerPoint slides. But if people are gravitating to their devices in meetings, it may be a sign that the meeting needs to be more engaging, says Rogelberg. "Devices are signals," he says. "Psychologically, the person is trying to regain control of the time."

Diversify the discussion. No one attendee should monopolize the conversation—and no good facilitator should let anyone do it. Dixon says he will pull faculty aside later if they are talking too much in meetings because it bothers other staff and "they will lose faith in you as a leader if you don't handle it," he says. All attendees can share in that responsibility by making an effort to contribute even if public speaking isn't their forte, says Allen. His research has shown that when people make an effort to participate in a meeting—especially when there is a decision-making component—they are happier with the meeting's result and the meeting is more effective.

Move it along. Dixon places a time limit on each discussion item when he plans his faculty meetings and enforces those limits with his smartphone's timer. Another way to prevent run-on discussions and create a sense of urgency, Rogelberg says, is to switch from hourlong weekly or monthly meetings to shorter, more frequent "huddles": 10- to 15-minute meet-ups designed to save time and boost efficiency. If a leader has a difficult time staying on task, any attendee can help move a meeting forward by tactfully redirecting his or her attention to the agenda, says Allen.

Be constructive. Meetings can unravel when attendees cut one another off, dismiss each other, hold side conversations or argue. Avoid such tension, such as by saying, "I agree with some of what you're saying" instead of a short-tempered, "I just don't agree with you," says Brenda Fellows, PhD, of the Haas School of Business, University of California. Along those lines, Dixon advises the department chairs he mentors never to put a contentious issue to a vote in a meeting because it makes people uncomfortable. "Voting only divides, it never unites," he says. "When you resort to a vote, you have stopped talking."

Additional reading

Participate or Else! The Effect of Participation in Decision-Making in Meetings on Employee Engagement
Yoerger, M., Crowe, J., & Allen, J.A. Consulting Psychology Journal: Practice and Research, 2015

Meeting Design Characteristics and Attendee Perceptions of Staff/Team Meeting Quality
Cohen, M.A., Rogelberg, S.G., Allen, J.A., & Luong, A. Group Dynamics: Theory, Research, and Practice, 2011

"Not Another Meeting!" Are Meeting Time Demands Related to Employee Well-Being?
Rogelberg, S.G., Leach, D.J., Warr, P.B., & Burnfield, J.L. Journal of Applied Psychology, 2006

By Jamie Chamberlin


This article was originally published in the December 2016 Monitor on Psychology

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20 Jun 2017

NIH Toolbox Offers Easier Data Collection

NIH Toolbox Offers Easier Data Collection

The set of measures is useful for both researchers and clinicians alike—and can save money and time over traditional tools

For years, neurobehavioral researchers often couldn't compare data across studies or even within the same longitudinal study because they lacked a "common currency" for collecting data on various aspects of research participants' functioning.

"People used all sorts of different measures and assessments," says Molly V. Wagster, PhD, a psychologist who heads the behavioral and systems neuroscience branch in the National Institute on Aging's neuroscience division. And because there were different tests for different age groups, she says, "people had to resort to all sorts of different measures to follow someone over a period of time." Plus, she adds, researchers looking for quick-and-easy assessments sometimes resorted to tools designed for diagnosing disorders, not assessing function.

Now all that has changed, thanks to the National Institutes of Health's creation of the NIH Toolbox® for Assessment of Neurological and Behavioral Function. Developed by more than 250 scientists, many of them psychologists, the toolbox offers brief measures—some already existing and some created especially for the project—for assessing cognitive, emotional, sensory and motor functioning in research participants ages 3 to 85.

Introduced in 2012 and adapted for the iPad in 2015, the NIH Toolbox offers researchers a comprehensive set of tools for collecting data that can be compared across existing and future studies, says Wagster, the lead federal project officer for the toolbox.

