{"paper_id":"0b16f5db-efc7-40c5-a8fa-c327fc29c022","body_text":"Integrating Clinical Psychology Interns in Primary Care: Perceptions from Healthcare Providers in Puerto Rico | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Integrating Clinical Psychology Interns in Primary Care: Perceptions from Healthcare Providers in Puerto Rico Nydia M Cappas, Nydia Ortiz, Viviana Hoyos, Valerie Toro This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5499934/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract This study explores healthcare professionals' perceptions of integrating clinical psychology interns in primary care settings in Puerto Rico. The authors conducted an exploratory study using secondary survey data from 2020 to 2021, involving 91 participants from medical and nursing professions in seven primary care clinics and one general hospital. Quantitative measures included a survey based on the GATHER framework of Primary Care Behavioral Health. Survey responses were based on a 5-point Likert scale. Qualitative data were analyzed for themes. Quantitative data showed high satisfaction with the interns across disciplines, with an average score of 4.75. The Kruskal-Wallis test revealed significant differences between professions in two survey items: \"I have discussed cases with psychology interns\" (H = 20.82, p < .001) and \"I have seen patients with psychology interns\" (H = 11.27, p = .046). Post-hoc Mann-Whitney U tests indicated significant differences between family medicine and nursing ( U = 251.0, p <.001), general medicine and nursing ( U = 140.5, p = 0.003), and nursing and pediatrics ( U = 45.0, p = 0.034). Additional significant differences were found in familiarity with interns and ease of referring patients based on years working at the clinic. Qualitative analysis of open-ended responses identified themes of professionalism, flexibility, collaboration, and positive patient impact. The findings highlight the positive perceptions of healthcare professionals regarding the integration of clinical psychology interns, reflecting the effective advancement of interprofessional care. Limitations and implications for behavioral health are discussed. Healthcare Professionals’ Perceptions Interprofessional Collaboration Primary Care Psychology Integrated Healthcare Introduction In 2013, the Health Service Psychology Education Collaborative (HSPEC) shifted the focus of professional psychology towards health service psychology, emphasizing the role of psychologists in health care 1 . This change envisioned a future where psychology trainees would be integral members of healthcare teams, contributing their expertise to primary care. Although progress has been gradual, healthcare delivery is increasingly adopting an integrated focus. Federal and state-level changes have facilitated the inclusion of clinical psychologists in medical settings such as Federally Qualified Health Centers 2,3 . These changes have expanded opportunities for psychology trainees to practice as part of interprofessional teams 4 . This trend towards integration is also evident in Puerto Rico, where clinical psychologists' roles were historically compartmentalized 5,6 . Training programs in Puerto Rico, like those in the United States, traditionally emphasized siloed practice models and limited student exposure to interprofessional collaboration. In 2008, the Primary Care Psychology Program (PCPP) established a training program to address the growing need for psychological services in medical practices 7 . The program partners with a network of primary care clinics, immunology clinics, and general hospitals to provide interprofessional internship opportunities for clinical psychology students. The PCPP adopts the Primary Care Behavioral Health model of service 8 to train psychologists in collaborative, team-based care approaches essential for effective intervention in primary care settings. The inclusion of clinical psychology interns within healthcare teams represents a progressive step toward interprofessional care. The importance of clinical psychology internships extends beyond skill development, they also play a role in shaping the perceptions and skills of other healthcare professionals 9–11 . Interns contribute to patient care and team dynamics, potentially influencing how their role is viewed within the healthcare setting. Although research has advanced in exploring the perceptions of physicians and healthcare professionals about integrating behavioral health 12–14 , few studies explore the perceptions of healthcare professionals practicing alongside clinical psychology trainees 15 . Understanding these perceptions may be important for enhancing interprofessional training and collaboration. Given this backdrop, the