Training Psychologists in Integrated Primary Care and Child Maltreatment: Trainee and Supervisor Perspectives on Lessons Learned

  • Elizabeth A. MillerEmail author
  • Puanani J. Hee
  • Barbara L. Bonner
  • Amanda S. Cherry


Psychologists are key team members in the delivery of integrated behavioral healthcare. Healthcare reform has supported a shift toward a team-based, interdisciplinary model of service delivery, with increasing emphasis on primary care services, prevention, and health promotion. In conjunction with this shift has been a greater focus on psychosocial problems and social determinants of health, particularly childhood adversity. Psychologists in primary care are uniquely positioned to advance efforts to prevent and ameliorate childhood adversity, which are essential to improving care for underserved populations and reducing health disparities. Targeted training efforts are needed to increase the number of psychologists equipped to work in primary care settings with underserved populations. This paper provides an overview of a training program designed to provide psychology trainees with specialized training in both integrated primary care and child maltreatment. The overarching goal of the program is to provide trainees with the skillset to work within integrated primary care settings and the expertise needed to further efforts to address and prevent child maltreatment, as well as childhood adversity more broadly, to improve outcomes for underserved populations. The paper reviews strengths, challenges, and lessons learned from this program.


Integrated primary care Training and education Child maltreatment Primary care psychology 



This project was supported by the Health Resources and Service Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under Grant D40HP26871 ‘Integrated Behavioral Services for Underserved Populations’ for $1,049,997. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government. EAM was supported during the writing of this paper by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number TL1TR001858. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of interest

