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					Primary Care Psychology                                      Project Director: Baker, Jeff


IV SUMMARY OF PROJECT

Project Title: Primary Care Psychology

Organization Name: University of Texas Medical Branch

Address: Psychology Training Program – 301 University Blvd. – Galveston, Texas 77555-1152

Project Director: Jeff Baker, Ph.D.    Phone: 409 772-9576 FAX: 409 747-1524
                   (jbaker@utmb.edu)

Project Period: September 1, 2002 – August 31, 2003

Purpose, Need, & Rationale: The purpose of the Primary Care Psychology (PCP) project is to
increase the number of clinical psychologists (CPs), Occupational Therapists (OT), and
Physician Assistants (PA) prepared to provide primary care to at risk populations, especially
those from underrepresented minority/disadvantaged backgrounds, by practicing in medically
underserved areas (MUAs) in Texas. This project will be developed through a collaboration of
the Psychology Resident Training Program (PRTP), Department of Occupational Therapy (OT),
Department of Physician Assistant Studies (PA) Studies, Rehabilitation Services, and the Acute
Care for Elders (ACE) Geriatrics Unit located at the University of Texas Medical Branch.
Through established relationships with current treatment facilities (psychology internship
rotations), this project will develop an interdisciplinary course for CP, OT, and PA students with
clinical experiences in pediatrics, the rehabilitation center, anesthesiology pain clinic, ACE,
spine surgery clinic, and the Shriners Burns Hospital. All of these entities support training
psychology residents to address patient‟s quality of life issues along with prevention and health
promotion. They are willing to expand current and establish new clinical training sites for these
students and interns that provide collaborative primary care and mental health services to
underserved populations, and serve as an innovative model to link Allied Health practitioners
and CP‟s practice, education, and research. Program completers of the PCP project will be better
prepared to provide culturally competent and sensitive allied health and psychological services to
residents living in medically underserved communities.

Objectives: Increase the number of clinical psychologists, occupational therapists, and
physician assistants prepared to provide primary psychological care to under served populations
in medically underserved areas.

Methodology: 1) To provide training in an interdisciplinary curriculum for clinical
psychologists, occupational therapists, and physician assistants in a course taught by the primary
investigator entitled clinical psychiatry; 2) To provide clinical training in a wide variety of
primary care settings including clinics, inpatient services, and community agencies that have a
long tradition of providing health services to medically underserved populations; and 3) To
expand and refine current training opportunities in a hospital and community agencies that have
a history of providing care to underserved populations.




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Primary Care Psychology                                       Project Director: Baker, Jeff

Evaluation: The evaluation will include a measure of cultural sensitivity measured before and
after the training; the number of students choosing training (affiliations or postdocs) in medically
underserved areas and the number of minority students participating in this project.

Number of Students to be Trained and Their Disciplines: These opportunities will be
provided to 5 psychology interns, 20 occupational therapy students and 40 physician assistant
students.

Names and Descriptions of the Proposed Clinical Underserved Training Sites: 1) The
University of Texas Medical Branch is owned by the University of Texas System and has a long
history of providing services to under represented populations; 2) The following clinics will
serve as training sites: a) Orthopedic Spine Surgery has a high percentage of patients with
chronic medical conditions; b) Anesthesiology Pain Clinic provides pain management to patients
who have failed back syndrome and are in need of psychological as well as medical management
of their pain; c) Cardiothoracic Surgery has a significant number of patients that have lung
cancer and have incorporated psychology in the standard protocol of patient care; d) Adult
Rehabilitation Center is a 16 bed inpatient care facility for patients who are recovering from
surgery or a traumatic event; e) Shriners Burns Hosptial for Children is a 30 bed hospital located
on the UTMB campus that provides free care for children with severe burns; f) pediatric chronic
care unit has inpatient and outpatient clinics for children who have chronic medical or
developmental conditions; g) Acute Care for Elderly (ACE) unit is a new service that psychology
has not been in before this grant period. It provides services for patients who have deteriorating
health and in need of specialty elder care; h) Alcohol & Drug Abuse (ADA) House is a
community agency that provides services for women who are recovering from substance abuse
problems; i) Discovery Club is an after school program for at risk children who have been
identified by the Galveston Independent School District (GISD); j) Gulf Coast Center
(TXMHMR) is a community service of the Texas Mental Health Mental Retardation. It provides
services for community residents that typically have a high representation of underserved clients;
and k) Our Daily Bread is a homeless shelter that focuses on addressing substance abuse
problems, career exploration, self-esteem issues, and community re-integration.

Funding Preference: The funding preference is requested for this project.


Bureau of Health Professions Comprehensive Performance Management System (CPMS)
  This project addresses the following BHPr goals, outcomes, and indicators:

Goal I.        Improve access to quality health care through appropriate preparation,
               composition, and distribution of the health profession workforce.
Outcome:       Prepare an appropriate number of health professionals necessary to support
               quality primary care.
Indicator:     Number of program completers of health professions that choose rural settings for
               their clinical affiliations or choose postdoctoral training in rural settings and/or
               provide primary psychological care to under represented populations.




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Primary Care Psychology                                      Project Director: Baker, Jeff


Goal II.       Improve access to a diverse and culturally competent and sensitive health
               professions workforce.
Outcome 1:     Increase the number of allied health and psychology interns sensitive to cultural
               and economic issues of patients from rural settings and/or who are traditionally
               underserved by health care systems.
Indicator:     Number of allied health students and psychology interns participating in cross-
               cultural training as related to mental health of patients from underserved
               populations.
Outcome 2:     Increase the number of underrepresented/disadvantaged program completers.
Indicator:     Number of minority/disadvantaged program completers.

Relationship of PCP Project to Statutory Purposes
     The Allied Health Projects Grants Program, Section 755 of the Public Health Service Act, as
amended, authorizes the Secretary to make Allied Health Project grants to be eligible entities to
assist them in meeting the costs associated with expanding or establishing programs that will
increase the number of individuals trained in allied health professions. The Program
Announcement indicates that programs funded under this section must address at least one of
nine statutory purposes. The PCP project addresses two of these purposes:
     A training curriculum that emphasizes knowledge and practice in the areas of prevention and
health promotion through an integrated clinical psychiatry course. The PCP project will provide
an interdisciplinary course in clinical psychiatry. The internship program is closely linked to the
allied health curriculum and is currently part of an HRSA funded project with Occupational
Therapy at this site as well as an Health Careers Opportunity Program (HCOP) grant that focuses
on similar, yet different issues for underserved populations through increasing the number of
providers available. The goals are to enrich academic and clinical learning experiences that
emphasize knowledge and practice in prevention and health promotion in a medical center that
has a significant history of serving underserved populations. The focus for the medical center
includes pediatric patients, geriatric patients in the ACE unit, patients hospitalized in our
Commission on Accrediting Rehabilitation Facilities (CARF) accredited rehabilitation center and
Shriners Burns Hospital, inpatient Consultation &Liaison services and outpatient clinics for
patients with chronic pain due to chronic medical conditions.
     Expand and support clinical training sites for allied health professionals to medically
underserved populations in order to increase the number of individuals trained. The PCP project
will support four clinical training sites already established at UTMB to include collaborative OT,
PA, and CP mental health services that are provided to underserved populations. In addition, one
additional clinical training site will be established for a population that has not had significant
psychological services at UTMB, the ACE geriatrics unit. This project will train 20 OT students,
40 PA students, and provide support training for 5 CP interns (at 20% or 1 Full-time Effort
[FTE]) which will add to the clinical services provided to community service agencies (CSAs)
that have been established by our currently funded HRSA grant in the Occupational Therapy
department. This project will add clinical experiences for 20 OT students and 40 PA students in
collaboration with the currently funded projects that assign a few students to engage in
community service work. This project will also support UTMB clinical affiliations in pediatrics,
geriatrics, surgery (for chronic medical conditions), and pain management for patients with
chronic medical conditions during this one-year project period.




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Primary Care Psychology                                      Project Director: Baker, Jeff


VI.      CONSOLIDATED BUDGET
VII. DETAILED DESCRIPTION OF PROJECT
    The PCP project responds to local, state, and national needs for PAs, OTs, and CPs,
especially those from underrepresented minority backgrounds who are trained to provide hospital
and community-based mental health services to underserved populations or in underserved
communities. Through continuing clinical services provided to specific inpatient and outpatient
hospital and community services, the PA and OT departments, with the Psychology Resident
Training Program will develop and implement an interdisciplinary PA, OT, and CP curriculum
(clinical psychiatry course). That curriculum will emphasize knowledge and practice in
prevention and health promotion in community-based practice, and with patients that are
predominantly underserved. The students‟ hospital and community service, and their sharing
case-based presentations on those services, will result in enhanced learning and better services to
the community (Eyler, & Giles, 1999). Over a one-year period, 20 OT students, 40 PA students,
and 5 CP interns will participate in HRSA activities in 4 different UTMB hospital services, and
three different community sites in Galveston County.
    The PCP project will also develop joint learning opportunities for PA and OT departments,
and the CP internship program. Over a one-year period, 20 OT and 40 PA students will
collaborate with the five CP interns to provide services to UTMB inpatient and Galveston
community-based mental health services.
    At least three community-based clinical training sites will be used to provide collaborative
PA, OT, and CP mental health services, including those that focus on alcohol and drug recovery,
health promotion, prevocational and vocational skill development, peer resistance and skill
building for youth at-risk, and life skills coaching. These sites are already established as OT and
CP training sites in partnership with CSAs in the city of Galveston (ADA Center, Discovery
Club, Our Daily Bread). Learning activities that span both the OT and PA curriculum as well as
the CP internship program are classes in clinical psychiatry and current involvement in the
Partnerships for Healthy Communities (Partnerships) grant funded by HRSA. Participants from
PA, OT, and CP will interact in the clinical psychiatry course and then participate in delivering
mental health services at our adult rehabilitation center, the Galveston Teen Health Center,
Alcohol & Drug Abuse (ADA) House, Discovery Club (at-risk youth) and Our Daily Bread
(Homeless Shelter). They will discuss their professions‟ unique and collective contributions to
the community-based assessment and service delivery process.
    Through this joint interaction, psychological services from clinical psychology interns,
physician assistant, and occupational therapy students will provide services to patients in the
rehabilitation center, a surgery outpatient clinic, and the community agencies listed above. This
collaboration will enhance interaction among these disciplines, increase psychological services
to underserved populations, and help students develop a better appreciation for patients in need
of psychological services.

   A. PURPOSE, NEED, AND RATIONALE
Demand and Need for Health Professionals
    There are over 10.5 million health professionals in the United States, comprising 7.6% of the
nation‟s total work force. Over 3 million of these health professionals, or 2.2% of the total
national work force, are allied health professionals (U.S. Department of Health and Human
Services [USDHHS], 2000a). Although the health care industry continues to be subject to cost
containment, employment in this industry is expected to increase 26% between the years 1998


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Primary Care Psychology                                       Project Director: Baker, Jeff

and 2008 as compared to the 15% average increase projected across all industries (U.S.
Department of Labor, 2000a). Specifically, the growth in demand for physician assistants
nationwide will increase faster than the current average for primary care (25-35%); the demand
for occupational therapists nationwide will increase faster than average (21-35%), whereas the
demand for psychologists will increase at about average (10-20%). These growth rates translate
into 4,420 average annual openings in the occupational therapy and physician assistant job
market and 2,540 average annual job openings in psychology between the years 1998 and 2008
(U. S. Department of Labor, 2000b). Reasons for these high growth rates include (1) an increase
in the number of individuals living with disability or functional limitations that require therapy,
(2) movement of the baby boom generation into middle age when incidences of heart attack and
stroke increase, (3) rapid growth of the population that is 75 years of age and over, (4) medical
advances that increase the survival rate and need for therapy of people with formerly fatal
conditions, (5) expansion of the school-age population and services for students with disabilities,
(6) increases in employee assistance programs, and (7) increased opportunities in outpatient
mental health and substance abuse treatment programs (U.S. Department of Labor, 2000c).
     The need for additional allied health professionals in Texas has been extensively
documented. Recently, the Center for Rural Health Initiatives, Bureau of State Health Data and
Policy Analysis, Texas Department of Health issued Rural Health in Texas, 1999: A Report to
the Governor and the 76th Texas Legislature. This report indicates that, of the 254 counties in
Texas, the 196 rural counties have a significantly lower provider-to-population ratio for almost
all categories of health care professionals, including occupational therapists and psychologists,
than the 58 urban counties. Additionally, 175 (69%) counties are designated as MUAs. Another
52 counties (20%) have partial county designations as MUAs. In total, 227 of the 254 counties
(89%) have either whole or partial county designations as MUAs (Texas Department of Health
[TDH], 2000a). Another 123 (48%) of the 254 counties in Texas have been identified as Health
Professional Shortage Areas (HPSAs). Thirty-one (12%) of the counties have partial county
designations as HPSAs. A total of 154 (61%) counties have been designated as either whole or
partial HPSAs in Texas (TDH, 2000a).
     Occupational therapists, physician assistants, and psychologists are specifically identified as
among those health professionals that are in short supply in the state of Texas. Although Texas
ranks 23rd in the nation for occupational therapists per capita (USDHHS, 2000a), the fact that
91% of occupational therapists in Texas work in urban counties led the Rural Health in Texas
Report to state that community settings and geographic areas that are underserved by
occupational therapists have the greatest need for occupational therapists (Center for Rural
Health Initiatives, 1999). The report also addresses primary care by physician assistants and
finds a higher percentage practicing in rural areas, but there are more than 25 Texas counties
without a PA or an MD. The report further states that the need for psychologists is also high,
given that 96% of psychologists in the state work in urban counties. Currently, Texas ranks 39th
out of the 50 states for psychologists per capita (USDHHS, 2000a). Because availability of and
access to behavioral medicine/mental health services are significantly limited in rural Texas, one
of the recommendations of this report is that “the availability of behavioral medicine/mental
health professionals to rural citizens in rural areas should be made a priority for health
professionals training programs” (p. xvi).
     The PCP project addresses this recommendation by providing an interdisciplinary learning
environment through the clinical psychiatry course taught by the project director. This will offer
a combined effort for PA, OT, and CP interns, especially those from underrepresented/minority


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Primary Care Psychology                                      Project Director: Baker, Jeff

backgrounds, which will emphasize knowledge and practice in prevention and health promotion.
Through their participation in the proposed project, 20 OT students, 40 PA students, and 5 CP
interns will be better prepared to provide mental health services in underserved areas of rural
Texas.