The NIH Toolbox saves researchers time, says psychologist Richard C. Gershon, PhD, the NIH Toolbox's principal investigator and a professor at Northwestern University's Feinberg School of Medicine. "You can administer the equivalent of a one- or two-day neuropsych battery in two hours," says Gershon. The complete cognition battery can be administered in about 30 minutes.

The toolbox can also save money, says Gershon. Take the test used to assess people's sense of balance, which could be used to gauge older people's risk of falling. "Our test arguably replaces between $10,000 and $100,000 worth of equipment with a $160 iPad," he says.

Clinical psychologists could find the NIH Toolbox useful, too, says Abigail B. Sivan, PhD, an associate professor of clinical psychiatry and behavioral sciences at Northwestern, who helped develop it. In the future, a clinical psychologist might use the toolbox's assessments to help distinguish between attention-deficit/hyperactivity disorder and anxiety, for example, or between Alzheimer's disease and normal age-related changes in memory, she says. Clinicians could also use the NIH Toolbox to track patients' progress over time, she says.

Available as an app at iTunes, the NIH Toolbox can be downloaded on up to 10 iPads for an annual subscription fee of $500. Users can try it out for free for 60 days.

For more information, visit www.nihtoolbox.org.

By Rebecca  A. Clay


This article was originally published in the December 2016 Monitor on Psychology

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05 Jun 2017

Research-Based Strategies for Better Balance

Research-Based Strategies for Better Balance

1. Practice mindfulness. Numerous studies have demonstrated that mindfulness has benefits for body and mind, reducing stress and depression and even boosting immune function. It can also be instrumental in maintaining work-life balance. In a study of working parents, psychologist Tammy D. Allen, PhD, found people with greater mindfulness reported better work-family balance, better sleep quality and greater vitality (Journal of Vocational Behavior, 2012). "Cultivating a habit of self-awareness is vital," says John Christensen, PhD, past co-chair of the APA Advisory Committee on Colleague Assistance. "One of the best things we can do is to develop a reflective habit of checking in with ourselves at least a couple times a day, taking note of the emotional ‘weather' without judgment."

2. Look for silver linings. H. Shellae Versey, PhD, a psychologist at Wesleyan University, found that when working adults looked for benefit in negative situations, they experienced fewer negative psychological effects from work-family conflict. The finding was especially strong for women. During stressful periods, for instance, it can help to think of work-family conflict as a temporary strain, and to focus on the payoffs, such as higher salaries and better opportunities. But lowering expectations and downgrading one's goals did not have that protective effect, she found (Developmental Psychology, 2015). The difference, she believes, is that positive reappraisal is a way of taking control, while downgrading goals can feel like giving up. "Lowering aspirations without having another goal or Plan B in mind could be detrimental," she says.

3. Draw from positive psychology. The principles of positive psychology can aid in psychologists' self-care, as Erica Wise, PhD, and colleagues described in an article on psychologist well-being (Professional Psychology: Research and Practice, 2012). Positive emotions can broaden cognitive, attentional and behavioral repertoires, she explains, which boosts resilience and facilitates well-being. One evidence-based way to boost positive emotions is to practice expressing gratitude on a regular basis.

4. Take advantage of social support. Seeking support from other people is critical to well-being. Geertje van Daalen, PhD, at Tilburg University in the Netherlands, and colleagues found that social support from spouses and colleagues can be especially important for reducing conflict from family obligations spilling over into the workday (Journal of Vocational Behavior, 2006). Connecting with professional colleagues can be especially important for psychologists, Christensen adds. "Many psychologists work in their own silos and have little contact with professional peers," he says. "That isolation can be a risk factor for burnout."

5. Seek out good supervisors. Unsurprisingly, sympathetic bosses can also be helpful — something to keep in mind if you're on the hunt for a new job. David Almeida, PhD, at Penn State University, and colleagues found people had more negative emotions and greater stress on days when work obligations interfered with family responsibilities. But those negative effects were buffered by supportive supervisors (Journal of Marriage and Family, 2016).