Elizabeth A. Miller, Puanani J. Hee, Barbara L. Bonner and Amanda S. Cherry have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. Arndorfer, R. E., Allen, K. D., & Aljazireh, L. (1999). Behavioral health needs in pediatric medicine and the acceptability of behavioral solutions: Implications for behavioral psychologists. Behavior Therapy, 30, 137–148. Scholar
  2. Asarnow, J. R., Rozenman, M., Wiblin, J., & Zeltzer, L. (2015). Integrated medical-behavioral care compared with usual primary care for child and adolescent behavioral health: A meta-analysis. JAMA Pediatrics, 169, 929–937. Scholar
  3. Baird, M., Blount, A., Brungardt, S., Dickinson, P., Dietrich, A., Epperly, T., … Working Party Group on Integrated Behavioral Healthcare. (2014). Joint principles: Integrating behavioral health care into the patient-centered medical home. The Annals of Family Medicine, 12, 183–185. Scholar
  4. Boyd, R. (2014). African American disproportionality and disparity in child welfare: Toward a comprehensive conceptual framework. Children and Youth Services Review, 37, 15–27. Scholar
  5. Butler, M., Kane, R. L., McAlpine, D., Kathol, R. G., Fu, S. S., Hagedorn, H., & Wilt, T. J. (2008). Integration of mental health/substance abuse and primary care (Evidence Reports/Technology Assessments No. 173). Rockville, MD: Agency for Healthcare Research and Quality.Google Scholar
  6. Campo, J. V., Geist, R., & Kolko, D. J. (2018). Integration of pediatric behavioral health services in primary care: Improving access and outcomes with collaborative care. The Canadian Journal of Psychiatry, 63, 432–438. Scholar
  7. Child Abuse Prevention and Treatment Act of 2003, Pub. L. No. 108-36, 42 U.S.C. § 5106 (2003).Google Scholar
  8. Cooper, S., Valleley, R. J., Polaha, J., Begeny, J., & Evans, J. H. (2006). Running out of time: Physician management of behavioral health concerns in rural pediatric primary care. Pediatrics, 118, e132–e138. Scholar
  9. Cubic, B., Mance, J., Turgesen, J. N., & Lamanna, J. D. (2012). Interprofessional education: Preparing psychologists for success in integrated primary care. Journal of Clinical Psychology in Medical Settings, 19, 84–92. Scholar
  10. Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., … Wong, J. B. (2018). Interventions to prevent child maltreatment: US Preventive Services Task Force recommendation statement. JAMA, 320, 2122–2128.
  11. Damashek, A., Balachova, T., & Bonner, B. (2011). Training competent psychologists in the field of child maltreatment. Journal of Clinical Psychology, 67, 752–757. Scholar
  12. Daro, D., & Donnelly, A. C. (2015). Reflections on child maltreatment research and practice: Consistent challenges. In D. Daro, A. C. Donnelly, L. A. Huang, & B. J. Powell (Eds.), Advances in child abuse prevention knowledge (pp. 3–18). Cham: Springer.CrossRefGoogle Scholar
  13. Dobmeyer, A. C., Rowan, A. B., Etherage, J. R., & Wilson, R. J. (2003). Training psychology interns in primary behavioral health care. Professional Psychology: Research and Practice, 34, 586–594. Scholar
  14. Drake, B., Jolley, J. M., Lanier, P., Fluke, J., Barth, R. P., & Jonson-Reid, M. (2011). Racial bias in child protection? A comparison of competing explanations using national data. Pediatrics, 127, 471–478. Scholar
  15. Dube, S. R. (2018). Continuing conversations about adverse childhood experiences (ACEs) screening: A public health perspective. Child Abuse and Neglect, 85, 180–184. Scholar
  16. Dubowitz, H., Feigelman, S., Lane, W., & Kim, J. (2009). Pediatric primary care to help prevent child maltreatment: The Safe Environment for Every Kid (SEEK) model. Pediatrics, 123, 858–864. Scholar
  17. Dubowitz, H., Lane, W., Semiatin, J. N., & Magder, L. S. (2012). The SEEK model of pediatric primary care: Can child maltreatment be prevented in a low-risk population? Academic Pediatrics, 12, 259–268.CrossRefPubMedPubMedCentralGoogle Scholar
  18. Eismann, E. A., Theuerling, J., Maguire, S., Hente, E. A., & Shapiro, R. A. (2019). Integration of the Safe Environment for Every Kid (SEEK) model across primary care settings. Clinical Pediatrics, 58, 166–176. Scholar
  19. Esposito, J. F., & Getz, H. G. (2005). In-the-room supervision: Reactions of supervisors, supervisees, and clients. Retrieved March 19, 2019 from
  20. Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) study. American Journal of Preventive Medicine, 14, 245–258.
  21. Finkelhor, D. (2018). Screening for adverse childhood experiences (ACEs): Cautions and suggestions. Child Abuse and Neglect, 85, 174–179. Scholar
  22. Fisher, L., & Dickinson, W. P. (2014). Psychology and primary care: New collaborations for providing effective care for adults with chronic health conditions. American Psychologist, 69, 355–363. Scholar
  23. Fox, J. C., Blank, M., Rovnyak, V. G., & Barnett, R. Y. (2001). Barriers to help seeking for mental disorders in a rural impoverished population. Community Mental Health Journal, 37, 421–436. Scholar
  24. Gilbody, S., Bower, P., Fletcher, J., Richards, D., & Sutton, A. J. (2006). Collaborative care for depression: A cumulative meta-analysis and review of longer-term outcomes. Archives of Internal Medicine, 166, 2314–2321. Scholar