Towards a Diverse Health Professions Workforce
    Nationally, minority groups are underrepresented in most of the health professions. Allied
health providers are the largest and most diverse constituency within the health care workforce
(USDHHS, 1995), but growing evidence suggests that the number of allied health professionals
from minority backgrounds may not be sufficient to meet future demands of the nation‟s health
care system (Health Systems Research, Inc., 1998). Health professionals from minority
backgrounds comprise less than 10% of the health care workforce, although they make up
approximately 25% of the U.S. population. In 1999, physician assistants, occupational therapists,
and psychologists from minority backgrounds constituted 9%, 11%, and 18% respectively of
their total national professional numbers.
    Graduates from minority backgrounds also earn a disproportionately lower share of
undergraduate degrees when compared with their representation in the population. Collectively,
they earned only 13% of all science and engineering baccalaureates in 1995, although they
constituted 28% of college-age students that year (Kamat, 1999). According to the U.S. Bureau
of the Census, in 1997, Whites led both African-Americans and Hispanics in educational
attainment at the high school and college levels. Moreover, the percentage of African-Americans
and Hispanics earning a BS degree or greater is about half that of Whites (Health Systems
Research, Inc., 1998). In Texas, the higher education student body is becoming more diverse
over time, particularly for community colleges, where the number of African-American and
Hispanic students continues to increase. Since 1986, Hispanics have grown from 15% to 23% of
the student body and African-Americans from 9% to 10% of the student body. Nevertheless, the
diversity of the student body decreases at each step of the educational pipeline as students move
from high school, to community college and/or university, and on to graduate and professional
schools (Texas Higher Education Coordinating Board, 1998).
    Health professions schools have a low enrollment of African-American, Hispanic, Asian and
Pacific Islander, and American Indian/Alaska Native students. Their enrollment is currently 13%
of the overall student enrollment, 12% below the 25% required to reach parity with
representation in the general population. The number of degrees in the health professions
awarded to African-Americans increased from a baseline of 5.0% in the academic year 1985-86
to 5.9% in 1993-94, well below the target of 8.0% set for the year 2000. The number of Hispanic
graduates increased from a baseline of 3.0% for all health professions degrees in 1985-86 to
4.3% in 1993-94, again below the target of 6.4% for the year 2000 (United States Department of
Health and Human Services [USDHHS], 1998). In the academic year 1996-97, 17% of the
occupational therapy degrees and 12% of the psychology doctoral degrees awarded nationally
were to graduates from minority backgrounds (USDHHS, 2000a).
    In contrast to these data, current enrollment figures for PA and OT students and CP interns at
UTMB are presented in the table below. The enrollment figures for PA and OT students from
underrepresented minority backgrounds in the two current classes are 28% and 44%, while
enrollment of CP interns from underrepresented minority backgrounds over the past two years is
29%. These figures indicate that all three of these programs at UTMB have a strong foundation
for recruitment and retention of students and interns from minority backgrounds upon which the


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Primary Care Psychology                                            Project Director: Baker, Jeff

PCP project can build. UTMB has a significant history for recruiting, retaining, and graduating
under represented populations.

                         Enrollment of Students/Interns from Minority Backgrounds
   UTMB Physician Assistant, Occupational Therapy, and Clinical Psychology Programs (1999-2000)
                               Physician Assistant      Occupational Therapy          Clinical Psychology
                             1999         2000           1999           2000         1999             2000
Asian/Pacific Islander       11 (6%)      14 (9%)      6 (13%)         2 (6%)     1 (14.5%)          0 (0%)
Black                        6 (3%)       5 (3%)       7 (16%)        7 (20%)       0 (0%)         1 (14.5%)
Hispanic                     49 (26%)     42 (26%)     7 (16%)        6 (18%)     1 (14.5%)        1 (14.5%)
Foreign                      0            0             0 (0%)         1 (3%)       0 (0%)           0 (0%)
Unknown                      0            0             3 (7%)         0 (0%)       0 (0%)           0 (0%)
White                        122 (65%) 100 (62%)      21 (48%)        18 (53%)     5 (71%)          5 (71%)
Minority Background         66 (35%)     61 (38%)     20 (45%)        15 (44%)     2 (29%)          2 (29%)
Total                       188 (100%) 161 (100%)    44 (100%)       34 (100%)    7 (100%)         7 (100%)

    The factors affecting under representation of students from minority backgrounds in health
professions education are interrelated. There are few role models from minority backgrounds for
students to emulate and scant support networks for promising students at the undergraduate level.
Poor academic and career advising, inadequate academic preparation, lack of accurate financial
aid information, and high competition for admission to health professions schools are significant
barriers to increasing the enrollment of African-American, Hispanic, Asian and Pacific Islander,
and American Indian/Alaska Native students into allied health professions schools. Any attrition
of these students exacerbates the perception that allied health programs are not feasible options
for them. Effective steps to creating a favorable environment for students from minority
backgrounds in health professions include implementation of culturally competent and sensitive
curricula, presence of racially and ethnically diverse faculty and peers to serve as mentors, and
community-based clinical training experiences (Fox, 1999; Wyche, 1995).
    The proposed PCP project addresses the need to increase the number of PA, OT, and CP
program completers from underrepresented minority backgrounds by providing support for
retention of these students and interns through implementation of a more comprehensive skills-
based training curriculum through clinical psychiatry. Support for students and interns from
minority backgrounds will also be provided through the ongoing SAHS STARRS program
funded by the HCOP. The goal of STARRS is to improve the identification, recruitment,
retention, and graduation of individuals from minority/disadvantaged backgrounds within the
SAHS. For more information on the STARRS program, see Institutional Summary and
Resources: School of Allied Health Sciences.

Health Care Goals and Challenges
    Healthy People 2010 (HP2010) has two overarching goals: (1) to increase quality and years
of healthy life, and (2) to eliminate health disparities (USDHHS, 2000b). The first goal targets
increasing the life expectancy and improving the quality of life of individuals of all ages. The
second goal focuses on elimination of health disparities among different segments of the
population. In order to achieve these goals, Healthy People 2010 has organized 467 objectives
into 28 focus areas, including specific goals for each area. Three focus areas are particularly
pertinent to the proposed project: Mental Health and Mental Disorders, Substance Abuse, and
Educational and Community-Based Programs and patients with chronic medical conditions in
our inpatient and outpatient clinics.


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Primary Care Psychology                                      Project Director: Baker, Jeff



     Mental Health and Mental Disorders. A goal of Healthy People 2010 is to improve mental
health and ensure access to appropriate mental health services. Mental illness and/or mental
disorders affect all individuals, regardless of age, race, ethnicity, gender, and educational or
socioeconomic status. Nationally, 22% of the population (40 million people aged 18 to 64 years)
were diagnosed with a mental disorder or a co-occurring mental and addictive disorder, resulting
in direct costs of $69 billion in 1996 (USDHHS, 2000b). In Texas in 1999, approximately 2.94
million people (nearly 1 in 6) were diagnosed with some form of mental illness. Over the past
year, Gulf Coast Center, the state-designated provider of mental health and mental retardation
services in Galveston and Brazoria Counties, reported an average of 2,684 visits per month.
Direct costs of mental illness/mental disorders are estimated at $4.8 billion per year (Texas
Mental Health and Mental Retardation Authority [TXMHMR], 2000). Indirect costs of mental
illness/disorders include school failure, reduced productivity, lost employment, alcohol or illicit
drug use, vehicular accidents, criminal activity, violence, suicide, and homelessness (USDHHS,
2000b; TXMHMR, 2000). In terms of per capita expenditures for mental health services, Texas
is ranked 42nd of the 50 states (TXMHMR, 2000).
     Homelessness is a frequent co-occurring factor with mental illness; 50% to 60% of people
who are homeless are estimated to have comorbid mental and/or addictive disorders (USDHHS,
2000b). Over the past 10 years, service providers have focused on ways to reach people who are
homeless and have mental illnesses in order to connect them to mainstream treatment systems. In
addition to treatment and permanent housing, however, people with mental illness also require
mental health and social supports in the form of case management/service coordination,
supported housing and employment, and other services that will facilitate their ability to function
and thrive in the community (USDHHS, 2000b; TXMHMR, 2000).
     According to the U.S. Census of 1990, the population of the city of Galveston was 59,070.
Approximately 24% of this population had an income below the poverty level (U.S. Census
Bureau, 2000) and 36% of Galveston‟s children lived in poverty (Galveston County Health
District, 1998). The city‟s unemployment rate averaged 10.5%, nearly double the state‟s rate of
5.4%. These statistics indicate a high risk for homelessness in Galveston. The Galveston
Independent School District‟s Program for the Education of Homeless Children (sponsoring
agency of Discovery Club) enrolled 692 students in the 1997-98 school year. This will also serve
as a site to discuss and provide career counseling to students regarding health careers (Kids Into
Health Careers). Our Daily Bread, a Galveston day shelter for people who are homeless, reported
their serving 18,606 meals in 1998 and a steady increase in the number of people seeking their
services. Their staff cited mental illness, substance abuse, and lack of affordable housing as
factors in this increase.
     The PCP project will provide support for the psychology training program to continue to
exist. As all health science centers are facing challenges, UTMB is not unique in this problem.
This funded project will allow the psychology internship to continue to exist as it and all
programs at UTMB are under pressure to prove they are in the top 25% of programs nationally.
The internship program has a strong reputation among clinicians at UTMB, but administration
continues to explore funding options that threaten the removal of under funded programs.
     This project will allow UTMB to expand two current clinical training sites that provide
services for children and adults who are homeless, including those with mental illness
(Discovery Club, Our Daily Bread). In addition, the PCP project will establish a new clinical
training site (in partnership with the ACE Geriatrics Unit) to provide collaborative PA, OT, and


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Primary Care Psychology                                        Project Director: Baker, Jeff

CP mental health services for geriatric patients with mental illness/mental disorders and/or who
have difficulty with their quality of life and adjustment. Through their participation in this
project, 20 OT, 40 PA students, and 5 CP interns, including those from
underrepresented/minority backgrounds, will be trained to provide these services in medically
underserved communities in the future.

    Substance Abuse: Another goal of Healthy People 2010 is to reduce substance abuse to
protect the health, safety, and quality of life for all, especially children. Substance abuse and its
associated problems affect individuals across all racial, cultural, and socioeconomic groups;
together, substance abuse and its consequences are pervasive health and social concerns
(USDHHS, 2000b). Among the over 82 million people (44%) aged 18 years or older in the U.S.
who reported their consuming 12 or more drinks in the past year, about 8 million of these people
(10%) met criteria for a diagnosis of alcohol dependence while an additional 5.6 million people
(7%) met diagnostic criteria for alcohol abuse. In Texas, these figures are almost reversed: 5% of
Texans surveyed in 1996 met diagnostic criteria for alcohol dependence, while 11% met criteria
for a diagnosis of alcohol abuse (Maxwell, 2000). Illicit drugs were used by 13.6 million people
(6.2%) aged 12 years and older nationwide in 1998. Among adolescents aged 12 to 17, drug use
doubled from 5.3% to 11.4% in the five years between 1992 and 1997. Direct costs of substance
abuse in 1995 were $276 billion, more than $1000 per person in the U.S. Indirect consequences
include lost workplace productivity, crime, child abuse, domestic violence, homicide, suicide,
high-risk sexual behavior, and injuries/deaths from vehicular accidents, falls, fires, and
drownings (USDHHS, 2000b).
    Galveston and Brazoria Counties accounted for 16.2% of statewide admissions to substance
abuse treatment facilities that were licensed by the Texas Commission on Alcohol and Drug
Abuse in 1998 (TCADA, 2000). In that same year, there were 313 substance-related deaths in
these counties. In 1995, Galveston Independent School District reported that 35% of its seventh
graders indicated that they had used alcohol in the previous month, 12% indicated marijuana use,
and 19% indicated cigarette use. Statewide, these percentages were 24% for alcohol use, 6% for
marijuana use, and 16% for cigarette use. These percentages for substance use by youth
approximately doubled for both the city of Galveston and Texas by twelfth grade (Galveston
County Health District, 1998). Taken together, these figures are indicative of the numbers of
children, adolescents, and adults at risk for or in recovery from substance abuse in the city of
Galveston as well as Galveston and Brazoria Counties.
    Strategies to prevent and treat substance abuse among youth include raising awareness;
education, including parent education; developing social skills; learning peer resistance skills;
building psychosocial skills and confidence; providing alternative activities; and employing
environmental approaches. In general, effective substance abuse prevention and intervention
relies on access to services that are culturally, linguistically, and developmentally appropriate
(USDHHS, 2000b). Also needed are programs that provide general education, job training, and
employment, parenting education, and services for women, people with dual diagnoses of
substance abuse and mental illness/disorder, and people with learning disabilities. Community
partnerships and having “buy-in” from local participants enhance the success all of these
approaches.
    The PCP project will support the current clinical training sites (ADA Center, Discovery Club,
Our Daily Bread) and establish one new clinical training sites (in partnership with the ACE
Geriatrics Unit at UTMB) to provide collaborative psychological services from PA, OT, and CP


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Primary Care Psychology                                      Project Director: Baker, Jeff

mental health services for children, adolescents, and older adults at risk for or in recovery from
substance abuse. Through their participation in this project, 20 OT students, 40 PA student, and 5
CP interns, including those from underrepresented/minority backgrounds, will be trained to
provide these services in medically underserved communities in the future.

   Educational and Community-Based Programs: A goal of Healthy People 2010 is to increase
the quality, availability, and effectiveness of educational and community-based programs
designed to prevent disease and improve health and quality of life. This goal is based on the
understanding that the health of a community is dependent on not only its individual members‟
health, but also physical and social aspects of the community itself. Health status disparities
persist in racially and culturally diverse populations when compared to the overall U.S.
population (USDHHS, 2000b). As the national population continues to become more racially and
ethnically diverse, the need for prevention and health promotion programs specifically tailored to
individual communities will also increase. Community health promotion and community-based
programs are most successful when they involve many components of the community, including
government agencies, educational institutions, faith organizations, health care organizations,
voluntary agencies/non-profit agencies, and the public. Equally important is the establishment of
partnerships among these community components that enables their full participation in the
needs assessment, planning, implementation, and evaluation of these programs (USDHHS,
2000b). The need for community-based programs is recognized by the Center for Rural Health
Initiatives in its report, Rural Health in Texas, 1999. The report recommends that community
education efforts should be coordinated “by state agencies to produce more effective ways to
better educate rural citizens, communities, and service users about health related topics and
services. Education should include assistance in developing healthier lifestyles as a goal to
reduce health care related costs” (p. xvi).
   The PCP project will serve as an innovative model that links PA, OT, and CP clinical
practice, education, and research in an interdisciplinary clinical practice setting and experiences
that emphasize prevention and health promotion in community-based and medical inpatient
services including mental health services. This model will develop partnerships among a
geriatric primary care unit (ACE Geriatrics Unit), an educational institution (UTMB PA, OT, and
CP programs), and non-profit agencies (local CSAs, including ADA Center, Discovery Club, and
Our Daily Bread).