study aims to explore healthcare professionals’ perceptions of integrating clinical psychology interns in Puerto Rican healthcare settings. The specific aims are: (a) assess the perceptions of physicians and nurses regarding the integration of clinical psychology interns into healthcare teams in Puerto Rico, and (b) identify potential differences in perceptions based on profession, years of experience, and years working at the current site. Methodology This study employs an exploratory, retrospective secondary data analysis of an existing dataset, initially collected through an annual survey to evaluate the performance of clinical psychology interns. Utilizing secondary data analysis facilitates an efficient and cost-effective exploration of research questions through existing data 16 . This approach is complemented by exploratory data analysis utilized to summarize the data and identify underlying patterns that may inform future hypotheses 17,18 . The data that support the findings of this study are not publicly available. However, data can be made available from the authors upon reasonable request and with the permission of the Primary Care Psychology Program and Ponce Research Institute. Data Collection The survey data was collected between 2020 and 2021. During this period, the PCPP had 17 doctoral clinical psychology interns assigned to seven primary care clinics and one general hospital. These facilities serve low-income, underserved populations across seven municipalities on the island. Each site integrates clinical psychology interns and has at least one on-site clinical psychology supervisor. The PCPP coordinator distributed a survey link via email or messaging service to all healthcare professionals working at each clinic. Survey responses were stored anonymously in the program’s database. Sample The survey data includes 91 responses. Survey respondents are nurses and physicians from family medicine, internal medicine, general medicine, emergency medicine, pediatrics, and obstetrics. Family medicine physicians and nurses were the most represented professions in the sample, with 33% and 32% respectively. The distribution of respondents’ professions is summarized in Table I. Table I Percentage of professions represented in the study Profession n % Family medicine 30 33.0 Nursing 29 31.9 General medicine 17 18.7 Internal medicine 6 6.6 Pediatrics 6 6.6 Emergency medicine 3 3.3 Note: Percentages are calculated based on the total number of participants. Most surveyed professionals reported practicing their profession for of 1 to 5 years, with the next largest group having practiced for 16 to 20 years, as detailed in Table II. Additionally, over half of the respondents have been working at their current primary care site for 0 to 5 years, with the following most common range being 6 to 10 years. Table II Distribution of the sample by years in the profession and years working at the current site Years working in the profession Years working at the site n % n % 0-5 years 31 34.1% 50 54.9% 6-10 years 16 17.6% 17 18.7% 11-15 years 11 12.1% 14 15.4% 16-20 years 18 19.8% 2 2.2% More than 21 years 15 16.5% 8 8.8% Note: Percentages are calculated based on the total number of participants. Measure The survey instrument used in this study was developed in 2019 (unpublished data) to capture healthcare professionals’ perceptions of the integration efforts of PCPP interns in primary care settings. It incorporates eight quantitative Likert-scale questions, each coded from 1 (strongly disagree) to 5 (strongly agree), and one qualitative, open-ended question. The questions are based on the GATHER framework, a core component of the Primary Care Behavioral Health (PCBH) model 8 . The GATHER framework consists of six components: Generalist, Accessibility, Team-based, High productivity, Educator, and Routine, which collectively describe the integration of behavioral health into primary care settings (see Table III for survey questions). The survey instrument demonstrated high internal reliability (Cronbach's Alpha = 0.951), and the factor analysis confirmed high loadings of all items on a single factor (ranging from 0.731 to 0.951). These measures suggest excellent internal consistency measuring the same underlying construct of “integration\". Table III Survey Questions Mapped to the GATHER Theoretical Framework Survey Question GATHER Framework Component I have discussed cases with the psychology interns Team-based I have seen patients along with the psychology interns Team-based I know the psychology interns by name Team-based It is easy for me to refer patients to the interns Accessibility, High Productivity I am satisfied with the contributions of the interns Educator The clinical services are enhanced by the presence