6. Get moving. A robust body of research has shown that exercise can boost mood in the short term, and in the long term can improve symptoms of depression, anxiety, addictive disorders and cognitive decline.

7. Go outside. Spending time in nature has been linked to improved cognition, attention, mood and subjective well-being. It also appears to reduce symptoms of stress and depression, as Roger Walsh, PhD, a psychologist at the University of California, Irvine, described in a review of lifestyle changes and mental health (American Psychologist, 2011).

8. Make your life meaningful. In his American Psychologist article, Walsh also described the benefits of seeking meaning — whether through religion, spirituality or volunteer service. "We do our best work and live our best lives when we have a sense of meaning — a feeling that what we do extends beyond us and brings good to others," says clinical psychologist Sandra Lewis, PsyD.


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05 Jun 2017

Healing by Design

Nix the glass table and fill the room with light. These and other research-based design insights for therapists' offices can reap client benefits

As clients enter the Portland, Oregon, office of psychologist Thomas Joseph Doherty, PsyD, they are greeted by the majestic sight of Mt. Hood out an east-facing window, a profusion of healthy green plants, comfortable, supportive chairs and nature-based artwork. Diplomas hang in a corner to advertise Doherty's expertise, and his clean, clutter-free desk adds to the feeling of openness and space. "Ideally your office should have a clean, living, generative sense—one that fosters a renewed sense of physical vitality, alertness and creativity for your clients and yourself," says Doherty, whose practice centers on helping his clients develop what he calls "sustainable" habits like rest, exercise, social support and connection with nature—strategies that help maintain health and performance over the long term. 

Doherty's space is a good example of today's direction in health-care design, which uses research on human behavior and design principles to promote positive interactions between therapists and clients.

"A space should be something that supports you as you try to achieve specific goals," explains Sally Augustin, PhD, an applied environmental and design psychologist and founder of Design with Science, an international consulting firm. For therapy offices, that means creating a calm and refreshing environment to balance the rigorous mental and emotional work of therapy, she says.

Well-designed therapy offices also exude softness, personalization and orderliness, finds research by environmental psychologist Ann S. Devlin, PhD, of Connecticut College, and urban planning researcher Jack L. Nasar, PhD, of The Ohio State University. In their research examining people's reactions to 30 photographs of actual therapy offices, the more a space exhibited those characteristics—cozy elements like comfortable chairs and soft pillows, attractive touches like artwork, and neatness—the better people felt about the offices and the therapists who worked there, they found (Professional Psychology: Research and Practice, 2012).

In addition, good therapy office design should take into account the human instinct to protect ourselves and our territory—a feature that may be particularly important to consider with vulnerable therapy clients, Augustin says. "We are animals, after all," she says. "We do our best mental work when we feel a little bit protected."

So, given such insights how should practitioners design an office from scratch or redo a space that's seen better days? Specifically, therapists should:

Keep it light. The color of the office walls sets a tone. Wall colors in light, soothing colors like sage green or dusty blue promote a sense of calm and relaxation, environmental designers say.

Go with the grain. For reasons that aren't entirely clear, people prefer natural-colored wood with a grain rather than nongrain surfaces, research finds. People also feel more comfortable with wood than with slicker options like glass and chrome, Augustin says. 

That said, there's a limit to how much wood you should use: Research shows that when natural wood surfaces like floors and walls exceed 45 percent of a room's surface, they start losing their stress-busting effects.

Let the sun shine in. Natural light is a big mood booster, so when possible, incorporate windows or skylights, says Dawn Gum, director of interior architecture at the national firm EwingCole. If windows are at eye level, the best views look out on calming, natural scenery, not onto bustling sidewalks or roads with distracting sights and sounds.

If your office lacks windows, use floor and table lamps with soft lighting rather than overhead fluorescent lighting to promote a feeling of comfort and coziness, says Gum. Some lightbulbs even simulate natural light, which can boost the positive ambience of windowless offices.