  25. Giles, L. L., & Martini, D. R. (2017). Essential elements of a collaborative mental health training program for primary care. Child and Adolescent Psychiatric Clinics of North America, 26, 839–850. Scholar
  26. Heath, B., Wise Romero, P., & Reynolds, K. (2013). A review and proposed standard framework for levels of integrated healthcare. Washington, DC: SAMHSA-HRSA Center for Integrated Health Solutions.Google Scholar
  27. Hoffses, K. W., Ramirez, L. Y., Berdan, L., Tunick, R., Honaker, S. M., Meadows, T. J., … Stancin, T. (2016). Topical review: Building competency: Professional skills for pediatric psychologists in integrated primary care settings. Journal of Pediatric Psychology, 41, 1144–1160.
  28. Jimenez, D. E., Bartels, S. J., Cardenas, V., Dhaliwal, S. S., & Alegría, M. (2012). Cultural beliefs and mental health treatment preferences of ethnically diverse older adult consumers in primary care. The American Journal of Geriatric Psychiatry, 20, 533–542. Scholar
  29. Kasl-Godley, J. E., King, D. A., & Quill, T. E. (2014). Opportunities for psychologists in palliative care: Working with patients and families across the disease continuum. American Psychologist, 69, 364–376. Scholar
  30. Katon, W., Unützer, J., Wells, K., & Jones, L. (2010). Collaborative depression care: history, evolution and ways to enhance dissemination and sustainability. General Hospital Psychiatry, 32, 456–464. Scholar
  31. Kepley, H. O., & Streeter, R. A. (2018). Closing behavioral health workforce gaps: A HRSA program expanding direct mental health service access in underserved areas. American Journal of Preventive Medicine, 54, S190–S191. Scholar
  32. Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602. Scholar
  33. Kim, H., Wildeman, C., Jonson-Reid, M., & Drake, B. (2017). Lifetime prevalence of investigating child maltreatment among US children. American Journal of Public Health, 107, 274–280. Scholar
  34. King, D. K., Glasgow, R. E., Toobert, D. J., Strycker, L. A., Estabrooks, P. A., Osuna, D., & Faber, A. J. (2010). Self-efficacy, problem solving, and social-environmental support are associated with diabetes self-management behaviors. Diabetes Care, 33, 751–753. Scholar
  35. Kroenke, K., Wu, J., Bair, M. J., Krebs, E. E., Damush, T. M., & Tu, W. (2011). Reciprocal relationship between pain and depression: A 12-month longitudinal analysis in primary care. The Journal of Pain, 12, 964–973. Scholar
  36. Lambert, D., Ziller, E. C., & Lenardson, J. D. (2008). Use of mental health services by rural children (No. Working Paper #39). Portland, ME: University of Southern Maine, Muskie School of Public Service, Maine Rural Health Research Center.Google Scholar
  37. Larkin, K. T., Bridges, A. J., Fields, S. A., & Vogel, M. E. (2016). Acquiring competencies in integrated behavioral health care in doctoral, internship, and postdoctoral programs. Training and Education in Professional Psychology, 10, 14–23. Scholar
  38. Lotfaliany, M., Bowe, S. J., Kowal, P., Orellana, L., Berk, M., & Mohebbi, M. (2018). Depression and chronic diseases: Co-occurrence and communality of risk factors. Journal of Affective Disorders, 241, 461–468. Scholar
  39. Maura, J., & Weisman de Mamani, A. (2017). Mental health disparities, treatment engagement, and attrition among racial/ethnic minorities with severe mental illness: A review. Journal of Clinical Psychology in Medical Settings, 24, 187–210. Scholar
  40. McDaniel, S. H., & deGruy, F. V. (2014). An introduction to primary care and psychology. American Psychologist, 69, 325–331. Scholar
  41. McDaniel, S. H., Grus, C. L., Cubic, B. A., Hunter, C. L., Kearney, L. K., Schuman, C. C., … Johnson, S. B. (2014). Competencies for psychology practice in primary care. American Psychologist, 69, 409–429.
  42. McGuire, T. G., & Miranda, J. (2008). New evidence regarding racial and ethnic disparities in mental health: Policy implications. Health Affairs, 27, 393–403. Scholar
  43. Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change (3rd ed.). New York, NY: Guilford Press.Google Scholar
  44. Moffitt, T. E., Caspi, A., Taylor, A., Kokaua, J., Milne, B. J., Polanczyk, G., & Poulton, R. (2010). How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychological Medicine, 40, 899–909. Scholar
  45. Njoroge, W. F. M., Williamson, A. A., Mautone, J. A., Robins, P. M., & Benton, T. D. (2017). Competencies and training guidelines for behavioral health providers in pediatric primary care. Child and Adolescent Psychiatric Clinics of North America, 26, 717–731. Scholar
  46. Palermo, T. M., Janicke, D. M., McQuaid, E. L., Mullins, L. L., Robins, P. M., & Wu, Y. P. (2014). Recommendations for training in pediatric psychology: Defining core competencies across training levels. Journal of Pediatric Psychology, 39, 965–984. Scholar
  47. Peek, C. J., Cohen, D. J., & deGruy, F. V. (2014). Research and evaluation in the transformation of primary care. The American Psychologist, 69, 430–442. Scholar
  48. Polaha, J., Dalton, W. T., & Allen, S. (2011). The prevalence of emotional and behavior problems in pediatric primary care serving rural children. Journal of Pediatric Psychology, 36, 652–660. Scholar