of interns Generalist Approach, Routine Interns are accessible and open to feedback Accessibility I want to continue collaborating with the Primary Care Psychology Program Team Based, Routine Qualitatively, responders provided open-ended comments detailing their experiences and perceptions of the psychology interns' contributions to patient care and clinical operations. The specific prompt read: “Please include any other comment regarding your satisfaction with the Primary Care Psychology Internship Program”. Descriptive Analysis Descriptive statistics were used to analyze the distribution of professional roles among respondents, years of experience in the profession, years at the clinical site, and average scores for each survey question. Inferential Analysis Non-parametric tests were utilized due to their suitability for ordinal and non-normally distributed data. The Kruskal-Wallis Test assessed differences in perceptions based on years of experience and years at the current clinical site. All survey items were analyzed to identify significant differences between groups. A Mann-Whitney U Test was used to conduct post hoc analysis of the questions with statistically significant scores. This analysis enabled the identification of specific groups responsible for the statistical differences. Qualitative Analysis The authors employed thematic analysis to examine qualitative data obtained from 48 responses to the open-ended survey question. The first author developed a coding scheme by manually categorizing responses into distinct themes. A second independent researcher also coded the data to ensure reliability. Inter-rater reliability was assessed using Cohen’s Kappa. Results Healthcare Professional’s Perceptions of Psychology Integration The analysis revealed consistently high levels of satisfaction among all professions. Table IV shows the score averages for each survey question across the surveyed professions. Collectively, 97.8% of the surveyed professionals agreed (12%) or strongly agreed (86%) with the statement “I am satisfied with the contributions of the interns.” Similarly, 97% agreed (19%) or strongly agreed (79%) that their services were enhanced by the intern services. Table IV Average scores from surveyed professional groups on collaboration with psychology interns Survey Question Family Medicine General Medicine Internal Medicine Emergency Medicine Pediatrics Nursing I have discussed cases with the psychology interns 4.93 4.94 4.67 3.67 5.00 4.41 I have seen patients along with the psychology interns 4.57 4.53 4.50 3.33 5.00 4.03 I know the psychology interns by name 4.77 4.65 4.67 3.00 4.83 4.62 It is easy for me to refer patients to the interns 4.90 4.88 4.83 3.67 5.00 4.45 I am satisfied with the contributions of the interns 4.93 4.94 4.83 3.67 5.00 4.62 The clinical services are enhanced by the presence of interns 4.87 4.88 4.67 3.67 5.00 4.55 Interns are accessible and open to feedback 5.00 4.80 4.83 3.67 5.00 4.66 I want to continue collaborating with the Primary Care Psychology Program 4.97 4.94 4.83 3.67 5.00 4.62 Note. The survey questions were scored on a Likert scale, where 1 meant strongly disagree and 5 meant strongly agree. Differences in perceptions by profession, years of experience, and years at the current site The Kruskal-Wallis test results revealed significant differences in two of the eight survey questions. Significant differences were observed across professions in response to question one, “I have discussed cases with the psychology interns” item ( H = 20.82, p <.001). The post-hoc pairwise comparisons using the Mann-Whitney U test revealed significant differences between family medicine and nursing ( U = 251.0, p <.001), general medicine and nursing ( U = 140.5, p = 0.003), and nursing and pediatrics ( U = 45.0, p = 0.034). Physicians from family medicine, general medicine, and pediatrics tend to hive higher ranks than the nursing and emergency medicine professionals. The second significant difference was found in question two “I have seen patients along with the psychology interns” ( H = 11.27, p = .046). The post hoc analysis revealed significant differences between family medicine physicians and nurses ( U = 307.0, p = .031) and between nurses and pediatricians ( U = 36.0, p = 0.015). Family medicine physicians and pediatricians reported conducting dual interviews more frequently than nursing professionals. The Kruskal-Wallis test revealed significant differences in questions three ( H = 14.77; p = .005) and four ( H = 10.18; p = .037) based on the number of years working at the clinic. Post-hoc pairwise comparisons using the Mann-Whitney U for question three, “I know the psychology interns by name” revealed statistically significant differences between participants