Community Psychologists in Healthcare

THEory into ACTion

A Bulletin of New Developments in Community Psychology Practice
April, 2014

by

Mary C. Benton, Seattle

     Recently I had the opportunity to speak with three community psychologists–William Neigher, Ph.D., Sharon Johnson-Hakim, Ph.D. and Chris Kirk, Ph.D. Their situation is unique in that they are all employed as community psychologists working at the same place, Atlantic Health System, in New Jersey (www.atlantichealth.org). This is in large part due to the shared vision of healthcare between Neigher, Vice President and Chief Strategy Officer, and the President and CEO of Atlantic Health System, Joseph Trunfio, Ph.D. Trunfio trained as a clinical psychologist but completed a postdoctoral fellowship in community psychology with SCRA’s first President, Robert Reiff.  Neigher and Trunfio, along with many of the board of trustees and others at Atlantic Health System, believe that communities play a vital role in their own personal well-being. 

     This belief is reflected in the recent change in Atlantic Health System’s vision statement, which now reads “Empower our communities to be the healthiest in the nation.” It is also demonstrated in the mission statement of the organization, which is to “Deliver high-quality, safe, affordable care within a healing culture” (Neigher & Hakim, 2012). The phrase, “within a healing culture,” emphasizes the complexity of patient well-being and recognizes that settings and contexts matter.  It acknowledges that patient health is best viewed from an ecological, multi-layered approach. It also posits that health care staff work together with patients and their families in order to affect real change in patients’ well-being.

     The importance of communities’ involvement in their own patient healing is also reflected in the change in the vision statement of Atlantic Health, from a focus on applying top clinical care to one that emphasizes community psychology principles of prevention and health promotion. These changes do not simply reflect a change in wording or a new marketing campaign, but rather a fundamental shift in the way the health system sees itself and defines its role. The goal now is to develop a “line of sight” understanding between each Atlantic Health System employee’s job and the vision and mission of the organization. This “line of sight” mentality was eloquently demonstrated to Neigher earlier in his career when visiting a nursing facility operated by his friend, Dr. Sidney Greenwald. When introduced to an elderly gentleman with a mop and bucket, Dr. Greenwald asked the gentleman, “Tell my friend Dr. Neigher what you do here.” To which he replied, “I’m in infection control.” He then demonstrated how he cleaned toilets to prevent residents from getting sick (Neigher, 2011).  The elderly man’s role was seen as integral to the success of the nursing facility.

     Drs. Neigher, Kirk and Johnson-Hakim are working to develop a variety of innovative programs consonant with the principles of community psychology, aimed at shifting the focus from one centered on disease to well-being. Additionally, the concept of empowerment rings true in their work; one such avenue where they apply an empowerment perspective is health literacy. Defined as the “degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions” (Ratzan & Parker, 2000), health literacy has great implications for health status. For example, those with lower levels of health literacy demonstrate less ability to read labels, take medications correctly, and among seniors, poorer health status (Agency for Healthcare Research and Quality, 2011).  In an effort to empower and minimize the confusion of being a patient, Atlantic Health System developed a Health Literacy Task Force in order to create a more health literate healthcare system (Kirk & Neigher, 2013).

     Besides community and hospital based programming, Drs. Neigher, Kirk, and Johnson-Hakim are involved in a line of applied research around adaptability (Neigher & Hakim, 2012).  Instead of focusing solely on healing patients and returning them to their previous state before illness or injury, Atlantic Health System wants to foster more adaptable patients. They have developed an Adaptability model which is operationally defined as the ratio of an individual’s resilience to their vulnerability. Many times health circumstances are beyond a person’s control, but what is in their control is how they adapt and cope with those circumstances. Currently, a study using a large sample of joint replacement patients is examining the predictive validity of the Adaptability model.  The objective is to develop a valid and reliable measure that can be utilized and administered by an individual’s physician each time they visit a healthcare facility. Over time, the use of such an instrument would provide a life course perspective of an individual’s adaptability, and allow providers and community agencies to intervene earlier. In addition, the model could be used by organizations or communities, measuring their adaptability and/or creating interventions to increase adaptability to events such as terrorist attacks or natural disasters.

     As evidenced, a lot of exciting work is being conducted by community psychologists at Atlantic Health. Furthermore, as Neigher remarked, with the passage of the Patient Protection and Affordable Care Act (2010), now is a very good time to be a community psychologist, especially in the field of healthcare. The skills that community psychologists have are precisely those skills that are paramount for successful implementation of the Affordable Care Act. And while most positions are not advertising for community psychologists as such, the skills and expertise necessary are very often ones that we have. The challenge for community psychology and community psychologists is to translate our language into the lexicon of the employer, which is often very medically focused. The experiences of community psychologists at Atlantic Health System have shown how effectively this can be done. 

References

Agency for Healthcare Research and Quality (2011). Health Literacy Interventions and Outcomes: An Updated Systematic Review.  Washington D.C.: Agency for Healthcare Research and Quality, 2011.

Kirk, C. M. and Neigher, W. D. (2013). Community psychology and the future of healthcare. Global Journal of Community Psychology Practice, 4(4), 1-9. http://www.gjcpp.org/en/article.php?issue=16&article=82

Neigher, W. D. (2011). Invited address to the 2011 SCRA Biennial Conference accepting the Distinguished Contribution to Practice in Community Psychology [2010]. Global Journal of Community Psychology Practice, 2(3), 1-15. http://www.gjcpp.org/en/resource.php?issue=8&resource=62

Neigher W. D. & Hakim, S. M. (2012). Creating a sustainable “healing culture” throughout a healthcare system: Using community psychology principles as a guide.  Global Journal of Community Psychology Practice, 2(3), 1-25. http://www.gjcpp.org/en/article.php?issue=8&article=36

Patient Protection and Affordable Care Act, PL 111-148, March 23, 2010. http://www.hhs.gov/healthcare/rights/law/

Ratzan,  S.C. & Parker R. M. (2000). Introduction. In: National Library of Medicine Current Bibliographies in Medicine: Health Literacy. NLM Pub. No. CBM 2000-1. Selden CR, Zorn M, Ratzan SC, Parker RM, Editors. Bethesda, MD: National Institutes of Health, U.S. Department of Health and Human Services.

This is one of a series of bulletins highlighting the use of community psychology in practice. Comments, suggestions, and questions are welcome. Please direct them to Bill Berkowitz at william_berkowitz@uml.edu