   Texas Challenged: Diversity and Growth. Texas is the second most populous state in the
nation, with almost 21 million current residents (Hedges, 2000). It is also one of the country‟s
most diverse states. In 1998, 42% of the state‟s population consisted of minority groups; the
remaining 58% was White (TDH, 2000a). Minority groups accounted for 37% of Galveston
County‟s population and 31% of Brazoria County‟s in 1997. The city of Galveston has an even
greater diversity with 50% of its population in minority groups (29% African-American; 21%
Hispanic); the remaining 50% consists of the category of Other, including White (Galveston
County Health District, 1998).
    Over the past decade, the Texas population has grown 22.8%. By 2020, the population is
projected to increase another 28% (USDHHS, 2000a). Assuming a growth pattern consistent
with 1980 and 1990 figures, the state‟s population will reach 33.8 million by the year 2030. This
projected growth rate carries with it significant changes in the ethnic make-up of the state. In
terms of population diversity, between 1990 and 2030, the Hispanic population is expected to


                                                17
Primary Care Psychology                                      Project Director: Baker, Jeff

increase by 250%, the African-American population by 60%, and the category of Other by 648%
(the Anglo population, however, is expected to increase by only 20%). Nearly 90% of the
projected growth in the Texas population will be due to growth in minority population groups.
By 2030, minority groups will make up 63% of the state‟s population, with no one minority
constituting a majority (Murdock, Hoque, Michael, White, & Pecotte, 1997).
    With this change in demographics come challenges in providing health care. Minority groups
in Texas are more likely than Anglos to have difficulty accessing the health care system (TDH,
1995). These difficulties may be physical, financial, bureaucratic, or cultural. Physical barriers
include geographical isolation and the concomitant lack of available services and transportation;
these barriers are most dramatic in rural areas and affect all rural residents. The Office of
Minority Health and Cultural Competency, Texas Department of Health states that development
of community-based interventions, with community input and participation, is critical to
achieving one of the overarching goals of Healthy People 2010, elimination of health disparities
among minority and disadvantaged segments of the population (TDH, 2000b).
    The PCP project, in partnership with the HRSA grant funded to address local communities
and their service agencies in the city of Galveston, will expand and develop clinical training
experiences for PA, OT, and CP inpatient services for medical populations and mental health
services in three clinical training sites, including those that serve populations from
underrepresented minority backgrounds. The 20 OT students, 40 PA students, and 5 CP interns
who participate in the PCP project will be better prepared to plan, develop, and deliver these
hospital and community-based services in diverse and medically underserved communities in the
future.

Community Mental Health Services
    Community mental health began as a political movement in response to the traditional
psychiatric practice of placing people with mental illnesses or disorders in institutions far
removed from their home communities. As a model, community mental health emphasizes
delivery of services in the community and identifies the community itself as in need of change,
not solely the individual (Barris, Kielhofner, & Watts, 1988). Community mental health is best
described as “an organized, planned approach to mental health issues, built on an understanding
of the structure and needs of a particular community, the acceptance by the community of
responsibility for the mental health of all its residents, and the involvement of the community in
the development and implementation of easily accessible preventive, curative, and rehabilitative
mental health services” (Shore, 1992, p. 257). This change in focus in most industrialized,
Western countries over the last three decades from institutionalized services to
deinstitutionalization and community-based services (Lyons, 1995) was welcomed by
psychiatrists, psychologists, social workers, nurses, occupational therapists, and community
mental health advocacy programs (Barris, Kielhofner, & Watts, 1988). Since 80% of
psychopharmaceuticals are prescribed by primary care practitioners, it only follows that PAs
practicing in rural Texas will be relegated a significant part of this clinical responsibility.
    Unfortunately for community mental health services in the U.S., the Community Mental
Health Centers Act of 1963 never realized its full promise of a new approach to mental health
service delivery. This was partially due to its reliance on traditional, biomedical models of
practice (Barris, Kielhofner, & Watts, 1988; Jeger, 1980), and political opposition and resistance
related to its being perceived as a socialized federal health care program (Perry, Albee, Bloom, &
Gullotta, 1996). Similarly, OT and CP community mental health services failed to achieve their


                                               18
Primary Care Psychology                                      Project Director: Baker, Jeff

full potential because of their tendency to cling to the biomedical model, thereby limiting the
scope and content of the services they provided to those that are supported by this model (Bloom
& Parad, 1978; Kleinman, 1992; Sarason, 1976).
    During this period, Australia, Britain, and Canada were more successful than the U.S. in
developing and implementing community-based health services. This success was shaped and
reinforced by health care reforms and cost containment in all three countries during the 1980s
and 1990s (Cameron & Masterson, 1998; Hebert, Thibeault, Landry, Boisvenu, & Laporte, 2000;
Scaletti, 1999). Similar demands for reform and cost containment in the U.S. over the past
decade have led to renewed calls for community-based delivery of health services (Andrulis,
Acuff, Weiss, & Anderson, 1996; Baum & Law, 1998; Reppucci, Woolard, & Fried, 1999). OT
and CP educators in the U.S. can benefit from lessons learned by their counterparts in Australia,
Britain, and Canada on how to prepare their graduates for today‟s changing workplaces.

Identified Gaps in Health Professions Education
     PA‟s, OT‟s, and CP‟s changing workplaces, as they move from institutions to hospitals and
communities, place significant demands on their educational programs. Traditionally, their
education has been based on behavioral and biomedical models supported by knowledge from
biological and medical sciences. If PA, OT, and CP are to successfully transition to hospital and
community practice, new educational models are needed (Baum & Law, 1998; Blanch, 1995;
Lysack, Stadnyk, Paterson, McLeod, & Krefting, 1995; McColl, 1998; Perry, Albee, Bloom, &
Gullotta, 1996). These new models must facilitate students‟ abilities to provide clinical health
psychology services in hospitals and community settings as well as to problem solve, think
critically, and deal with diversity (Brown, 1997; Lysack, Stadnyk, Paterson, McLeod, &
Krefting, 1995; McColl, 1998; Shugar, O‟Neill, & Bader, 1991). A review of the literature
revealed the following gaps in current PA, OT, and CP educational curricula related to
graduates‟ preparation for their delivery of community-based mental health services to culturally
diverse populations in underserved areas.

   Preparation for Interdisciplinary Teamwork: Professional practice in hospital and community
settings places unique demands and strains on interdisciplinary teamwork and interprofessional
role relationships. Some of these issues involved include unclear service territories and
professional boundaries (Yau, 1995), lack of awareness of other health professionals‟ functions
and contributions to the team (Taylor & Rubin, 1999), strong adherence to individual
professional cultures (Peck & Norman, 1999), the need for interprofessional collaboration for
effective service delivery (Taylor & Rubin, 1999), and lack of confidence and assertiveness in
professional identity, roles, and functions (Lysack, Stadnyk, Paterson, McLeod, & Krefting,
1995; Peck & Norman, 1999). To better prepare health professionals for hospital and
community-based practice, educational opportunities at UTMB will be provided through the
clinical psychiatry course taught by the Project Director and will provide opportunities for these
students to interact together as they learn about each other‟s roles and functions and provide
individual and interdisciplinary services.

   Clinical Training Experiences: Clinical training experiences in community settings were
identified as essential for preparation of PAs, OTs, and CPs for community practice (Blanch,
1995; Lysack, Stadnyk, Paterson, McLeod, & Krefting, 1995; Lyons, 1995). A major obstacle to
students‟ participation in community clinical training experiences is the shortage of PAs, OTs,


                                                19
Primary Care Psychology                                      Project Director: Baker, Jeff

and CPs working with medical populations in the hospital and mental health services for
community populations who are available to provide clinical training sites. The primary
objective of a clinical experience is student learning; the primary beneficiary is the student.
   Educational curricula that address these gaps in health professions education are consistent
with one of the recommendations from the Report of the National Committee on Allied Health
(USDHHS, 1995). The PCP project will develop and implement an interdisciplinary curriculum
and experiences for PA and OT students and CP interns that address the three gaps in educational
curricula related to provision of medical patients in hospital and mental health services in
community-based services as discussed above: interdisciplinary interaction through course work,
preparation for interdisciplinary teamwork, and clinical training experiences. In particular, this
project will be responsive to the needs of the emerging health care system and promote
competent and multi-competent health professionals through its expansion of the
interdisciplinary and core curricula of the UTMB PA, OT, and CP programs through the clinical
psychiatry course taught by the principal investigator to each of these disciplines.

Linking Clinical Practice, Education, and Research in the Community
   The clinical practice of psychology traditionally has been associated largely with mental
health and continues to be in the public‟s image of the field. UTMB has broadened that
definition and currently has integrated into a number of medical services that address the role of
psychology in primary health care. A number of medical services have identified that
psychologists trained in the science and measurement of human behavior can make a major
contribution in the assessment of health care outcomes. UTMB is preparing psychologists for
primary health care service (assessment, intervention, and consultation), teaching, research, and
administration as active members of the primary care interprofessional team. Using the 1998
Project on Managed Behavioral Health Care and Primary Care titled Interpersonal Health Care
Services in Primary Care Settings: Implications for the Education and Training of Psychologists,
UTMB has structured psychology rotations in a wide variety of medical settings for both
inpatient and outpatient medical care. Ninety five percent of psychology training at UTMB takes
place outside of a psychiatric setting.
    Practice, education, and research can be linked in hospital and community-based PA, OT, and
CP services. Practice-based inquiry (Hoshmand & Polkinghorne, 1992), using an
interdisciplinary interaction through the clinical psychiatry course, provides a process to combine
education, research, and collective action to help solve problems in each community agency or
site. Using a case based curriculum in clinical psychiatry in which general lessons are learned
from specific cases, theory can be built, concepts can be operationalized, and comparisons can be
developed, through repeated case applications (Greenwood, Whyte, & Harkavy, 1993). Lessons
learned from one community-based site can be combined and synthesized with lessons gained
from other sites to develop a model that links practice/action, education, and research in a
community context.
    The PCP project‟s use of the interdisciplinary approach to link PA, OT, and CP clinical
practice, education, and research in its interdisciplinary PA, OT, and CP service learning (SL)
coursework and patient contact addresses one of the recommendations from the Report of the
National Committee on Allied Health (USDHHS, 1995):
    Recommendation 11: Allied health educational programs at all levels and in all settings
should collaborate with each other and with other health professions to create a broader and
more effective educational system. The development of partnerships within educational


                                                20
Primary Care Psychology                                       Project Director: Baker, Jeff

institutions and with the health services industry should prepare practitioners to meet workforce
demands and maximize resources.
   A pertinent action for this recommendation follows:
    Health professions educational programs should develop models that unify academic and
         clinical experiences and promote research projects to evaluate the efficacy and
         effectiveness of such models.

   B. OBJECTIVES
Objective 1
   To develop the interdisciplinary clinical psychiatry course for UTMB PA and OT students,
and CP interns, especially those from underrepresented minority/disadvantaged backgrounds.
Course content will emphasize knowledge and practice in prevention and health promotion in
medical psychology for inpatient services and CSAs. This will increase the number of PA
program completers, OT program completers, and CP program completers practicing in
underserved areas or choosing affiliation placements in underserved areas (20 OT and 40 PA
students and 5 CP interns over a one-year period).

Objective 2 (HP2010)
   Support a joint PA, OT, and CP training experience emphasizing knowledge and practice in
case based learning for prevention and health promotion in inpatient work and CSAs that will
increase the number of OT and PA program completers to choose rural affiliations and CP
program completers, especially those from underrepresented minority/disadvantaged
backgrounds, choosing practice or choose an affiliation in underserved areas. (20 OT, 40 PA, and
5 CP interns over a one-year period)

Objective 3 (HP2010)
   Use multiple clinical training sites at UTMB and in the Galveston community (Rehab Center,
Surgery outpatient, Cancer outpatient, Shriners Burns Hospital, Children‟s Hospital and CSAs:
ADA Center, Discovery Club, and Our Daily Bread) to include collaborative PA, OT, and CP
mental health services provided to underserved populations. Such use will help increase the
number of OT students/interns and CP interns, especially those from underrepresented
minority/disadvantaged backgrounds, trained to provide these services in underserved areas in
the future.

Objective 4
   Establish a new clinical training site, in partnership with the ACE unit in Geriatrics, to include
collaborative PA, OT, and CP mental health services provided to underserved populations in
order to increase the number of PA, OT, students and CP interns, especially those from
underrepresented minority/disadvantaged backgrounds, trained to provide these services in
underserved areas in the future.

Objective 5 (HP2010)
    Establish the PCP project as an innovative model using a case based approach that links PA,
OT, and CP clinical practice, education, and research in an interdisciplinary curriculum and
training experiences that emphasize prevention and health promotion in hospital and community-
based practice.


                                                 21
Primary Care Psychology                                              Project Director: Baker, Jeff



Objective 6
   Evaluate the PCP project to determine its achievement of its goals and objectives for the
purposes of future planning, budgeting, and sharing experiences with other educators and health
care professionals for this one-year program.


     National Workforce Goal I: Improve access to quality health care through appropriate preparation,
     composition, and distribution of the health care workforce.


        BHPr Outcome               BHPr Indicators            Applicant Objective           Applicant Indicators
         Objectives

     Prepare an appropriate    Number of graduates and /    20 occupational therapy      Number of occupational
     number of allied health   or program completers        completers, 40 physician     therapy and physician
     professionals necessary   that support primary care.   assistant program            assistant completers that
     to support primary                                     completers and 5 clinical    choose rural affiliations and
     care.                                                  psychology program           clinical psychology program
                                                            completers will be           completers each year that
                                                            prepared during this one     choose to work in rural or
                                                            year to provide hospital     work with underserved
                                                            and community-based          populations.
                                                            mental health services.
     Increase the number of    Number of graduates and /    20 occupational therapy      Number of occupational
     graduates and/or          program completers who       completers, 40 physician     therapy and physician
     program completers        enter practice settings      assistant completers and 5   assistant completers that
     practicing in             serving underserved areas.   clinical psychology          choose rural affiliations and
     underserved areas.                                     program completers will      clinical psychology program
                                                            have a minimum of 2          completers each year who
                                                            community experiences        accept post docs or clinical
                                                            and 1 hospital experience    affiliations serving
                                                            during the year. Funding     underserved areas.
                                                            will be sought for
                                                            additional program
                                                            support and another
                                                            outcome would be to
                                                            measure that 10 OT, 20
                                                            PA, and 3 CP completers
                                                            (50% for each program)
                                                            will go into hospital or
                                                            community based practice
                                                            in underserved areas.


     National Workforce Goal II: Improve access to a diverse and culturally competent health professions
     workforce
        BHPr Outcome               BHPr Indicators            Applicant Objective           Applicant Indicators
         Objectives
     Increase in the number    Number of minorities         Recruit and retain one       Number of minority faculty
     of minority faculty.      serving as faculty.          minority faculty member      members at the Allied
                                                            in occupational therapy,     Health School.



