In this edited text about how pharmacologically trained psychologists work with pediatricians, editor Dr. George Kapalka, a clinical psychologist and associate professor from Monmouth University in New Jersey, weaves a tapestry of ideas from a variety of psychologists across the nation, including a number from Louisiana. He and his contributors demonstrate that whether in prescribing or non-prescribing states, psychologists can collaborate with pediatricians and other primary care physicians to deliver the best and highest quality care to children and adolescents.
“I’m really quite thrilled to have such a breath and depth of contributions,” Dr. Kapalka told the Times. In Practitioner’s Guide authors provide a rich variety of perspectives, information, experiences, and case studies. They write in different voices, from different views of the patient and from different perspectives of practice, all woven together by a solid structure from the editor.
“One of the biggest challenges was to pull it all together and get the consistency,” George said. Practitioner’s Guide is nicely organized into four main themes starting with Part I, “Foundations of Collaborative Care,” followed by “Collaboration in Specific Settings.” Part III is “Collaboration for Specific Disorders,” and the text concludes with Part IV, “Future Directions.”
Who’s Writing What?
Any reader should find something of value in this volume, from those who wish to learn more about collaboration, to those trained in pharmacology who want to help the primary care physician with choices, to those with RxP who have responsibility for prescribing. “It was a really rewarding project,” George Kapalka told the Times, “because I think the end product is a good volume with some superb contributions, including those from some people from Louisiana.”
“I wanted to show that in states where we do not prescribe, we can still make very meaningful contributions,” George said, who has Level 3 training in psychopharmacology. He has found that physicians are “quite appreciative of the dimensions that we can bring.”
In his balanced and cogent preface, Dr. Kapalka lays out the rationale for pharmacological treatment with children, showing that “many factors may contribute to the decision to utilize pharmacological approaches in conjunction with or instead of psychotherapy,” including severity, speed of improvement, time and effort required to participate in psychotherapy, expense, and limitations from insurance.
In Chapter 1, “Psychology, Psychopharmacotherapy, and Pediatrics: When to Treat and When to Refer,” Dr. Marc Muse, who has practiced in Maurepas, Louisiana, and who is now residing in Maryland, and his coauthors provide an algorithm for deciding who, and at what point, should be involved for various conditions. “I enjoyed working with my coauthors,” Mark said, “a pediatrician and a neuropsychologist. I believe in, and practice, integrated services, and so collaborating with adjacent specialties is always a learning opportunity.” Mark has a book in production with John Wiley & Sons, Handbook of Clinical Psychopharmacology for Psychologists.
Chapter 2,“Collaboration Between Pharmacologically Trained Psychologists and Pediatricians: History and Professional Issues,” concludes Part I. Part II, begins with Chapter 3 “The Clinical Experience of RxP- Trained Psychologists Working in Non-RxP States.”
Dr. Darlyne Nemeth co-authors Chapter 4, “The Practice of Medical Psychology in an RxP State: New Opportunities for Comprehensive Pediatric Care,” along with physician Dr. Sandra Franz a pediatrician for Our Lady of the Lake Regional Medical Center’s Pediatric Residency Program, Dr. Emma Kruger, physician and founder of the Metabolic Anti-Aging Center in Baton Rouge, and Maydel Schexnayder, MS, certified rehabilitation counselor and Vocational Rehabilitation District Supervisor.
The authors outline the collaborative process from the medical psychologist’s perspective, the pediatrician’s perspective, and from the parent’s perspective, and point out that collaboration greatly reduces the need for pediatric primary care appointments. “It is the responsibility of the medical psychologist to determine if medication is really necessary,” the authors say, by fully analyzing family dynamics, unconscious expectations, comorbidities, developmental problems trauma, concurrent medical conditions, and adverse reactions.
“What I like best about this chapter,” Darlyne told the Times, “is that it emphasizes that a medical psychologist is first and foremost a psychologist […] that all aspects of behavior are analyzed before medication is utilized with children.” […] But, when necessary, the medical psychologist can prescribe, monitor, and titrate the most effective medication for the child and help the family with behavioral change.” She said, “…I truly attempted to gather together authors who represented the real world and who would give meaningful thought/perspective to the project. It was wonderful to work with such talented people.”
Chapter 5 covers “Integrated Care in Rural Settings” followed by “Collaborate Practice with Pediatricians Within the Indian Health Service: Taking Care of Frontier Children,” coauthored by Dr. Kevin McGuinness, is licensed in Louisiana. He currently is a clinical and clinical health psychologist, and medical psychologist working in rural New Mexico.
Louisiana medical psychologist Dr. John Courtney authors Chapter 7, “The Practice of Medical Psychologist in a Pediatric Hospital Setting: A Personal Account from an RxP State.” John describes the inpatient medical psychology consultation, writing, “The hospital setting presents the medical psychologist with a number of unique challenges.” And, “…despite psychology’s long battle to discourage dualism (mind vs. body), this splitting of patients based upon their functional and physical symptoms is more common than not.”
Part III focuses on specific disorders and begins with Chapter 8 by Dr. Kapalka, “Collaborative Treatment of Disruptive and Mood Disorders.” Chapter 9 is “Collaboration Between Pediatricians and Pharmacologically Trained Psychologists in the Treatment of Anxiety Disorders in Pediatric Patients.” The section continues with Chapter 10, “Collaborative Treatment of Eating Disorders,” followed by, “Collaborative Treatment of Medical Disorders: The Management of Diabetes.”
Lindsay Clendaniel, PhD, pediatric psychologist at Children’s Hospital in N.O., who specializes in treating children with gastrointestinal disorders and pain-related illness, coauthors chapter 12, “Collaborating with Pediatricians and Gastroenterologists: A Biopsychosocial Approach to Treatment of Gastrointestinal Disorders,” with Dr. Paul Hyman, physician and Professor of Pediatrics at LSU and Chief of Pediatric Gastroenterology at Children’s, and Dr. John Courtney, Director of Psychology at Children’s are coauthors.
Authors explain GI tract symptoms for youngsters, outlining the complex and sometimes circular ways that the mind and body can trigger problems. “An important aspect of care in pediatric gastrointestinal disorders is the brain-gut interaction,” the authors note. “The connection between physiological and psychological factors can be seen within the GI tract.”
Part IV on begins with “Brain Markers: An Emerging Technology with Potential to Enhance Collaboration Between Pediatricians and Pharmacologically Trained Psychologists.” Chapter 14 follows, “Internships and Fellowship experiences: Preparing Psychology Trainees for Effective Collaboration with Primary Care Physicians.”
Ms. Traci Olivier, doctoral student at Nova Southeastern University Center for Psychological Studies, authors Chapter 15, “The New Face of Psychology Predoctoral Training: Psychopharmacology and Collaborative Care.”
Traci sets out a sample curriculum for students who want to pursue psychopharmacological training and describes core values for training in the practice of consultation and collaboration, highlighting the importance of integrated care.
She explained to the Times that she spoke at an APA symposium because her mentor, Dr. Nemeth urged involvement in professional organizations. “I spoke from a student’s perspective about how prescriptive privileges impact training,” Traci said. “After the presentation, an editor from National Psychologist asked me if I would write an article based on my presentation,” When George Kapalka read the article, he asked her to contribute to Practitioner’s Guide. She emphasizes the important of networking to all other students.
The section and text concludes with “RxP Training Informs the Practice of Supervision of Nonpharmacologically Trained Mental Health Practitioners.”
Practitioner’s Guide provides a wealth of ideas and information for all levels of clinical and collaborating psychologists, for those who treat, consult, or prescribe.