with 0-5 years and 11-15 years at the clinic ( U = 196.0, p = .001). Professionals with fewer years at the clinic (0-5 years) had higher mean ranks compared to those with more years (11-15 years), indicating that those with fewer years at the clinic are more likely to know the psychology interns by name. Similarly, for question four “It’s easy for me to refer patients to the interns” the Mann-Whitney U test revealed a statistically significant difference in the scores between participants with 0-5 years and 11-15 years at the clinic ( U = 259.0, p = .046). Participants with fewer years at the clinic (0-5 years) had higher mean ranks compared to those with more years (11-15 years) suggesting that those with fewer years at the clinic find it easier to refer patients to the psychology interns. The Kruskal-Wallis test revealed no significant differences in any of the survey questions based on years of experience in the profession. Thematic Analysis of Qualitative Feedback Five main themes emerged from the analysis: positive patient impact, professionalism and competence, collaboration and teamwork, flexibility and availability, and general praise. The results of the inter-rater reliability analysis indicated a high level of agreement between the two researchers with Cohen's Kappa calculated at 0.758 ( p <.001). Below is a description of the results obtained from the thematic analysis by categories, supported by verbatim comments from respondents. Positive Patient Impact This theme highlights the positive effects of psychology interns on patients. Many respondents noted that patients felt better understood and more comfortable when interacting with interns, emphasizing their positive influence on patient care. Example: \"As part of the family medicine team I have seen the excellent contribution the psychology interns are being for the program and the patients\" reported by a family medicine physician. Professionalism and Competence Responses on this category reflect the high regard for the professional conduct, competence, and skill of psychology interns. Respondents described psychology interns as \"excellent professionals\" and \"very competent.\" Example. \"Very pleased to work with responsible, dedicated, and professional psychology interns.\" reported by a family medicine physician. Flexibility and Availability This theme highlighted the interns’ ability to adapt to various clinical environments and respond to dynamic needs. Example: \" … disponibilidad al momento de ser necesario y de buena ayuda para el equipo interdiciplinario.” [availability at the moment if necessary and a great help for the interdisciplinary team.], reported by a nurse. Collaboration and Teamwork Responses in this category focused on valuing teamwork and collaborative efforts involving psychology interns, acknowledging them as integral members of the primary care team. Example: “It is a pleasure for me the interrelate with the interns. It’s a mutual learning experience..” reported by an internal medicine physician. General Praise This theme encompassed positive acknowledgments that didn't fit neatly into other categories, such as “Excellent” and “Excellent resources to our clinic”. These comments provided a general idea of the appreciation of the healthcare professional, although without specification of what they valued. The qualitative analysis underscored psychology interns' positive impact in clinical settings, particularly emphasizing patient care, professionalism, flexibility, and teamwork. Discussion The findings from this exploratory study provide valuable insights into the positive impact that psychology trainees can have on their healthcare colleagues. The favorable perceptions held by nurses and physicians toward the integration of clinical psychology interns in Puerto Rican primary care settings are encouraging. These results align with previous studies that demonstrate how behavioral health professionals are positively perceived by physicians and enhance physicians' commitment to mental health, as well as their perceived ability to manage patients' mental health needs 19 , 20 . The qualitative feedback supports the quantitative findings, underscoring the value of clinical psychology interns. The themes identified in the analysis—professionalism, competency, adaptability, flexibility, collaboration, and teamwork—reflect key competencies in health service and primary care psychology 21 , 22 . Despite the overall positive feedback, notable differences in perceptions between nurses, family physicians, general physicians, and pediatricians warrant further investigation. The reduced frequency of dual interviews involving interns and nurses highlights potential underlying dynamics that could benefit from targeted interprofessional