                                                      22
Primary Care Psychology                                             Project Director: Baker, Jeff


     National Workforce Goal II: Improve access to a diverse and culturally competent health professions
     workforce
        BHPr Outcome              BHPr Indicators             Applicant Objective            Applicant Indicators
         Objectives
                                                           physician assistant studies,
                                                           or clinical psychology
                                                           during the grant project
                                                           period.
     Increase in the number   Number of minority /         Increase the number of         Number and percent of
     of minority /            disadvantaged program        minority / disadvantaged       minority / disadvantaged
     disadvantaged program    completers.                  occupational therapy,          occupational therapy and
     completers.                                           physician assistant            physician assistant program
                                                           program completers and         completers and clinical
                                                           clinical psychology            psychology program
                                                           program completers to          completers.
                                                           complete a rural, primary
                                                           care, or hospital setting in
                                                           an underserved area by
                                                           10% from previous year
                                                           baseline.


   C. METHODOLOGY
1. Approach

Objective 1: Support an interdisciplinary curriculum through the clinical psychiatry course for
UTMB PA and OT students, and CP interns, especially those from underrepresented
minority/disadvantaged backgrounds. The course content and activities would emphasize
knowledge and practice in prevention and health promotion in inpatient services and CSAs,
through which we will increase the number of PA, OT, and CP program completers choosing
clinical affiliations, postdoctoral study, or practices in underserved areas.
   Interdisciplinary activities will be combined for the first time by putting the OT and PA
students together in the same class that previously had two different clinical psychiatry courses.
This will increase interdisciplinary interaction during the one-year grant. The knowledge and
skills acquired in these courses will be directed at case based study with requirements for
community-based psychology and direct experience with underserved populations on the Adult
Rehabilitation Unit, selected outpatient clinics, and the ACE Geriatrics Unit. The
interdisciplinary experiences will also occur in CSAs where PA and OT students and CP interns
provide actual services and will receive feedback on the impact of their services. Participants
will have the opportunity to reflect on their experiences during class and case based discussions
and computer-based documentation, and through interactions with peers, faculty supervisors, and
CSA staff and clients.
   Activity 1.1: (Fall Semester) Create a collaborative environment by combining the PHAS
5323 and OCCT 3207 Clinical Psychiatry courses. This will now be a combined interdisciplinary
course for Physician Assistant and Occupational Therapy students. The component will include a
requirement to provide 15 hours of direct service in one of the three existing CSA sites (ADA
House, Our Daily Bread, and Discovery Club) and/or the adult rehabilitation center, the ACE
(geriatrics) Unit. Students in this course will also be required to complete the MMSE (Folstein
MiniMental Status Exam) and the HADS (Hospital Anxiety and Depression Scale) for inpatients


                                                      23
Primary Care Psychology                                     Project Director: Baker, Jeff

on the Adult Rehabilitation Center and the ACE Geriatrics Unit. Clinical Psychology interns will
provide the supervision and feedback for their participation for both the CSAs and the hospital
based clinical experience.
 Identify CSAs and assign PA and OT students to exposure to unique underserved
    populations.
 Supervise student/intern groups as they conduct assessment, and plan, implement, and
    evaluate services with clients.
 Incorporate weekly patient case based teaching regarding the major common problems in
    community and hospital based experiences into the CP course, in which PA, OT, and CP
    participants share and process the experience and discuss the clinical psychology cases which
    are unique and also provide case based information on depression, anxiety, personality
    disorders, and Chronic Medical Conditions.
   Activity 1.2: (Throughout the year) CP Interns will provide psychological services to patients
in adult rehabilitation, outpatient surgery clinics, and inpatient medical psychology patients.
Conduct a case-based seminar throughout the year for interns to learn from one another by
assigning three case presentations each for discussion and review.
   Activity 1.5: (Throughout the Year) Implement a mentorship program through which
heterogeneous groups of CP interns can receive mentoring from Rehabilitation Science faculty
and expand cultural diversity, sensitivity, and competence with working with these populations.

Objective 2 (HP2010): Develop a clinical experience for the PA, OT, and CP internship
program emphasizing knowledge and practice in prevention and health promotion to underserved
populations in our clinical affiliations at UTMB and in CSAs. This clinical experience will
increase the number of PA, OT, and CP program completers who choose a rural or health
psychology rotation, especially those from underrepresented minority/disadvantaged
backgrounds, practicing in underserved areas.
   Activity 2.1: Require 20 OT students and 40 PA students per year to begin practicing their
mental health clinical skills in the adult rehabilitation unit or one of the CSAs, through group
activities or one-on-one client interaction. Students will receive supervision from psychology
interns regarding patient interviewing and assessment of basic psychological functioning by
using the MMSE (MiniMental Status Exam) and the HADS (Hospital Anxiety and Depression
Scale) during the fall Semester.
   Activity 2.2: Recruit a total of five CP interns per year for the internship program that will
participate in the Community and Health Psychology rotations.
   Activity 2.3: Implement collaborative internship and student activities, as follows:
 Assign PA, OT, and CP intern groups that will work collaboratively to deliver services with a
    ratio of one CP intern per 10 OT students and 20 PA students.
 Create clinical experiences where PA, OT, and CP work together to deliver structured
    assessment instruments and improve basic counseling skills to patients from under
    represented populations.
 Facilitate information sharing via documentation of clinical activities at CSAs and UTMB
    inpatient and outpatient services.
 Assign one case presentation per group, in which each student shares his or her unique
    perspectives of the same clients/groups at a given site but from different disciplines.
   Activity 2.5: Supervise PA, OT, and CP interns as they provide weekly collaborative mental
health services to the CSAs. PA, OT, and CP interns will collaboratively conduct needs


                                               24
Primary Care Psychology                                      Project Director: Baker, Jeff

assessments, and plan, implement, and evaluate services at each CSA. PA, OT, and CP interns
will work under the supervision of the Project Therapist and the Director of Psychology Resident
Training Program.

2. Timetable
   The table below indicates the timetable for students‟ and interns‟ participation in the SL
curriculum and joint internship program. Across the course of one calendar year, approximately
20 UTMB OT and 40 PA students will participate in SL activities in the clinical psychiatry
course in the Fall Semester as part of their academic education. Five CP interns will participate
in both SL and internship activities concurrently in a seamless fashion across three four-month
rotations throughout the year. Each CP intern will dedicate two days a week to community-based
practice in the CSAs. Approximately 20 OT and 40 PA students will have participated in the
interdisciplinary curriculum; five CP interns will have participated in both the curriculum and the
internship program.

                                 Timetable for Objectives 1 and 2
     Aug            Sep Oct Nov Dec     Jan      Feb   Mar      Apr      May       June      July
    OT & PA
Interdisciplinary
    Activities
 Psych Course
   CP Interns
    Supervise
    OT & PA
    Students
                                      Provide
                                       Psych
                                      Services

Objective 3 (HP2010): Introduce CSA clinical training sites (ADA Center, Discovery Club, and
Our Daily Bread) to include collaborative PA, OT, and CP mental health services provided to
underserved populations. This will increase the number of OT and PA students and CP interns,
especially those from underrepresented minority/disadvantaged backgrounds, trained to provide
these services in underserved areas in the future.
   Activity 3.1: Expand and support current PA, OT, and CP sites to offer collaborative PA, OT,
and CP ongoing mental health services under project personnel supervision. This will be
accomplished through the following:
 Assessment of mental health of inpatients on the rehab center, spine surgery clinic,
    anesthesiology pain clinic and provide support for CSA problems identified by OT/CP
    HRSA grant that can be addressed more effectively through collaborative PA, OT, and CP
    services.
 Refine and continue the development of collaborative service goals and activities.
   Activity 3.2: Implement and supervise students‟ and interns‟ ongoing service development,
provision, and evaluation through the clinical psychiatry course and mental health assessment in
the above named sites.




                                                  25
Primary Care Psychology                                       Project Director: Baker, Jeff

Objective 4: Establish one new clinical training site, in partnership with ACE Geriatric Service,
to include collaborative PA, OT, and CP mental health services provided to underserved
populations in order to increase the number of PA, OT, students and CP interns, especially those
from underrepresented minority/disadvantaged backgrounds, trained to provide these services in
underserved areas in the future.
    Activity 4.1: Identify and develop one new clinical training site through the ACE Geriatric
Center internship and clinical psychiatry course case based experiences. The process for
developing clinical training sites will be based on that which was used to develop current CP
clinical sites at UTMB:
 Identify and secure collaborative agreement with the geriatric inpatient service ACE (Acute
     Care for Elderly) whose mission aligns with the PCP project.
 Supervise interns as they conduct a comprehensive needs assessment of the site and the
     geriatric members that it serves. This includes meeting with current staff to discuss and
     review epidemiological data; review of the goals of the agency; survey and interview to
     ascertain aspirations of staff, clients, and where possible, family members; participant
     observation of daily activities at the ACE; and environmental assessment at the ACE.
 Oversee development of planning and implementation of services.
 Supervise and assist interns, OT, and PA students with evaluation of service provision.
 Provide opportunities for reflection on clinical experiences, with peers, with staff, and with
     project personnel through the clinical psychiatry course.
    Successful hospital based sites for PA, OT, and CP activities and joint collaboration of PA,
OT, and CP internships.

Objective 5: Establish the PCP project as an innovative model using the clinical psychiatry
course to provide PA, OT, and CP collaborative clinical practice, education, and research in an
interdisciplinary course (curriculum) and a joint clinical experiences that emphasize prevention
and health promotion in inpatient and community-based practice.
   Activity 5.1: Create case-based inquiry assignments for PA, OT, and CP intern groups to
complete during the course/internship. Each assignment will include the following. Through
collaboration with clients and staff:
 Identify problems to be addressed by the hospital clinical site, or in the community.
 Develop an action plan that the PA, OT, and CP groups can facilitate as a solution to this
    problem.
 Implement the action plan.
 Evaluate the effectiveness of the action plan.
   Activity 5.2: Require PA, OT, and CP intern groups to submit their work for presentation
during the clinical psychiatry course and encourage presentations at professional forums.
   Activity 5.3: Describe a transcendent model of case-based inquiry, using an interdisciplinary
approach, drawing from the OT, PA, and interns‟ work. This process will include identification,
synthesis, and articulation of themes that characterize the process, attitudes, and values of case-
based inquiry in this context during the course.
   Activity 5.4: Develop a method to evaluate case-based inquiry in this context by identifying
variables, both quantitative and qualitative, on which future evaluation of the model can be
based.




                                                 26
Primary Care Psychology                                      Project Director: Baker, Jeff

Objective 6: Evaluate the PCP project to determine its achievement of its goals and objectives
for the purposes of future planning, budgeting, and sharing experiences with other educators and
health care professionals.
   Activity 6.1: Identify and/or develop curriculum suggestions to be used to collect quantitative
and qualitative data on summative indicators of student/intern learning and effectiveness of
academic and clinical experiences.
   Activity 6.2: Determine criteria of success for project‟s summative benchmarks,
collaboratively among the Evaluation Consultant, project personnel, medical personnel, and CSA
participants.
   Activity 6.3: Conduct formative evaluation of processes used to implement Objectives.
   Activity 6.4: Conduct summative evaluation of outcomes of Objectives.

Objective 7: Disseminate the PCP project as a model project to increase the number of PA, OT,
and CP program completers choosing hospital, community-based prevention and health
promotion services in underserved areas and to link PA, OT, and CP clinical practice, education,
and research in community-based practice.
   Presentations at professional meetings and publications in professional journals remain a
powerful tool in the dissemination process. The principal investigator in this project grant has
made over 50 presentations at professional meetings and published more than 25 journal articles.
   Activity 7.1: Submit at least one proposal for presentation of posters to professional
organizations such as Division 22 Rehabilitation Psychology APA, Society of Behavioral
Medicine, Division 43, Family Practice, Division 54 Pediatric Psychology, or Division 12
Clinical Psychology.
    Activity 7.2: Submit manuscripts describing various aspects of the PCP project for
publication in PA, OT, CP, community mental health, education, and allied health journals such
as Journal of Occupational Therapy, Journal of American Academy of Physician Assistant.
   Activity 7.3: Publicize the learning opportunities offered by the PCP project to potential PA,
OT, and CP internship applicants via the UTMB Department of Physician Assistant Studies,
Occupational Therapy, and the Psychology Resident Training Program‟s websites.
   Activity 7.4:
   The participants on this project identified on page 37 identifies the project personnel
responsible for each activity and the time frame for its implementation.

3. Evaluation
   Three ultimate outcomes of this project will be (1) increased numbers of PAs, OTs, and CPs
prepared to provide mental health services to support primary care, (2) increased numbers of
PAs, OTs, and CPs practicing (choosing clinical rotations) in underserved areas, and (3)
increased numbers of PA and OT program completers and CP program completers from
minority/disadvantaged backgrounds. Program completers of the PCP project will be better
prepared to provide culturally competent and sensitive PA, OT, and CP mental health services to
Texans living in medically underserved communities. These outcomes will be achieved through
development and implementation of an interdisciplinary PA, OT, and CP clinical psychiatry
course and a combined PA, OT, and CP internship clinical experience in inpatient and CSAs
emphasizing prevention and health promotion providing services to underserved populations.
   Summative evaluation of the overall outcomes of this project will consist of collection and
analysis of the following data: (1) numbers of OT and PA participating in rural clinical


                                               27
Primary Care Psychology                                     Project Director: Baker, Jeff

affiliations and CP program completers prepared to support primary care, (2) numbers of PA and
OT program completers and CP program completers who enter practice in underserved areas,
and (3) numbers of PA, OT, and CP program completers from underrepresented minority
backgrounds. See BHPr goals, objectives, and indicators.
   Summative evaluation of the integrated clinical psychiatry course will include indicators of
student/intern learning and effectiveness of academic and clinical experiences. Measures are in
place to evaluate and document the learning activities on the adult rehabilitation unit and
geriatrics unit. In addition, web-based note documentation forms for PA, OT, and CP interns are
automatically submitted to a database form and will be evaluated to focus on identifying
student/intern perceptions of their learning and their experiences in the PCP project. Specific
indicators of learning are revealed through this analysis that includes pre and posttests using
surveys that will be identified or developed and employed to capture these indicators
quantitatively.
    Quantitative measures of student/intern learning will consist of classroom case based
discussions and exams for PA and OT clinical psychiatry students after their participation in
either the integrated clinical psychiatry course. Student/intern learning related to multicultural
competence will be measured using the Multicultural Sensitivity Scale (Jibaja, Sebastian,
Kingery, & Holcomb, 2000). See Appendix E for a copy of this scale.
    As described above, other surveys or instruments will be identified or developed as indicators
are uncovered through the intensive course experience. For example, a one page of a survey
adapted to capture changes in beliefs, attitude, and knowledge about homelessness (Toro &
McDonell, 1992). The PA, OT, and CP interns‟ learning in the clinical training sites will also be
measured using the peer evaluation form that identifies the case presenters skill and knowledge
of certain psychological disorders, assessment techniques, and patient background history.
    Quantitative measures of effectiveness of student/intern academic experiences in the
integrated course and the joint clinical experiences will include SAHS academic course
evaluations completed by students. The PA, OT, and CP interns will complete training site
evaluations as a measure of effectiveness of their clinical experiences, including the supervision
that they receive during their internships. The Departments of Physician Assistant Studies and
Occupational Therapy, and the Psychology Resident Training Program have training site
evaluations already in use in their individual programs. Additional evaluations of the
collaborative PA, OT, and CP clinical training sites have been developed and are ready for use.
External measures of effectiveness of clinical experiences in the community-based training sites
will consist of surveys developed for CSA staff and clients from the original HRSA joint grant
for CP and OT students.