Embrace the natural. Bringing nature into the office—whether with plants, nature embodied in artwork, decorative objects or views of plant-filled courtyards and landscaped areas—can enhance the healing quality of a space. "Just looking at landscaping has been shown to lower blood pressure," Gum says.

The right nature-based artwork can also give clients a way to muse on life situations, these experts add. Images of a pathway through a serene landscape or a bench in the middle of a pleasingly landscaped garden can foster relaxation or allow clients to make mental associations with the imagery. But, Augustin cautions, avoid nature imagery that's confusing, chaotic or complex. "You want to look at a scene that would be comfortable to enter," she says.

Use positive distractions. Fish tanks in medical offices are somewhat cliché, but they may have empirical merit—they're an example of so-called "positive distractions," a phenomenon noted in many research studies (see Resources below). A glance into the tank, or at other inviting sights like art of pastoral landscapes, can provide a respite from talking about weighty issues. "You want views that draw you in and give the part of your brain that has to focus a mini break," Augustin says.

Promote your expertise. Displaying your credentials might seem self-serving, but clients want to see signs of your expertise, research also finds. In a study by Devlin and her students, participants looked briefly at photos of therapy offices with zero, two, four or nine diplomas on the wall. People rated therapists who worked in offices with four and nine credentials most favorably, with little difference between the two (Journal of Environmental Psychology, 2009).

Have your client's back. An evolutionary perspective can help you make intelligent decisions on what is arguably the most important element in your office: the client chair.

To support people's need for control, consider having chairs that can be moved or are large enough to let people shift to one side or the other and adjust the distance between themselves and the therapist. If any of your clients have histories of being physically violent, make sure chairs are heavy enough that they can't be easily picked up and thrown. Likewise, chairs with backs at shoulder height can facilitate a feeling of protection, environmental design researchers add. Other ways to promote a sense of personal safety include placing a plant behind the chair and positioning chairs so clients can see the door.

A related suggestion: Place small tables next to client chairs, which can enhance clients' sense of "territory" by giving them a place to put personal items. Your clients will appreciate that you've attended to their comfort and convenience, says Lynn Bufka, PhD, APA's associate executive director of practice.

Foster communication. If you use tables in your office for individual or family sessions, research shows that round tables support better communication and sense of control than square or rectangular ones, says EwingCole's director of research, environmental psychologist Nicholas Watkins, PhD. Also, the presence of computers is shown to impede communication, particularly when the client perceives that the provider is paying more attention to the computer than to him or her. Screen-sharing strategies—technology that enables you to project information onto a table, for example, or simply facing the screen toward clients—can promote clients' sense of trust and inclusion, Watkins notes.

Go with the flow. Anything that promotes flow and efficiency in your immediate and larger office space is worth addressing, according to research compiled by APA's Practice Organization. Keeping a clean, uncluttered desk and placing the items you need closest to you—computer, phones and appointment book, for instance—can help you keep a clear head and feel in charge of your space.

Experts also recommend walking through the functions of your day to identify areas of inefficiency for yourself, your staff and your clients. Fixes can be small and no cost—moving the location of your assistant's desk, for example—or more extensive, like knocking out a wall to create better traffic flow.

Not too fancy, not too shabby. When selecting furniture and finishes for your office, keep client demographics in mind, adds Gum. In general, people feel most comfortable with a middle range of furnishings—those that aren't overly fancy or expensive, but not cheap or shabby, either.

"If you're putting in very expensive materials but your clientele is not at the upper end of the socioeconomic spectrum, you can alienate people," says Gum. Conversely, old or poorly made furnishings can make it look like you're not doing well—the wrong message to send clients.

Put your client first. Remember that you're designing your office more for your client than for yourself, Gum emphasizes. Including some personal elements can be subliminally comforting to clients, but make sure they don't overpower a sense of neatness and calm, she advises.