training strategies. Additionally, the higher familiarity of newer clinic staff with interns’ merits deeper exploration to enhance integration strategies effectively. Although the findings are promising, several limitations should be considered when interpreting the results. The study's reliance on a secondary analysis of survey data, initially collected for evaluating interns, might introduce biases reflective of the survey's original intent. The anonymity of the survey responses precludes the ability to track longitudinal changes which would provide richer insights. Additionally, the sample size, while sufficient for exploratory analysis, restricts the generalizability of the findings. Moreover, the dependence on self-reporting may introduce response bias, with participants potentially offering socially desirable responses. Future research should include more detailed questions to allow for a nuanced understanding of healthcare professionals' perceptions. Expanding the participant pool to include other healthcare roles and integrating additional quantifiable measures could offer a more comprehensive view. Furthermore, employing a longitudinal design would also be beneficial, tracking shifts in perceptions over time to better understand the dynamics of integration. Implications for Behavioral Health The integration of clinical psychology interns into primary care teams offers promising implications for behavioral health services, particularly in underserved and low-income populations. By fostering interprofessional collaboration, psychology trainees help address mental health needs in primary care settings, where behavioral health services are often limited. The high levels of satisfaction reported by healthcare professionals suggest that psychology interns play a vital role in enhancing patient care and team dynamics, contributing to a more holistic approach to healthcare delivery. The results align with the broader trend outlined in the introduction—the shift toward the integration of health service psychology in primary care settings. As the healthcare system continues to embrace interprofessional models, psychology trainees will play a critical role in shaping the future of behavioral health services. The positive experiences highlighted in this study suggest that continued efforts to refine integration strategies will benefit patients and further solidify psychology's role as a core component of modern healthcare. The findings also underscore the importance of continuing to develop training programs that emphasize interprofessional collaboration and the Primary Care Behavioral Health (PCBH) model. As primary care clinics increasingly adopt integrated care models, the inclusion of psychology trainees offers a sustainable way to improve behavioral health outcomes. Their involvement has the potential to broaden access to mental health services and strengthen the capacity of healthcare teams to manage complex patient needs. Declarations Funding: This work was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of the BHWET and GPE awards. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. Competing Interests: The authors declare that there are no conflicts of interest regarding the publication of this manuscript. Ethics approval: This study was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The research protocol was reviewed and approved by the Ponce Medical School Foundation Institutional Review Board at Ponce Health Sciences University approval # 2403191296. Informed Consent Statement: This study utilized secondary data originally collected as part of program evaluation activities for the Primary Care Psychology Program. The data collection process was not specifically designed for research purposes, and as such, the study did not involve direct engagement with human subjects. Consequently, obtaining informed consent from individual participants was not feasible. The Institutional Review Board (IRB) at Ponce Health Sciences University reviewed and approved the study, including its use of de-identified secondary data. All reasonable steps were taken to ensure the confidentiality and privacy of the data throughout the research process. For additional questions or concerns about the ethical considerations of this study, please contact Dr. Nydia Cappas at [email protected] or the Ponce Health Sciences University IRB at 787-840-2575, ext. 4758. Data availability statement: The data used in this study were collected from an annual survey conducted from 2020 to 2021. These data are utilized internally by the program for decision-making and improvement purposes. As such, the data are not publicly available. However, they may be made accessible upon request to the corresponding author, subject to approval by the program administrators and adherence to data privacy regulations. Author contribution statement: All authors contributed to the study conception and design. The first draft of the manuscript was written by Nydia Cappas, and Nydia Ortiz contributed to the manuscript preparation and concept. Data preparation and analysis were performed by Viviana Hoyos, Valerie Toro, and Nydia Cappas. 