D. DISSEMINATION OF OUTCOMES

Outcomes for this project will be submitted for publication, scientific presentations, and poster
presentations at national meetings such as American Psychological Association (APA), Division
22 of APA, Rehabilitation Psychology, Society of Behavioral Medicine (SBM) and state
psychological meetings.




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Primary Care Psychology                                       Project Director: Baker, Jeff


E. RESOURCES
1. Institutional Resources
    The PCP project aligns with the values, visions, and missions of UTMB and the SAHS.
UTMB‟s core values of service, innovation, community, diversity, and education are central to
the PCP project‟s unique approach, which combines service and learning in hospital and
community-based, culturally diverse settings. This approach also resonates with the SAHS vision
statement that supports its faculty members‟ use of (1) interdisciplinary learning to develop a
team approach, (2) non-traditional methods to produce quality health professionals, and (3)
current technology to facilitate student learning. The proposed project‟s unique approach also
has a good fit with both UTMB‟s and the SAHS‟s missions of promoting scholarly teaching,
innovative scientific investigation, and state-of-the-art public service through its efforts to link
clinical practice, education, and research. This project is particularly well suited for a recent
initiative in the SAHS. IDEAL, a school-wide interdisciplinary initiative, aims to ensure that all
SAHS graduates are proficient in basic areas related to practice that are common to all health
professions, such as cross-cultural competence, legal and ethical issues, research, management,
critical thinking, communication, and professional role development. These areas align with the
goals and objectives of the PCP project.

University of Texas Medical Branch
    The University of Texas Medical Branch, situated on the eastern end of Galveston Island, is
the oldest medical school in Texas. UTMB consists of four schools and two institutes: the
Graduate School of Biomedical Sciences (GSBS), the School of Allied Health Sciences (SAHS),
the School of Medicine (SOM), the School of Nursing (SON), the Marine Biomedical Institute,
and the Institute for the Medical Humanities. It is one of 14 components of The University of
Texas System, which includes four Health Science Centers.
     Education, patient care, and research are three primary goals of UTMB. The GSBS offers
MS and PhD programs in nearly all of the biomedical sciences. The school also offers advanced
degrees in nursing, the allied health sciences, the medical humanities, and a combined MD/PhD
program with the medical school. The SAHS offers bachelor‟s and master‟s degrees through its
programs of clinical laboratory sciences, health promotion and clinical gerontology, occupational
therapy, physical therapy, physician assistant studies, and respiratory care. It also provides
training to pre-doctoral clinical psychology interns through its Psychology Resident Training
Program. UTMB‟s SOM offers a four-year curriculum leading to the doctor of medicine degree.
The SON offers BS, MS, and PhD degrees. The total student population at UTMB is
approximately 2000, of which 38.45% are students from underrepresented minority
backgrounds.
    Since UTMB is the state's only multicategorical health referral center, it receives patients
from all over Texas. UTMB has 950 beds in its seven hospitals and 89 outpatient clinics. Each
year, it treats approximately 36,000 inpatients, 207,000 outpatients, and 61,000 emergency cases.
It is the only general medical referral center for unsponsored patients in Texas and for
Department of Justice and Corrections prison inmates. In dedication to excellence in research,
UTMB has devoted approximately 212,000 square feet of its space to research. During the past
fiscal year, the University received more than $100 million in federal and private funds to
support about 400 extramural research and training projects.
    The community served by UTMB encompasses not only Galveston and its immediate
environs, but also the entire Gulf Coast and the lower Rio Grande Valley regions. As a facility, it


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Primary Care Psychology                                      Project Director: Baker, Jeff

is active in addressing all rural and minority health issues. Outreach clinics and consultation
visits take UTMB experts across the state. Continuing education is delivered regularly to a cross-
section of health care professionals in Texas hospitals. There is particular institutional concern
with education and placement of personnel in underserved areas of Texas. Special emphasis is
placed on programs that decrease health professional shortages in MUAs and HPSAs.
Agreements with colleges, schools, school districts, hospitals, health care centers, councils, and
societies statewide assist UTMB in maintaining its health care and educational roles.

School of Allied Health Sciences
   Established in 1968, the UTMB SAHS was the first school for allied health professionals in
the southwest United States. The SAHS offers 2+2 programs that lead to Bachelor of Science
degrees in clinical laboratory sciences, occupational therapy, and respiratory care as well as a
Master of Science degree in cooperation with the GSBS, with concentrations in health promotion
and clinical gerontology. This master‟s degree program is being phased out and is no longer
accepting students. A master‟s degree in Physician Assistant Studies is available, and a three-
year program of study leads to the Master of Physical Therapy (MPT) degree. The SAHS exists
to serve its students. Great pride is taken in our student body, and admissions committees strive
to admit the most qualified applicants. Each entering class represents diversity in educational,
socioeconomic, and cultural backgrounds.
   Strategies & Techniques Applied to Recruit & Retain Students (STARRS). The STARRS
Project (an HCOP Program) involves five disciplines (clinical laboratory sciences, occupational
therapy, physical therapy, physician assistant studies, and respiratory care) and faculty and
resources from three primary institutions (UTMB at Galveston with cooperative programs at the
University of Texas El Paso and the University of Texas Pan American in Edinburg, Texas). In
addition, ten feeder institutions participate in various aspects of the STARRS Project. The goal of
the STARRS Project is to improve the identification, recruitment, retention, and graduation of
individuals from underrepresented minority/disadvantaged backgrounds.
   Recruitment Programs maximize established feeder-school networks at college/universities
with minority enrollments of 50% or more. The goal is to increase applications from students
from underrepresented minority/disadvantaged backgrounds to the SAHS programs.
   Alternate Track Programs are available to applicants from underrepresented
minority/disadvantaged who were reviewed and denied standard admission into SAHS programs.
The program supports students who are academically, personally, and professionally successful –
and who would not have had the opportunity to prove themselves any other way.
   Academic Enrichment Programs/Application Workshops are conducted four times per year.
Students from underrepresented minority/disadvantaged backgrounds participate in the three-day
programs, including mock interviews, review of the application process, test taking skills, study
skills assessments, community orientation, and financial aid workshops.
   Early Acceptance Programs are designed to identify competitive students from
underrepresented minority/disadvantaged backgrounds with a focused interest in health careers at
the early college level. Based on specific criteria, these students are granted non-competitive
entry into the professional allied health programs. In addition, they participate in developmental
programs designed specifically for them before their enrollment in the SAHS.
   Early Enrollment Programs are conducted for accepted students from underrepresented
minority/disadvantaged backgrounds. A two-week program includes seminars on time
management, stress management, study skills, test taking, and writing skills; individual study


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Primary Care Psychology                                       Project Director: Baker, Jeff

habits are assessed and feedback is given to each student. Faculty and student groups assist in
acclimating Early Enrollment participants to the UTMB campus.
   Comprehensive Retention and Academic Support Services are provided throughout the
academic year by HCOP project staff. Peer tutors are provided along with ongoing structured
workshops for enrolled students from underrepresented minority/disadvantaged backgrounds.
Time management and study skills are provided as well as ongoing advising and counseling.
   Health Professions Advisor Conferences are for faculty and staff from feeder institutions. The
conferences focus on professional program requirements, admission and application procedures,
financial aid, and academic/retention services.
   Learning Resource Center. The Learning Resource Center (LRC) offers a variety of
innovative media/multimedia resources to students, faculty, and staff of the SAHS and SON,
including print material, computer programs, video programs, slides, and audio cassettes. The
facility includes study rooms, computer labs, e-mail and Internet access, copy machines, and
duplication areas. In addition, the LRC provides audiovisual, technical, graphics, photographic,
and video services to faculty and staff of the two schools. LRC staff members work closely with
faculty, students, administrators, and staff providing leadership in the use of educational
technologies and multimedia to increase teaching effectiveness and support the educational and
research environments of the two schools.

2. Organization and Administration
Psychology Resident Training Program
    The PCP project will be administered, housed, and coordinated through the Psychology
Resident Training Program (PRTP) in the SAHS. The UTMB Pre-Doctoral Psychology
Resident Training Program (PRTP) is designed to develop a psychologist's competency as a
practitioner and a scientist, a combination of skills in practice and research. This program is open
to CP interns nationwide. UTMB places an emphasis on clinical training, but research and
practice in health care settings are also important components of the training program. The
internship year is an opportunity for trainees to refine and apply previously acquired skills and to
obtain new skills, all under the supervision of licensed psychologists. The breadth and quality of
psychological services on the UTMB campus allows the interns to attain proficiency in several
areas and to experience exposure to a variety of training and service delivery opportunities.
UTMB has a diverse client population with training opportunities in many settings, including
inpatient and outpatient pediatric and adult psychiatry, inpatient clinical neuropsychology and
rehabilitation, outpatient pediatric rehabilitation, inpatient and outpatient pain management,
inpatient adult rehabilitation, and a children‟s‟ burn hospital. The current capacity of this
program is seven interns per year. The PCP project, if funded, will increase this support the
program by providing stipends of 25% for 5 of the 7 interns that will be directly involved in this
training grant. The remaining stipends and additional two interns will continue to be supported
by UTMB departments until Graduate Medical Education (GME) funds are made available for
application under the CMS (formerly Health Care Finance Administration HCFA) criteria. A
psychology postdoctoral program exists on the campus and has recently been organized and is
undergoing a self-study for application to APA Commission On Accreditation (COA) for review
in 2003.




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Primary Care Psychology                                      Project Director: Baker, Jeff


Department of Occupational Therapy
   The teaching goal of the Department of Occupational Therapy is to educate occupational
therapists who are able to meet the health needs of all segments of society as members of health
care teams in existing and emerging practice settings. The Department seeks to meet this goal by
inspiring students to acquire a broad understanding of the occupational nature of people,
wellness, the meaning and consequences of compromised capacity in a person‟s life, and the
dynamic quality of systems. In addition, the Department aims to facilitate students‟ acquisition
of an attitude of inquiry and commitment to lifelong learning, a dedication to the pursuit of
knowledge in the service of understanding the role of occupation in health and life satisfaction,
an appreciation of underlying professional values, and sensitivity to cultural differences. The
department demonstrates its commitment to diversity and inclusiveness through its active
recruitment of all students, regardless of race, ethnicity, gender, class, sexual orientation, and
disability.
   History of OT SL Activities. The Department of OT‟s Service Learning activities grew from
Assignment: Community, a pilot project conducted in 1998. In the context of OT courses in the
summer and fall semesters of that year, 40 students worked in small groups to conduct needs
assessments and develop and implement ten-week long health promotion programs for six
different CSAs. These in-class projects were completed during the fall semester of 1998.
Program expansion was made possible by a $50,000 grant from the Harris and Eliza Kempner
Fund. In 1999, we established partnerships with three of the agencies (ADA Center, Boys and
Girls Club, and Our Daily Bread) and extended the program so that OT services would be
provided year-round, rather than for only 10 weeks. In order to offer year-round services, an
occupational therapist was hired to develop and implement services at each site, to supervise
students during their in-class 10-week health promotion projects, and to supervise full time OT
interns during their 3-month long internships in the spring and summer semesters of 2000. In
2000, we obtained an additional $30,000 grant from the Eliza and Harris Kempner Fund, which
covers approximately 50% of the current Project Therapist‟s salary and benefits for this year; the
remainder is paid by the Department of OT.
   The PCP project builds on this solid foundation by expanding our capacity to offer a wealth
of new experiences, activities, and programs in the following ways. First, in keeping with best
practices, the integrated clinical psychiatry course will be incorporated into the PA and OT
curriculum. Supervision of community and hospital based clinical experiences will be provided
by the psychology interns during the clinical psychiatry course, not as an add-on but as an
integration in the curriculum. Second, the PCP project will be an interdisciplinary and
collaborative program for OT and PA students and CP interns. Third, specific curricular content
and experiences in prevention and health promotion in hospital based health psychology and
community-based practice, cultural competence, and interdisciplinary teamwork will be
developed and implemented. Finally, three clinical training sites will be made available to
increase clinical experiences for first year students to participate in the current psychology
rotations while expanding to one new clinical training site in which collaborative PA, OT, and
CP hospital and community-based mental health services will be provided through this
interdisciplinary course.

The Department of Physician Assistant Studies
The Department of Physician Assistant Studies is located at the University of Texas Medical
Branch (UTMB) in Galveston, Texas. The program‟s mission is to recruit, enroll, and graduate


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Primary Care Psychology                                        Project Director: Baker, Jeff

an academically, talented group who reflect the cultural, ethnic, and socio-economic diversity of
the population of the state of Texas and who will demonstrate a commitment to practice and
promote primary care medicine especially in partnership with the communities in rural and
underserved areas. The curriculum provides opportunities in clinical practice, research, and
professional services progressing from didactic courses (42 credit hours) to clinical rotations (54
credit hours). It integrates small group activities, distance learning, and an in-depth study into the
evidence-based medicine, problem-solving approach to clinical cases and patient care issues into
PA student education. The training program provides students with the basic knowledge and
skills necessary to practice as a primary care physician assistant. The master‟s level degree
curriculum is designed in a 4+2 format (four years of liberal arts or sciences and pre-professional
bachelor‟s studies followed by two years in the physician assistant program). Upon completion
of the curriculum, a master‟s degree in physician assistant studies is awarded. In support of its
mission, the program has maintained an excellent record for recruitment and retention of students
with an overall enrollment history of 1,158 students. Current enrollment is 104: 47 first-year, 46
second-year students, and eleven 3-year track students. The overall program attrition rate since
1971 is only six percent. With continued emphasis and awareness on minority recruitment and
student retention. Program enrollment reflects an overall minority enrollment since 1971 of 286
or 25%. Thirty-four percent of the candidates in the 2002 interview pool were minority and/or
disadvantaged, and enrollment projections for entering minority and/or disadvantaged students in
June 2002 is 47%. Current enrollment (2001-02) for first-year, 3-year track, and second-year
(clinical) students is 34 minority students (32%). Alumni records indicate a total of 223 minority
students have graduated (23%) from the UTMB program. Comparison of the training program's
figures to national numbers consistently indicates more impressive ratings, e.g., enrollment 35%
to 25%, and graduation 40% to 17%. Likewise, the program continues to maintain over 150
quality-training affiliations at off-campus sites (physician offices, hospitals, clinics, and other
health agencies) statewide. A primary interest and focus of the program is to continue to
establish and maintain sites in the underrepresented areas, especially East and South Texas.
Overall, 38% of the program‟s off-campus sites are in the South Texas area, and 13% are in the
East Texas area. The program also has a community-based satellite clinical year program in
Victoria, Texas that offers continuous clinical training for three to five second-year students
annually, and has implemented a similar model in Rio Grande City. The department receives
funding from a federal training grant, and major activities of the current proposal include: (1)
implementation and management of clinical year training options at community health clinics in
critically underserved areas and Texas border towns; (2) continued efforts and activities to
recruit, enroll, graduate, and mentor underrepresented and disadvantaged individuals; (3) a
curriculum component and theme focused upon didactic and clinical training in geriatric
medicine; and (4) establishment and utilization of advanced computer technology to educate,
link, and communicate with trainees and supervisors.