  49. Polaha, J., Williams, S. L., Heflinger, C. A., & Studts, C. R. (2015). The perceived stigma of mental health services among rural parents of children with psychosocial concerns. Journal of Pediatric Psychology, 40, 1095–1104. Scholar
  50. Reichman, N. E., & Teitler, J. O. (2013). Lifecourse exposures and socioeconomic disparities in child health. In N. S. Landale, S. M. McHale, & A. Booth (Eds.), Families and Child Health (pp. 107–134). New York: Springer. Scholar
  51. Robinson, P., Oyemaja, J., Beachy, B., Goodie, J., Sprague, L., Bell, J., … Ward, C. (2018). Creating a primary care workforce: Strategies for leaders, clinicians, and nurses. Journal of Clinical Psychology in Medical Settings, 25, 169–186.
  52. Rozensky, R. H. (2014). Implications of the Patient Protection and Affordable Care Act: Preparing the professional psychology workforce for primary care. Professional Psychology: Research and Practice, 45, 200–211. Scholar
  53. Scott, K. M., Lim, C., Al-Hamzawi, A., Alonso, J., Bruffaerts, R., Caldas-de-Almeida, J. M., … Kessler, R. C. (2016). Association of mental disorders with subsequent chronic physical conditions: World mental health surveys from 17 countries. JAMA Psychiatry, 73, 150.
  54. Sedlak, A. J., Mettenburg, J., Basena, M., Peta, I., McPherson, K., & Greene, A. (2010). Fourth national incidence study of child abuse and neglect (NIS-4). Washington, DC: US Department of Health and Human Services.Google Scholar
  55. Serrano, N., Cordes, C., Cubic, B., & Daub, S. (2018). The state and future of the primary care behavioral health model of service delivery workforce. Journal of Clinical Psychology in Medical Settings, 25, 157–168. Scholar
  56. Sharp, L., Pantell, R. H., Murphy, L. O., & Lewis, C. C. (1992). Psychosocial problems during child health supervision visits: Eliciting, then what? Pediatrics, 89, 619–623.PubMedGoogle Scholar
  57. Shonkoff, J. P., Garner, A. S., & The Committee on Psychosocial Aspects of Child and Family Health, C. (2012). The lifelong effects of early childhood adversity and toxic stress. Pediatrics, 129, e232–e246. Scholar
  58. Snowden, L. R., & Pingitore, D. (2002). Frequency and scope of mental health service delivery to African Americans in primary care. Mental Health Services Research, 4, 123–130.CrossRefPubMedGoogle Scholar
  59. Society of Health Psychology, Curriculum Development Sub-Committee, Committee on Integrated Primary Care. (2016). Integrated primary care psychology: An introductory curriculum.Google Scholar
  60. Stancin, T., & Perrin, E. C. (2014). Psychologists and pediatricians: Opportunities for collaboration in primary care. American Psychologist, 69, 332–343. Scholar
  61. Thomas, K. C., Ellis, A. R., Konrad, T. R., Holzer, C. E., & Morrissey, J. P. (2009). County-level estimates of mental health professional shortage in the United States. Psychiatric Services, 60, 1323–1328. Scholar
  62. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2019). Child maltreatment 2017. Retrieved March 19, 2019 from
  63. U.S. Department of Veterans, Affairs. (2008). Uniform mental health services in VA medical centers and clinics: VHA Handbook 1160.01. Washington, DC: Veterans Health Administration.Google Scholar
  64. U.S. Department of Veterans Affairs. (2018). Psychology training. Retrieved March 19, 2019 from
  65. Viswanathan, M., Fraser, J. G., Pan, H., Morgenlander, M., McKeeman, J. L., Forman-Hoffman, V. L., … Jonas, D. E. (2018). Primary care interventions to prevent child maltreatment: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA, 320, 2129–2140.
  66. Wang, P., Lane, M., Olfson, M., Pincus, H., Wells, W., & Kessler, R. C. (2005). Twelve-month use of mental health services in the united states: Results from the national comorbidity survey replication. Archives of General Psychiatry, 62, 629–640. Scholar
  67. Wildeman, C., Emanuel, N., Leventhal, J. M., Putnam-Hornstein, E., Waldfogel, J., & Lee, H. (2014). The prevalence of confirmed maltreatment among US children, 2004 to 2011. JAMA Pediatrics, 168, 706–713. Scholar
  68. World Health Organization. (2008). Integrating mental health into primary care: A global perspective. Geneva: World Health Organization.Google Scholar
  69. Zeiss, A. M., & Karlin, B. E. (2008). Integrating mental health and primary care services in the Department of Veterans Affairs health care system. Journal of Clinical Psychology in Medical Settings, 15, 73–78. Scholar
  70. Ziller, E. (2014). Access to medical care in rural America. In J. C. Warren & B. K. Smalley (Eds.), Rural public health. New York: Springer. Scholar

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Authors and Affiliations

  1. 1.Department of MedicineUniversity of PittsburghPittsburghUSA
  2. 2.Hawaiʻi Department of Health, Child and Adolescent Mental Health DivisionKauaʻiUSA
  3. 3.Department of Pediatrics, Section of Developmental and Behavioral PediatricsUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA
  4. 4.Department of Pediatrics, Section of General and Community PediatricsUniversity of Oklahoma Health Sciences CenterOklahoma CityUSA

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