On a related note, make sure your furniture addresses the specific needs of your clients, says Bufka. If children are among your clientele, make sure you have age-appropriate toys and chairs that are the right size. Be sure that chairs are comfortable for people of all sizes.

Including art that demonstrates your openness to different cultures can also be a plus, particularly if you serve multicultural clients, finds research by Devlin and colleagues (Professional Psychology: Research and Practice, 2013). When the team compared reactions of white college students and mainly ethnic minority adult community members to photos of a therapist's office, the community group rated the therapist more favorably when the art was more ethnic in flavor than Western. "If all of the artwork clients see ... represents a tradition different than their own, it is possible for them to feel unwelcome," the authors write.

Hire a pro. Finally, consider hiring a professional to help you, preferably a qualified architect or interior designer who specializes in health care (see "Tapping design help" below). He or she can help you map out how you actually work and how you want to work, and craft your space accordingly. They also know what's available in furniture and finishes, and about the changing landscape of health care, including new technologies.

Investing in good office design isn't just about creating an attractive space, it's about investing in your business and professional calling, adds Gum.

"If it's designed right," she says, "your office can help you deliver care in ways that really do promote your clients' well-being."

Interested in the link between psychology and design? Check out the work of APA Div. 34 (Society for Environmental, Population and Conservation Psychology), which among its foci explores behavior and the built environment. Learn more about Div. 34 at www.apadivisions.org/division-34/index.aspx.

Resources

Center for Health Design
The knowledge repository of research and resources on health-care design topics. www.healthdesign.org/search/articles

Transforming the Doctor's Office
Devlin, A.S. Routledge, 2014. Includes a section on therapists' offices.

Tapping design help

When considering an office redo, seek architects or interior designers with experience in health care and medical offices, advises Dawn Gum, director of interior architecture at EwingCole, an integrated architecture, engineering, interior design and planning firm.

  • For architects, seek professionals certified with EDAC, the Evidence-Based Design Accreditation and Certification, the certification for members of the Center for Health Design.
  • For interior designers, find someone certified by the NCIDQ, the National Council for Interior Design Qualification. Look for designers who work in commercial spaces with a health-care focus.

By Tori DeAngelis


This article was originally published in the March 2017 Monitor on Psychology

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05 Jun 2017

What are the Keys to a Good Electronic Records System?

These systems streamline practitioners' paperwork—and are no longer as intimidating or expensive as they once were

Psychologist Diana L. Prescott, PhD, already uses electronic health records in the integrated health-care work she does at Eastern Maine Medical Center. She even created the behavioral health component of the system for the center's pediatric obesity program. Now she wants to make the shift to electronic health records at the private practice she and her husband David L. Prescott, PhD, run in rural Maine.

"In a small practice, there's not a lot of space to store paper records," says Prescott, a member of APA's Committee for the Advancement of Professional Practice. "And it takes time to file those records." Plus, she says, patients expect electronic records, just like they see in medical offices.

But, she says, figuring out how to make the transition has been a time-consuming struggle. Should the practice buy a server—with all the expense and upkeep that entails—or go for a cloud-based product? The cloud offers protection from fires or burglary, but is it secure enough, especially since a breach of confidentiality could be particularly devastating to the reputation of a rural practice? How long would it take the Prescotts and practice manager Ruth Siebert to learn a new system? Answering these and other questions has proven so difficult that Prescott now hopes to make a decision some time during the new year.

Electronic health records are worth the hassle, says Lynn Bufka, PhD, associate executive director of research and policy in APA's Practice Directorate. In addition to offering "less paper, less filing, less cabinet space," she says, electronic records make it possible to access files remotely. It's easier to share records with patients or other providers when you can just click a button to print a copy or save to a flash drive instead of copying page after page of paper records. And thanks to the security measures you can put in place, such as automatic monitoring of who accesses what information and for how long, electronic records may actually be better at safeguarding confidentiality than paper ones, says Stacey Larson, JD, PsyD, a consultant who works with APA on legal and regulatory issues. "You can see if Joe Schmo accessed the record," she says. "You might not know if someone got into the file cabinet."