Equal Access and Compliance
    UTMB is committed to health care, education, and research efforts on behalf of all
individuals representing diverse societal groups. These efforts particularly extend to those groups
who are traditionally underrepresented. In 1994-95, the American Association of Medical
Schools listed UTMB‟s faculty and student groups at the 85-90 percentile in terms of under-
represented minority groups. UTMB‟s rich and unique multicultural clinical population also
contributes to the study of minority health issues. To meet the needs of its diverse community,


                                                 33
Primary Care Psychology                                       Project Director: Baker, Jeff

the SAHS makes a special effort to attract faculty and students with disabilities and variety in
their racial and/or ethnic background, and those who are mature and/or beginning second careers.
     The Project Director will strictly adhere to UTMB non-discrimination policies (7.1.10,
2.12.2) in the administration of this project: No person, in whatever relationship with the
University of Texas Medical Branch at Galveston, shall be subject to discrimination on the basis
of age, creed, color, disability, national origin, race, religion, gender, and marital or veteran
status.
     Faculty and Student Access. The UTMB/SAHS commitment to access of service for all is
represented across campus. The Office of Multi-Cultural Affairs, in conjunction with the
University Counseling Service, provides special assistance for all students to determine
educational and career interests, needs, and goals. Students seeking new directions are assisted
through individual counseling, interest testing, group workshops, and referral. Staff are sensitive
to problems of returning adult/mature students and students from minority backgrounds. They
provide assistance with admissions, registration, financial aid, and child care. Staff also conduct
workshops in the areas of vocational/life planning, mid-career evaluation, and coping with
student/worker/family roles.
     The Project Director will strictly adhere to UTMB‟s Americans with Disabilities Act (ADA)
policies (7.1.1, 2.12.1). These policies direct faculty, staff, and students in meeting the mandates
of this law and provide structure to the process of making necessary accommodations for persons
with disabilities. The UTMB Office of Affirmative Action helps students, faculty, and staff with
disabilities by providing campus orientation, academic advising, faculty consultations, special
parking facilities and permits, building access, elevator keys, and housing. Also available is
information on community services for people with disabilities, proxy registration procedures,
recording of textbooks, and guides to barrier-free routes/access to buildings. In support of
educational opportunities and advancement for students and faculty, UTMB policy mandates that
its libraries provide assistance for persons with disabilities. Study carrels and a Special Services
Resource Room equipped with assistive technology are available. Other services include adapted
food service/housing facilities; support services such as interpreters; adaptive equipment for
recreation, athletics, and entertainment; and individual counseling and career advisement.

Self-Sufficiency
   The SAHS at UTMB has a successful history of institutionalizing previous activities and
programs associated with federal funding. HCOP-funded educational and student support
programs developed between the years 1984 – 1990 in the SAHS Office of Student Affairs to
recruit, retain, and graduate students from underrepresented minority/disadvantaged backgrounds
have been successfully integrated into the academic infrastructure of the SAHS and UTMB.
Examples of activities include Introduction to Health Professions Workshops, Health Careers
Clarification Workshop, Introduction to the Application Process Workshop, Counselor and
Advisor Conferences, and student retention activities (tutoring, study skills, etc.). The Alternate
Track Program is one of the most successful examples of previous HCOP programs that have
been institutionalized in the SAHS. This program has been effective in introducing over 90
students from minority/disadvantaged into allied health programs. The graduation rate of these
students has been greater than 95%, which has equaled or surpassed the graduation rates for
students completing the regular admissions process. The principal investigator of this project,
though not the principal investigator on the HCOP project, has been integral to the success of the




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Primary Care Psychology                                      Project Director: Baker, Jeff

HCOP project as a primary consultant in the design and development of the HCOP project in
1982 and 1984-1990.
    A second previously federally funded program that has been successfully integrated into the
SAHS academic infrastructure is the Health Information System Simulation (HISS) project.
Funded by the Bureau of Health Professions over the years 1991-1997, the HISS project teaches
problem-solving skills to SAHS students using computer technology. This project is currently
integrated into SAHS curricula. A third previously funded HRSA program that has been
integrated into the SAHS academic infrastructure is the Laboratory Education and Advancement
Project (LEAP) in the Department of Clinical Laboratory Sciences (CLS). This project was
designed to develop and implement distance education for medical laboratory technicians and
other laboratory personnel in the rural east and Gulf coast areas of Texas. Distance education is
now regularly offered as an alternative to on-site education in the CLS department. Finally, an
interdisciplinary geriatric health promotion elective course, which was developed and evaluated
by SAHS faculty in the departments of Health Promotion and Gerontology, Occupational
Therapy, and Physical Therapy with the support of funding from the Bureau of Health
Professions over the years 1995-1998, continues to be offered on a regular basis as a school-wide
elective. This course is another example of the School‟s commitment to institutionalizing
externally funded programs into its infrastructure. Another recently funded program by HRSA
provides a program to train OT and CP students in community settings. This grant does not fund
stipends for CP interns and the submission of this grant is to assist with the funding of stipends.
The programs will support each other in both their mission and several shared clinical sites. The
current grant will financially support the psychology intern program student stipends and will
expand services to training PA students and inpatient services for elderly, pediatrics, and
rehabilitation patients.
     The costs for this project are associated with the development, implementation, evaluation,
and dissemination of the PA, OT, and CP SL curriculum and clinical experiences; health
promotion, hospital and community-based practice; and a web-based module on cultural
competence. Costs will also be incurred for the expansion of three existing clinical training sites
to include collaborative PA, OT, and CP services; establishment of an additional inpatient
service at the ACE Geriatrics Unit; and development and dissemination of a model to link
clinical practice, education, and research using the integrated curriculum approach. We are
seeking support through this grant application for $112,000 for a one-year project period. As an
indication of our commitment to this project, we are contributing a total of $107,000 in-kind
from our institutional funds, or close to 50% of the project‟s total costs.
     The Dean of the SAHS, Dr. Charles Christiansen, has indicated in his support letter that the
establishment of the PCP project is well aligned with UTMB and SAHS initiatives for
interdisciplinary education. Additionally, the Department of Occupational Therapy is currently
designing an entry-level Master‟s degree in OT curriculum projected to admit its first students in
fall of 2003. The PCP project is only one year long but will apply for continuing funding if
eligible and will be integrated into this new degree program as the Bachelor of Science degree in
OT is phased out, in accordance with the mandate of the American Occupational Therapy
Association‟s Accreditation Council for Occupational Therapy Education. Therefore, all project
activities should be supported with state funds by that time. The Physician Assistant Program is
currently a master‟s level program, which was initiated as a BS degree program in 1968 and
transitioned to a master‟s program in 2001. The project director for the PCP program has
extensive involvement with implementing these types of grants as he worked at Southern Illinois


                                                35
Primary Care Psychology                                        Project Director: Baker, Jeff

University and was extensively involved in the Medical Education Preparatory Program
(MEDPREP) program from 1974-1978 as a graduate student and later an instructor for the
School of Medicine Minority Enrollment program. This program continues as a successful
model. In addition, he has a history with UTMB and worked as a consultant in 1982 to write the
current model for recruitment and retention of allied health minority and disadvantaged students;
he was hired full-time in 1984. His current involvement with the program is minimal beyond
advisement and consultation of enrolled and early admission students. The project director has
over 10 publications and presentation related specifically to recruitment and retention of minority
and disadvantaged students dating from 1976 through 2001.


3. Faculty and Support Personnel
   This project requires personnel who are knowledgeable and experienced in clinical psychiatry
for PA, OT, and CP education and providing hospital and community-based services. All project
personnel are well qualified to carry out their responsibilities related to this project.

Faculty Member              Academic   Area of Degree         Area of Responsibility
                            Degree
Jeff Baker                  Ph.D.      Psychology             Project Director, Training Director, Instructor,
                                                              Clinical Supervisor/Faculty
Sheryl Bishop               Ph.D.      Stats & Measurement    Program Design & Evaluation/Faculty
Dru Copeland                Ph.D.      Psychology             Clinical Supervisor/Preceptor
Vera Gonzales               Ph.D.      Psychology             Clinical Supervisor & Multicultural Issues/Faculty
Freddy Paniagua             Ph.D.      Psychology             Multicultural Coordinator/Faculty
Loree Primeau, OT           Ph.D.      Occupational Therapy   Coordinator for OT Students/Faculty
Richard Rahr, Ed.D., PA-C   Ed.D.      Physician Assistant    Coordinator for PA Students/Faculty
Rhonda Robert               Ph.D.      Psychology             Clinical Supervisor/Preceptor
Susan Rosenthal             Ph.D.      Psychology             Coordinator for Pediatric Experiences/Faculty

    Project Director: Jeff Baker, PhD (50% FTE Requested). Qualifications: Dr. Baker is
Chief Psychologist and Director of Training for UTMB‟s Psychology Resident Training
Program. He is an associate professor and Acting Chair in the Departments of Health Promotion
and Gerontology, a Clinical Associate Professor of Orthopaedic Surgery and Rehabilitation,
Chief Psychologist for the Anesthesiology Pain Clinic, the Internal Medicine Irritable Bowel
Syndrome (IBS) Clinic, and Orthopedics Spine Surgery Clinic and the Director of Counseling
and Student Services for the SAHS at UTMB. He is an accomplished professional, earning his
PhD and EdS from Southern Illinois University at Carbondale. He also holds an MA in
Psychological Counseling from Southeast Missouri State University. Dr. Baker is responsible for
supervision of psychology residents, conducting psychological evaluations and treatment
programs, crisis intervention, counseling, and psychotherapy. He is currently a board member of
the Association of Postdoctoral and Psychology Internship Centers (APPIC). He has also been an
active member of the Medical and Professional Staff Advisory Board for Texas MHMR and
served as the Chair of the prescription medication task force for the State of Texas MHMR.
    Project Responsibilities: Dr. Baker will be responsible for the overall operation,
implementation, evaluation, and dissemination of the project. He will provide the coordination
required to teach students in the clinical psychiatry course and supervise interns, develop and
implement the curriculum and the multimedia delivery system used in the web-based courses,
supervise project personnel, manage the budget, assure that the proposed objectives and methods


                                                    36
Primary Care Psychology                                       Project Director: Baker, Jeff

of this proposal are carried out, and prepare grant progress reports. He will also participate in and
supervise the activities related to the development of the model of practice-based inquiry that
will link PA, OT, and CP clinical practice, education, and research using a participatory action
research approach.
    Loree Primeau, PhD, OTR (5% FTE Requested). Dr. Primeau is the Chair and Program
Director of the Department of OT at UTMB. She earned her PhD in Occupational Science from
the University of Southern California and is a licensed OT in Canada and the U.S. Prior to her
appointment as Chair in 1998, Dr. Primeau was an Assistant Professor in the School of OT,
Dalhousie University, Halifax, Nova Scotia. She has over 20 years of experience working with
children, adolescents, and adults with psychosocial problems in a variety of community settings.
Her experience in the Canadian health care system and its shift to community practice brings a
unique perspective to this project. To date, she has received over $80,000 to support the current
OT SL activities. She also has three years experience in federal grant-related work through her
employment as Project Specialist and Grants Manager in Los Angeles. Her research experience
includes qualitative studies of child and family health, including her doctoral research on work
and play in families, which was recognized for its academic excellence. She has supervised a
total of 13 honors baccalaureate research projects, many of which were outcome evaluations of
community services.
    Project Responsibilities: Dr. Primeau will recruit, supervise, and evaluate the OT students.
She is also responsible for administration of the OT curriculum and participation in the program.
    Richard Rahr, EdD PA-C (5% FTE Requested). Dr. Rahr is a tenured professor and chair
of the Department of Physician Assistant Studies at the School of Allied Health Sciences. Dr.
Rahr„s early training began as a radiologic technologist; however, he soon went on to complete a
bachelor of science degree in zoology from the University of Texas at Austin. In 1973, he
entered the physician assistant program at UTMB, and received a Bachelor of Science degree in
health care sciences and a certificate of proficiency in internal medicine. In 1981, he completed a
master‟s in business administration with a minor in health care administration from the
University of Houston at Clear Lake. In 1987, he obtained a doctorate in education in allied
health administration from the University of Houston and Baylor College of Medicine.
   Dr. Rahr has been involved in education and administration since 1967. He has served as
chair of the physician assistant department at UTMB since 1982. During this time, he has
achieved national and state recognition for his contributions to the training and education of
physician assistants. He has been recognized as a forerunner in PA distance education primarily
through his involvement and management of the cooperative training program at UT Pan
American at Edinburg. In addition, he was recognized as the National PA Educator of the Year
by the American Academy of Physician Assistants in 2000 for his outstanding teaching and
leadership accomplishments. In addition to his numerous teaching and leadership awards, he
serves on the editorial board of a national journal, is an accreditation consultant and team
member, a grant reviewer for the Department of Health and Human Services, and a member of
the UT system faculty advisory committee. Dr. Rahr is active in both professional and
community affairs. He has served as president of both the national physician assistant program
organization and the state allied health society. He currently serves as president of the UTMB
faculty senate. Dr. Rahr‟s research interests give emphasis to learning styles, geriatric medicine,
physician assistant education, and student recruitment and retention.
    Project Responsibilities: Dr. Rahr will recruit, supervise, and evaluate the PA students. He
also will be responsible for administration of the PA curriculum and participation in the program.


