are inexpensive, widely available, and can be dis-
seminated in a wide variety of settings (e.g., primary
care physicians’offices).
Third, and in a related vein, it is predicted that
more and more behavioral health services will
occur in primary care and other less traditional set-
tings like schools and the workplace (Clarke et al.,
2006). This shift in delivery settings is driven by a
number of factors, including the availability of self-
help modalities, the increased use of medications to
manage psychological problems, and the stigma still
associated with presenting to a psychologist’sor
psychiatrist’s office.
These trends in managed care and the delivery
of behavioral health services will directly affect the
employment outlook for doctoral-level clinical psy-
chologists who plan to make a career of clinical
practice. Master’s-level practitioners and paraprofes-
sionals are much“cheaper”to use for the same ser-
vices and, therefore, will be seen as more
economically attractive to managed care companies
(Baker et al., 2009; McFall, 2002, 2006).
But the training of the scientist-practitioner or
clinical scientist does offer some opportunities in
this environment (Baker et al., 2009; Barlow,
2004a, 2004b; McFall, 2006). For example, clinical
psychologists are likely to be the primary providers
of psychological treatment that is based in psycho-
logical science. By virtue of the rigorous training in
both the evaluation and administration of empiri-
cally supported treatments, clinical psychologists
from clinical science or scientist-practitioner pro-
grams are uniquely positioned to serve as consul-
tants and overseers of psychological treatment in
an environment that emphasizes quality and cost-
effectiveness. Ironically, as we discuss below, gain-
ing prescription privileges may have the unintended
consequence of diverting clinical psychologists
away from what makes them unique among mental
health professionals—the“complete package”of a
clinician who can both conduct assessment and treat-
ment research as well as administer and disseminate
effective psychological treatments. An increased
focus on accountability and patient outcomes will
open the doors for clinical psychologists who have
expertise in clinical and psychometric research.
These individuals will be called upon to design and
evaluate studies of patient outcome, patient satisfac-
tion, and the effectiveness of various psychological
interventions.
These observations about behavioral health care
highlight a number of implications for the training
and careers of psychologists (see Table 3-4). Training
programs in clinical psychology need to place moreT A B L E 3-4 Recent Developments Relevant
to Behavioral Health Care- Costs of health care are expected to rise again.In
2007, it is estimated that the United States spent
$2.26 trillion dollars on health care, over $7,000.00
per resident. This represents about 16% of the U.S.
gross domestic product (GDP). By 2017, it is expected
that health care costs will rise to 19.5% of the GDP.
Clearly, the one-time savings involved in shifting
most Americans to managed care plans from fee-
for-service have been realized. Increased costs in the
future will be associated primarily with medical tech-
nology, physician services, and prescription drugs. - Psychotherapists are adopting novel approaches to
managed care and may expand their roles.To
maintain their autonomy, some psychotherapists are
opting for self-review of their own costs. By formally
serving as their own“watchdogs”and cost man-
agers, groups of mental health professionals can
avoid losing control over service delivery to the case
managers of outside managed care organizations.
For example, therapists serve as their own“gate-
keepers”by critically reviewing the number of ses-
sions allotted to individual patients and evaluating
quality of services internally. In addition, it is likely
that clinical psychologists in private practice may
develop expertise in alternative medicine, tele-
health, psychopharmacology, or life coaching in
order to preserve their income as reimbursement
rates from managed care are likely to remain flat or
even decrease. - Consumer-driven health plans are likely to become
more popular.These plans shift the cost and respon-
sibility of behavioral health care to the individual
consumer. With rising costs on the horizon, employ-
ers and insurance companies are less likely to share
the burden and it will be up to each person to save for
and manage the health care received. In this way, the
consumer will be able to“shop”for services to iden-
tify the highest quality treatment for the money.
Services will be paid for largely from individual health
savings accounts that are tax-exempt.
74 CHAPTER 3