The federal government is also pushing the use of electronic health records, with the hope that "interoperable" records that can communicate not just within but across practices and health-care systems will reduce redundancies and improve care by ensuring that all providers involved in a patient's care have access to test results and treatment plans. Down the road, says Bufka, referrals from other health-care providers or even payers may even come via electronic records.

Given those advantages, how can you make the process of selecting a system easier? Bufka and others suggest the following steps:

Conduct a needs assessment. Think about the capabilities your practice needs in addition to such basic functions as billing and scheduling, says Bufka. If your office offers testing services, for example, determine whether the record can store the resulting data. If you'll be storing psychotherapy notes on the system, you'll need "data segmentation," which allows those notes to stay hidden when a record is shared. Also consider who will be using the system. If your practice includes a psychiatrist or another professional who can prescribe, you'll want a system that includes electronic prescribing. You might find other features—an internal email system or a web portal for patients, perhaps—attractive.

Set a budget. Many solo or small practices worry that electronic health record systems will be prohibitively expensive, says Larson. The high prices many people have heard about came from early adopters, she says. "There weren't as many options back then, so they adopted big, big systems," she says. Others may have invested in new servers to run their systems or opted for systems with all the bells and whistles small practices may not need, such as prescribing portals in practices where no one can prescribe, she says. Systems—especially cloud-based ones—are now much more affordable, she says, adding that she has seen ones that cost as little as $50 a month to use.

When you're looking at prices, make sure you're looking at all the costs involved, not just the initial start-up costs. Other costs may include training and monthly subscription fees either for the practice as a whole or per provider.

Ensure patient privacy. "Be knowledgeable about how data are stored," says Bufka. "There's not necessarily a right or wrong answer when it comes to cloud versus localized storage, but you'll want to know the pros and cons."

Privacy is the main issue Prescott is struggling with as she searches for the right system for her practice. Cloud-based products seem very secure, she says, and the vendors would assume much of the responsibility for complying with the Health Insurance Portability and Accountability Act (HIPAA). (With a server-based system, she explains, responsibility for HIPAA compliance rests on the practice.) "Even though there are a lot of arguments that records are more secure on the cloud, many people are uncomfortable with private information being placed in the cloud," she says. "You read in the paper all the time about things being hacked." While keeping records on a server within the building would probably be best for her, she adds, it's a much more expensive option.

Review your options. If you're already using practice management software, ask the vendor about electronic health record software that's compatible so you can stick with what you're already comfortable with, suggests Larson.

If that's not possible, ask colleagues whose practices have needs that are comparable to yours what system they like, says Prescott. A colleague who touted one brand turned out to like it because of its billing feature—a nonissue for Prescott's practice, which requires patients to pay up front.

You can also view options online through an aggregator site, such as www.capterra.com, which brings together information on hundreds of electronic health record systems, including about 150 systems specifically designed for mental health professionals. "You can type in what you want, and it spits back options," Larson says.

Test the system and the vendor's technical support. Be sure to try out an electronic health record system before you commit, Larson emphasizes. Once you've got your choices narrowed down to two or three, contact each vendor and ask them to walk you through their systems. Many will even let you test demos online. "If your practice isn't tech-savvy, choose a system that's more intuitive and has good customer support," says Bufka. Also ask what kind of support you'll have as you learn the system. And remember that you can always call APA and the APA Practice Organization staff for advice. "It has been super-helpful to talk with different staff members about the research they've done," says Prescott.

Additional resources

www.apapracticecentral.org
Visit APA's Practice Central and search for "electronic health records" to watch a video on using electronic health records.

www.HealthIT.gov
Learn more about contracts for electronic health records at the federal government website.

By Rebecca A. Clay


This article was originally published in the January 2017 Monitor on Psychology

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