                                                 37
Primary Care Psychology                                       Project Director: Baker, Jeff

    Susan Rosenthal, PhD (10% FTE Requested) Dr. Rosenthal is Professor in the Department
of Pediatrics. She has published extensively in adolescent health, is a national leader in research,
grant activity, and patient education for children and adolescents regarding sexual behavior and
prevention of disease.
    Project Responsibilities: Dr. Rosenthal will assist in recruitment, supervision, and evaluate
the CP pediatric psychology students.
    Freddy Paniagua, PhD (5% FTE Requested). Dr. Paniagua is a full professor in the
Department of Psychiatry with extensive writing and experience in working with patients from
underserved populations and severe mental illness. Currently he serves as the Minority Affairs
committee for the APA and is also the Associate Director for UTMB‟s Postdoctoral Psychology
Fellowship. In addition, he is a primary supervisor for the American Psychological Association
accredited Psychology Internship training program at UTMB. His experience and research have
been instrumental to the success of UTMB‟s recruitment and retention of underrepresented
populations in the psychology internship program. He provides an annual training seminar that is
highly valued by every trainee that has participated in the event.
    Project Responsibilities: Dr. Paniagua will provide the direction for a better understanding
of cultural aspects of training and working with individuals who have had difficulty accessing
mental health care.
    Psychology Residents (Interns): TBA (20% FTE Requested). Five of the seven UTMB
Psychology residents will receive funding support at a rate of 25% to provide direct services in
the community health settings and the UTMB hospitals in pediatrics, geriatrics, adult
rehabilitation, cardiothoracic surgery, and anesthesiology pain clinic. Two will be in the Clinical
Health track; two will be in the pediatric psychology track and one will be in the rehabilitation
psychology track. This will allow us to expand our internship program by one FTE.
    Project Responsibilities: The UTMB psychology residents will provide supervision to the
PA and OT students in the clinical psychiatry course, community based settings, and adult
rehabilitation center to provide assessment and direct services to the above-mentioned clinics in
health promotion and prevention to assist in implementing the Healthy People 2010 objectives.
   Sheryl Bishop, PhD (5% FTE requested). Dr. Bishop is an associate professor in the
Department of Preventive Medicine and Community Health (PMCH). Her expertise is in the
statistical analysis and data measures for qualitative and quantitative evaluation.
    Project Responsibilities: Dr. Bishop will serve as an independent evaluation consultant and
will be responsible for designing and developing the evaluation process. She will work with the
Project Director and other project personnel to develop criteria for success and she will assist
with summative evaluations. Dr. Bishop‟s consulting work will provide both on-site review of
the program and ongoing consultation to the program by telephone and electronic media.

4. Facilities and Equipment
   Moody Medical Library. The library maintains annual subscriptions to 2,400 scientific and
technical journals and acquires approximately 1,000 monographs and texts each year. It houses a
substantial audiovisual collection and electronic information resources, including standard
biomedical databases that may be searched by remote access. Primary information resources, in
the form of books and journals, and secondary information resources, in the form of indexes and
abstracts, are available. The library also provides a wide range of educational programs,
including use of local electronic information systems and use of external information resources




                                                38
Primary Care Psychology                                      Project Director: Baker, Jeff

such as those found on the Internet. All schools and departments have telephone, facsimile, and
e-mail access to the Library.
   Academic Technology Center. The Academic Technology Center (ATC) in the Moody
Medical Library offers multimedia support to UTMB faculty and staff in the design and creation
of educational materials in a range of digital formats. To fulfill this goal, the ATC provides
several services: access to the hardware and software necessary to design and create multimedia
resources for teaching and learning; consultants in the design, creation, and delivery of
customized multimedia; evaluation of new and emerging technologies for use in educational
media; education of the UTMB community in the potential and practicality of implementing new
and emerging technologies; and multimedia production support services.
   Office of Multicultural Affairs. The mission of the Office of Multicultural Affairs at UTMB is
to enhance and facilitate diversity in students, faculty, and staff. Clifford W. Houston, PhD, the
Director of the Office of Multicultural Affairs, was appointed in May 1991 to a new institutional
administrative position as Assistant Vice President for Multicultural Affairs at UTMB. Since that
time, the office has implemented and enhanced a number of novel, highly effective programs
directed toward students from underrepresented groups: (1) establishment of a science education
program for K-12 students in Galveston county schools, (2) assistance in the recruitment of
underrepresented students, residents, postdoctoral fellows, and faculty, (3) promotion of a better
appreciation for the value of cultural diversity through campus-wide special presentations, and (4)
development of scholarships as a recruitment and retention tool. Dr. Houston presently is Associate
Vice President for Multicultural Affairs. He was appointed by the Chancellor of the UT System in
1996 to chair the system-wide Committee on the Advancement of Minorities.
   Office of the Vice President for Research. The mission of the Office of the Vice President for
Research is to facilitate academic research through fostering seamless interaction among faculty,
administration, and the research service departments. With this interaction, this Office plays an
essential role in enhancing research resources, enabling UTMB to reach its research goals and
increase its state and national visibility. The office provides services and products that enable
UTMB research faculty to be more competitive in obtaining external funding. This goal is
accomplished through enhanced communication, identification of funding opportunities,
education and grant proposal development, and other services.

Community And Institutional Partners
ACE Geriatrics Unit. The ACE (Acute Care for Elders) Unit at UTMB is a unique service that
recognizes hospitalization can be an overwhelming experience for older adults and their families.
Frail elders in hospitals are especially vulnerable to unexpected events such as side effects from
medicines, complications from procedures, and loss of physical or mental strength. Research
shows that many complications, such as acute confusion, can be prevented when older adults are
cared for by hospital staff with expertise in aging. At UTMB, unlike most hospitals, we have an
inpatient unit devoted to the care of older adults. The ACE Unit has a team of providers who are
experts in geriatrics (the branch of medicine that deals with aging) and available to see patients
every day. The team consists of social worker, physical and occupational therapists, dietician and
pharmacist. This grant will fund an introduction to psychological services support from
psychology interns, OT, and PA students focusing specifically on quality of life and adjustment
to hospitalization and behavioral consequences.




                                                39
Primary Care Psychology                                      Project Director: Baker, Jeff

Adult Rehabilitation Center. This CARF accredited 16 bed facility has an average daily census
of 13.7 patients and is staffed by psychology interns providing psychological services for
evaluation and treatment of patients in the process of rehabilitation. The adult rehab center is an
established training site for psychology interns and the clinical psychiatry course will provide a
training site for the OT and PA students enrolled. The facility provides a full range of
rehabilitation services including Occupational Therapy, Physical Therapy, Speech and Language
Therapy, Recreational Therapy, as well as nursing and medical care provided by 3 MDs and 1
PA. This project will provide OT and PA students additional insight into the mental health
services provided to patients in the process of rehabilitation. The majority of their time will be
used to introduce them to basic psychological assessment and therapy for adjustment, health and
behavior assessment, and brief interventions for mild to moderate anxiety and depression related
to a chronic medical condition or trauma.

Alcohol/Drug Abuse (ADA) Women’s Center. ADA Center provides Galveston County
women, who lack financial resources, with licensed, residential substance abuse treatment at no
cost to the client. An intensive twenty-eight day treatment program, with an additional extended
program for eligible clients, is available. Chemical dependency education and treatment
addresses the issues of relapse prevention, relationships, parenting, and physical and emotional
health. The 12-step and personal social adjustment training models are used. ADA provides a
structured program to assist in building or rebuilding healthy relationships with family, friends,
and employers. ADA reports that 70% of its graduates maintain sobriety after treatment.

Anesthesiology Pain Clinic. This rotation is similar to the Spine Surgery Clinic though none or
very few of these patients are eligible for surgery. Many times these patients have failed back
syndrome in which they have no fewer than three low back surgeries, none with much success.
In conjunction with the anesthesiologists, psychology provides psychological pain management.
In addition, some patients are considered for interthecal pumps or dorsal cord stimulators. All of
these patients are required to participate in psychological evaluation to address secondary gain
issues and psychological intervention to treat chronic pain.

Cardiothoracic Surgery: This clinical affiliation provides research and clinical experiences for
UTMB psychology interns. We are in the process of collecting data to establish a brief
intervention model of psychological intervention to address coping skills, quality of life, and
supportive therapy. An NIH grant with the principal investigator has been submitted to support
and refine this training model. This project will incorporate a case based approach to include
patients that have these type of injuries or conditions (lung cancer, etc) as part of the health
promotion related to healthy behaviors as well as addressing patients that have few resources to
address psychological treatment. Coping skills are addressed along with spirituality and other
community based interventions. Patients are evaluated perioperative and followed while in the
hospital as part of the C&L service and again seen again during their follow-up appointments.
Preliminary data suggest that hospital length of stay (LOS) and narcotic use are increased for
patients that do not have adequate coping skills or have elevated anxiety and depressive
symptoms.

Children’s Hospital: This hospital provides care to children with chronic medical conditions as
well as acute problems. The focus in psychology is assessment and treatment of children with


                                                40
Primary Care Psychology                                       Project Director: Baker, Jeff

developmental and traumatic injuries. The facility is one of the UTMB hospitals that is a
multicategory treatment facility for the state of Texas. This facility has a pediatric rehabilitation
unit that is an established training site for UTMB psychology interns. This project will add a case
based study in the clinical psychiatry course that addresses children‟s issues with rehabilitation
and psychological assessment and treatment.

Discovery Club: Discovery Club is an after-school and summer program for city of Galveston
students, Pre-Kindergarten through Grade 12, who are homeless. It offers a safe environment for
these students that promotes positive social experiences and supports their academic
performance. The Discovery Club is sponsored by the Galveston Project for the Education of
Homeless Children, which addresses problems interfering with a child‟s ability to attend school
because of housing difficulties. Case management services, emergency clothing, school supplies
and emergency medical and dental care are also offered.

Nursing Program: This experience includes providing support services to nursing students who
are at risk due to a large number of sociological factors including non-traditional aspects such as
late career decider, single mothers, poverty, and minority and disadvantaged backgrounds. This
project is currently funded by the state of Texas to increase nursing practitioners and includes a
role for UTMB psychology interns that provide psychological assessment and evaluation of
students who have learning difficulties. In addition, a weekly support group will be provided to
this non-traditional set of students.

Our Daily Bread: Our Daily Bread, founded in 1986, provides daily services to men, women,
and children in the city of Galveston who are homeless. While helping them to identify the
underlying problems contributing to their homelessness and a plan of action to solve these
problems, day shelter, first aid, and nutritional support are offered. Additionally, clothing,
personal hygiene supplies and facilities, educational groups (addiction, recovery, and living
skills), 12-step support groups, and health risk screening are provided. Referrals to other
Galveston community agencies are used to break the cycle of homelessness.

Shriners Burns Hospital: This hospital located on the UTMB campus provides free care to all
patients. The facility offers specialized care in the treatment of children with severe burns. These
children are most often from underserved populations that have no other alternative. The facility
is world renowned for their treatment innovations and therapy for children with severe burns.
The psychological staff at this facility are recognized as international experts in the treatment of
trauma and rehabilitation.

Spine Surgery Clinic: The psychology interns currently provide assessment and treatment to
patients that are being considered for surgery due to chronic low back pain. For those patients
ineligible for surgery a pain management program is introduced to patients that do not normally
have access to these types of services. There is no charge for patients participating in group
treatment and the average member either is unsponsored for health care or is a Medicare
recipient. This project will expose PA and OT students to the dynamics of patients from
underserved areas and the possible treatments available including psychological assessment and
treatment.




                                                 41
Primary Care Psychology                                       Project Director: Baker, Jeff


F. CURRICULUM

1. General Educational Information
  The UTMB Psychology Resident (Intern) Training Program has a structured rotation model of
learning. Each rotation extends for 6 months and incorporates a scientist practioner model of
training. Rotations in the clinical health track include a wide variety of services as identified in
earlier in this project. The Occupational Therapy students also have a prescribed curriculum of
study that includes the clinical psychiatry course taught by the principal investigator and two 4
month clinical affiliations. The Physician assistant curriculum is a masters training program that
also includes a clinical psychiatry course taught by the primary investigator and three 4 month
clinical affiliations. The principal investigator also provides research supervision to the PA
students.

2. Plan of Study
  Each program has a plan of study that includes intensive feedback in clinical skills. The
primary investigator is responsible for teaching basic clinical interviewing and a wide variety of
interviewing techniques that includes death and dying, difficult patients, personality disorders,
case based studies of patients previously evaluated and treated by the primary investigator, and
psychopharmacology interventions.

3. Interdisciplinary Psychology Clinical Experience
  The project will allow the primary investigator to combine this course and include psychology
interns, physician assistant and occupational therapy students. The course includes a case based
focus along with a variety of lectures identified above and clinical opportunities in community
agencies and inpatient and outpatient settings in and around the UTMB campus.

4. Competencies
  Objective 1
   To develop the interdisciplinary clinical psychiatry course for UTMB PA and OT students,
and CP interns, especially those from underrepresented minority/disadvantaged backgrounds.
Course content will emphasize knowledge and practice in prevention and health promotion in
medical psychology for inpatient services and CSAs. This will increase the number of PA
program completers, OT program completers, and CP program completers practicing in
underserved areas or choosing affiliation placements in underserved areas (20 OT and 40 PA
students and 5 CP interns over a one-year period).

Objective 2 (HP2010)
   Support a joint PA, OT, and CP training experience emphasizing knowledge and practice in
case based learning for prevention and health promotion in inpatient work and CSAs that will
increase the number of OT and PA program completers to choose rural affiliations and CP
program completers, especially those from underrepresented minority/disadvantaged
backgrounds, choosing practice or choose an affiliation in underserved areas. (20 OT, 40 PA, and
5 CP interns over a one-year period)




                                                 42
Primary Care Psychology                                       Project Director: Baker, Jeff


Objective 3 (HP2010)
   Use multiple clinical training sites at UTMB and in the Galveston community (Rehab Center,
Surgery outpatient, Cancer outpatient, Shriners Burns Hospital, Children‟s Hospital and CSAs:
ADA Center, Discovery Club, and Our Daily Bread) to include collaborative PA, OT, and CP
mental health services provided to underserved populations. Such use will help increase the
number of OT students/interns and CP interns, especially those from underrepresented
minority/disadvantaged backgrounds, trained to provide these services in underserved areas in
the future.

Objective 4
   Establish a new clinical training site, in partnership with the ACE unit in Geriatrics, to include
collaborative PA, OT, and CP mental health services provided to underserved populations in
order to increase the number of PA, OT, students and CP interns, especially those from
underrepresented minority/disadvantaged backgrounds, trained to provide these services in
underserved areas in the future.

Objective 5 (HP2010)
    Establish the PCP project as an innovative model using a case based approach that links PA,
OT, and CP clinical practice, education, and research in an interdisciplinary curriculum and
training experiences that emphasize prevention and health promotion in hospital and community-
based practice.

Objective 6
   Evaluate the PCP project to determine its achievement of its goals and objectives for the
purposes of future planning, budgeting, and sharing experiences with other educators and health
care professionals for this one-year program.


G. RECRUITMENT AND SELECTION
  Psychology interns are matched through the APPIC match day procedures
(www.appic.org/match) but UTMB has a positive history of recruiting and retaining psychology
interns from minority and disadvantaged backgrounds. Applicants must provide a cover letter
that attests to their interest and experience in working with patients from underserved
backgrounds. The Physician Assistant program attracts applicants from a national pool and also
has a long history of enrolling a significant percentage of students from underserved
backgrounds. The Occupational Therapy program has already accepted 32 students for the 2002-
2004 program and it will require low effort to integrate the primary care psychology project into
the curriculum. Selection for the PCP project will require all students to participate in the
clinical psychiatry course and participation in the clinical activities scheduled for the course.
However, CP, OT, and PA students will self-select (for the most part) the post doctoral training
and the clinical affiliations. This will serve as one measure for outcomes of this project.




                                                 43
Primary Care Psychology                                         Project Director: Baker, Jeff


H EVALUATION
Graduate Psychology Education Program Clinical Site Recording Form

   Name of       Supervisor’s    Supervisor’s    Number       Type of       Services      Populations
   Setting          Name           Degree            of       Setting       Provided        Served
                                                 Learners
                                                Placed/ %
                                                   time
Pediatric        Dru Copeland    Ph.D.          2 CP 10%    Children‟s   Assessment,     Families,
Rehabilitation                                              Hospital     Consultation,   Chronically
                                                                         Psychotherapy   ill, Victims of
                                                                                         Abuse
Spine Clinic     Jeff Baker      Ph.D.          2 CP 20%    Outpatient   Assessment,     Patients with
                                                            Clinic       Consultation,   chronic
                                                                         Psychotherapy   medical
                                                                                         conditions
Anesthesiology   Vera Gonzales   Ph.D.          2 CP 10%    Outpatient   Assessment,     Patients with
Pain Clinic                                                 Clinic       Consultation,   Chronic Pain
                                                                         Psychotherapy
Adult Rehab      Jeff Baker      Ph.D.          1 CP 10%    Inpatient    Assessment,     Patients with
Center                                          20 OT       Service      Consultation,   traumatic
                                                40 PA                    Psychotherapy   injuries;
Shriners Burns   Rhonda Robert   Ph.D.          1 CP 10%    Inpatient    Assessment,     Children with
Hospital                                                    and          Consultation,   traumatic
                                                            Outpatient   Psychotherapy   burn injuries
                                                            Services
Cardiothoracic   Jeff Baker      Ph.D.          1 CP 10%    Inpatient    Assessment,     Adults with
Surgery                                                     and          Consultation,   lung cancer
                                                            Outpatient   Psychotherapy
                                                            Services
Acute Care for   Jeff Baker      Ph.D.          1 CP 10%    Inpatient    Assessment,     Elder Adults
Elderly (ACE)                                               Services     Consultation,   with chronic
                                                                         Psychotherapy   medical
                                                                                         conditions
Discovery        Susan           Ph.D.          1 CP 10%    Community    Assessment,     At risk
Club             Rosenthal                      7 OT        Agency       Consultation,   children
                                                15 PA                    Psychotherapy
ADA House        Jeff Baker      Ph.D.          1 CP 5%     Community    Assessment,     Women with
                                                7 OT        Agency       Consultation,   substance
                                                15 PA                    Psychotherapy   abuse issues
Our Daily        Jeff Baker      Ph.D.          1 CP 5%     Community    Assessment,     Homeless
Bread                                           6 OT        Agency       Consultation,   Shelter
                                                10 PA                    Psychotherapy




   Three ultimate outcomes of this project will be (1) increased numbers of PAs, OTs, and CPs
prepared to provide mental health services to support primary care, (2) increased numbers of
PAs, OTs, and CPs practicing in underserved areas, and (3) increased numbers of PA and OT
program completers and CP program completers from minority/disadvantaged backgrounds.
Program completers of the PCP project will be better prepared to provide culturally competent
and sensitive PA, OT, and CP mental health services to Texans living in medically underserved
communities. These outcomes will be achieved through development and implementation of an


                                                  44
Primary Care Psychology                                       Project Director: Baker, Jeff

interdisciplinary PA, OT, and CP clinical psychiatry course and a combined PA, OT, and CP
internship clinical experience in inpatient and CSAs emphasizing prevention and health
promotion providing services to underserved populations.
   Summative evaluation of the overall outcomes of this project will consist of collection and
analysis of the following data: (1) numbers of OT and PA participating in rural clinical
affiliations and CP program completers prepared to support primary care, (2) numbers of PA and
OT program completers and CP program completers who enter practice in underserved areas,
and (3) numbers of PA, OT, and CP program completers from underrepresented minority
backgrounds. See BHPr goals, objectives, and indicators.
   Summative evaluation of the integrated clinical psychiatry course will include indicators of
student/intern learning and effectiveness of academic and clinical experiences. Measures are in
place to evaluate and document the learning activities on the adult rehabilitation unit and
geriatrics unit. In addition, web-based note documentation forms for PA, OT, and CP interns are
automatically submitted to a database form and will be evaluated to focus on identifying
student/intern perceptions of their learning and their experiences in the PCP project. Specific
indicators of learning are revealed through this analysis that includes pre and posttests using
surveys that will be identified or developed and employed to capture these indicators
quantitatively.
    Quantitative measures of student/intern learning will consist of classroom case based
discussions and exams for PA and OT clinical psychiatry students after their participation in
either the integrated clinical psychiatry course. Student/intern learning related to multicultural
competence will be measured using the Multicultural Sensitivity Scale (Jibaja, Sebastian,
Kingery, & Holcomb, 2000). See Appendix E for a copy of this scale.
    As described above, other surveys or instruments will be identified or developed as indicators
are uncovered through the intensive course experience. For example, see Appendix E for a
sample of one page of a survey adapted to capture changes in beliefs, attitude, and knowledge
about homelessness (Toro & McDonell, 1992). The PA, OT, and CP interns‟ learning in the
clinical training sites will also be measured using the peer evaluation form that identifies the case
presenters skill and knowledge of certain psychological disorders, assessment techniques, and
patient background history.
    Quantitative measures of effectiveness of student/intern academic experiences in the
integrated course and the joint clinical experiences will include SAHS academic course
evaluations completed by students. The PA, OT, and CP interns will complete training site
evaluations as a measure of effectiveness of their clinical experiences, including the supervision
that they receive during their internships. The Departments of Physician Assistant Studies and
Occupational Therapy, and the Psychology Resident Training Program have training site
evaluations already in use in their individual programs. Additional evaluations of the
collaborative PA, OT, and CP clinical training sites have been developed and are ready for use.
External measures of effectiveness of clinical experiences in the community-based training sites
will consist of surveys developed for CSA staff and clients from the original HRSA joint grant
for CP and OT students.




                                                 45
Primary Care Psychology                                     Project Director: Baker, Jeff


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Primary Care Psychology                                    Project Director: Baker, Jeff

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Texas Higher Education Coordinating Board. (1998). Report on the effects of the Hopwood
   decision on minority applications, offers, and enrollments at public institutions of higher
   education in Texas. Austin, TX: Author.


                                              47
Primary Care Psychology                                   Project Director: Baker, Jeff

Texas Mental Health and Mental Retardation Authority (2000). Frequently asked questions about
   the TXMHMR System. [Online]. Available from
   http://www.mhmr.state.tx.us/CentralOffice/PublicInformationOffice/FaqsSYS.html
Toro, P. A., & McDonell, D. M. (1992). Beliefs, attitudes, and knowledge about homelessness:
   A survey of the general public. American Journal of Community Psychology, 20, 53-80.
United States Census Bureau. (2000). American FactFinder: Income and Poverty Status In 1989
   – 1990. [Online]. Available from http://www.census.gov/population
United States Department of Health and Human Services (1995). Report of the National
   Commission on Allied Health. Vienna, VA: Circle Solutions
United States Department of Health and Human Services (1998). HRSA Workforce Analysis.
   Rockville, MD: Author.
United States Department of Health and Human Services (2000a). HRSA State Health Workforce
   Profiles: Texas. Rockville, MD: Author.
United States Department of Health and Human Services (2000b). Healthy People 2010
   (Conference Edition, in Two Volumes). Washington, DC: Author.
United States Department of Labor. (2000a). Career Guide to Industries. [Online]. Available
   from http://stats.bls.gov/oco/cg/cgs035.htm
United States Department of Labor. (2000b). Occupational Projections. [Online]. Available from
   http://168.179.144.156/BLSOccPrj/SilverStream/Pages/BasePage96.html
United States Department of Labor. (2000c). Occupational Outlook Handbook. [Online].
   Available from http://stats.bls.gov/oco/home.htm
Wyche, J. H. (1995, Summer). A coordinated effort in mentoring. The Newsletter of the National
   Network for Health Sciences Partnerships, 4(2).
Yau, M. K. (1994). Occupational therapy in community mental health: Do we have a unique role
   in the interdisciplinary environment? Australian Occupational Therapy Journal, 42, 129-132.




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Primary Care Psychology                                                      Project Director: Baker, Jeff


X. FUNDING FACTORS
Funding Preference
    We are requesting a funding preference based on our high rate of placing graduates in
practice settings that have a focus on serving residents of medically underserved communities.

                         Enrollment of Students/Interns from Minority Backgrounds
   UTMB Physician Assistant, Occupational Therapy, and Clinical Psychology Programs (1999-2000)
                               Physician Assistant             Occupational Therapy               Clinical Psychology
                             1999         2000                  1999           2000              1999             2000
Asian/Pacific Islander       11 (6%)      14 (9%)             6 (13%)         2 (6%)          1 (14.5%)          0 (0%)
Black                        6 (3%)       5 (3%)              7 (16%)        7 (20%)            0 (0%)         1 (14.5%)
Hispanic                     49 (26%)     42 (26%)            7 (16%)        6 (18%)          1 (14.5%)        1 (14.5%)
Foreign                      0            0                    0 (0%)         1 (3%)            0 (0%)           0 (0%)
Unknown                      0            0                    3 (7%)         0 (0%)            0 (0%)           0 (0%)
White                        122 (65%) 100 (62%)             21 (48%)        18 (53%)          5 (71%)          5 (71%)
Minority Background         66 (35%)     61 (38%)            20 (45%)        15 (44%)          2 (29%)          2 (29%)
Total                       188 (100%) 161 (100%)           44 (100%)       34 (100%)         7 (100%)         7 (100%)

             Medically Underserved Community Funding Preference Request Form

Name of Applicant Institution: University of Texas Medical Branch

To qualify for preference based on "high rate," complete EITHER Column A or B.

To qualify for preference based on "significant increase in the rate," complete BOTH Columns A and B.

To qualify for this preference based on "new program,” check this box [ ] and provide supportive documentation.

If you do not wish to request the funding preference, check this box [ ].



                                                                       Column A           Column B
                                                                     Academic Year      Academic Year
                                                                       1999-2000          2000-2001

                Mental Health Shortage Areas                         3 CP / 36 PA /     3 CP / 38 PA / 11
                                                                        12 OT                  OT
                Community Health Centers

                Rural Health Clinics

                National Health Service Corps Sites                         2 PA              2 PA

                Indian Health Service Sites

                Federally Qualified Health Centers                          1 CP              1 CP

                Primary Medical Care Health Professional Shortage     3 OT / 7 PA        1 CP / 2 OT / 5
                Areas (HPSAs)                                                                  PA

                Total # of Graduates in these settings                       64                53

                Total # of Graduates                                         80                77

                Percentage of Graduates in these settings                   80%               69%



                                                            49
Primary Care Psychology                                     Project Director: Baker, Jeff




Funding Priority
    We are requesting a funding priority based on our high rate for placing program completers
in practice settings having the principal focus of serving residents of medically underserved
communities. For 2000-2001 program completers, UTMB CP residents (interns) were placed at
the following institutions: (1) MD Anderson Cancer Center (two program completers, one in
adult and one in children‟s health); (2) Harvard University (Kellog Foundation grant); (3) Baylor
College of Medicine (Women‟s Health Program faculty member); (4) a postdoctoral study in
Mississippi with a high patient population from underserved areas, and (5) one went into
Industrial/Organization (I/O) psychology. This accounts for 5/7 (70%) working in rural areas or
centers that provide services for under represented populations. The seventh intern took a year
off to complete her dissertation while having her first child and plans to move to rural Texas to
practice. For 1999-2000, the UTMB psychology interns were placed at: (1) a rehabilitation
hospital in rural Kentucky; (2) a pain management service in Temple, Texas; (3) the Children‟s
Hospital at UTMB, (4) a rehabilitation postdoctoral study in Oklahoma; and (5) a practice in an
inner city school in Washington DC. This accounts for 5/7 (70%) working in a rural or
underserved area. Of the remaining two, one is practicing in Southern California at Loma Linda
Health Center and one has left psychology. For the current year, 2001-2002 5/7 are currently
going into postdoctoral study in rural and underserved areas. This demonstrates our program
continues to provide psychologists to underserved areas/populations. The OT class and the PA
class have similar records as the PA program focuses on rural health care and the OT class is
predominantly made up of individuals from rural populations.

Special Initiatives
    The PCP project addresses the high profile HRSA initiative of developing linkages with
geriatric, underserved populations (Hispanics and African Americans), patients in rehabilitation,
patients with chronic pain, and child and adolescent populations in our Children‟s hospital and
Shriners Burns Hospital. The PCP project will also have linkages with CSAs that serve
predominantly underserved populations that focus on substance abuse, mental health, and
populations that do not readily have access to health and mental health care.
    This proposal is submitted by UTMB, an academic health center, and a component of the
University of Texas System. UTMB‟s SAHS provides education to five allied health professions.
This project includes collaboration between three of those professions, PA, OT, and CP.




                                               50
Primary Care Psychology                                     Project Director: Baker, Jeff


XI. CHECKLIST

This is the required last page of the application and should be appropriately numbered.
Check the appropriate boxes and provide the information requested.

TYPE OF APPLICATION

       __X___ New application (This application is being submitted to DHHS for a project or
       program not currently receiving support.

ASSURANCES, CERTIFICATIONS AND OTHER REQUIREMENTS

Please see the instructions for Assurances, Certifications and Other Requirements in Section IX.
If the necessary forms have been filed, assurances and certification made, and other requirements
met, please check “Yes” below. If “no” is checked, please explain.

       ___X___     Yes    ____    No (If “No”, attach explanation.)




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