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Fam Med . 2022;54(5):389-394. doi:10.22454/FamMed.2022.541800 Zallman L, Joseph R, O’Brien C, et al. Does behavioral health integration improve primary care providers’ perceptions of health-care system functioning and their own knowledge? Gen Hosp Psychiatry . 2017;46:88-93. doi:10.1016/J.GENHOSPPSYCH.2017.03.005 McDaniel SH, Grus CL, Cubic BA, et al. Competencies for psychology practice in primary care. American Psychologist . 2014;69(4):409-429. doi:10.1037/A0036072 McGaffee L, Rasmussen C, Rodolfa E. Competencies in health service psychology. Supporting trainees with competence problems: A practical guide for psychology trainers . Published online April 10, 2023:25-42. doi:10.1037/0000340-003 Additional Declarations The authors declare no competing interests. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-5499934\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Short Report\",\"associatedPublications\":[],\"authors\":[{\"id\":383063585,\"identity\":\"add0ca3a-80c0-4f6b-95c8-8294f4ec0a72\",\"order_by\":0,\"name\":\"Nydia M Cappas\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsUlEQVRIiWNgGAWjYBADOQjFRoIWY9K1JDYQrcWc/fCzxwU1denb+U8nMHwoO0xYi2VPmrnxjGOHc3fOyN3AOOMcEVoMbjCYSfOwHcjdcIN3AzNvG1Fa2L9J8/yrSzc4f3YD81/itPCYSfO2MScYAC1iZiRKy5mccuOZfYcNQX452HMunQgtx49ve1zwrU7enP/sxgc/yqwJawECNmawXiA+QJR6FC2jYBSMglEwCrACAA8ZO2rKcYf9AAAAAElFTkSuQmCC\",\"orcid\":\"https://orcid.org/0000-0002-0652-1013\",\"institution\":\"Ponce Health Sciences University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Nydia\",\"middleName\":\"M\",\"lastName\":\"Cappas\",\"suffix\":\"\"},{\"id\":383065221,\"identity\":\"ad40d1bd-28f8-4a75-9b66-3250d169c41d\",\"order_by\":1,\"name\":\"Nydia Ortiz\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ponce Health Sciences University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Nydia\",\"middleName\":\"\",\"lastName\":\"Ortiz\",\"suffix\":\"\"},{\"id\":383065222,\"identity\":\"812227d8-dd99-4b38-bc0f-aadc2a313e76\",\"order_by\":2,\"name\":\"Viviana Hoyos\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ponce Health Sciences University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Viviana\",\"middleName\":\"\",\"lastName\":\"Hoyos\",\"suffix\":\"\"},{\"id\":383065223,\"identity\":\"bd6483c7-b151-4c2d-92a6-61749ff487c3\",\"order_by\":3,\"name\":\"Valerie Toro\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Ponce Health Sciences University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Valerie\",\"middleName\":\"\",\"lastName\":\"Toro\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-11-21 18:44:16\",\"currentVersionCode\":1,\"declarations\":{\"humanSubjects\":true,\"vertebrateSubjects\":false,\"conflictsOfInterestStatement\":false,\"humanSubjectEthicalGuidelines\":true,\"humanSubjectConsent\":true,\"humanSubjectClinicalTrial\":false,\"humanSubjectCaseReport\":false,\"vertebrateSubjectEthicalGuidelines\":false},\"doi\":\"10.21203/rs.3.rs-5499934/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-5499934/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":70184698,\"identity\":\"ed8495ea-65cc-474b-bc98-ed941b570e98\",\"added_by\":\"auto\",\"created_at\":\"2024-11-29 09:10:56\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":385454,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-5499934/v1/b1059c65-dd77-4c8f-bffc-66166e0c2946.pdf\"}],\"financialInterests\":\"The authors declare no competing interests.\",\"formattedTitle\":\"\\u003cp\\u003eIntegrating Clinical Psychology Interns in Primary Care: Perceptions from Healthcare Providers in Puerto Rico\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eIn 2013, the Health Service Psychology Education Collaborative (HSPEC) shifted the focus of professional psychology towards health service psychology, emphasizing the role of psychologists in health care \\u003csup\\u003e1\\u003c/sup\\u003e. This change envisioned a future where psychology trainees would be integral members of healthcare teams, contributing their expertise to primary care. Although progress has been gradual, healthcare delivery is increasingly adopting an integrated focus. Federal and state-level changes have facilitated the inclusion of clinical psychologists in medical settings such as Federally Qualified Health Centers \\u003csup\\u003e2,3\\u003c/sup\\u003e. These changes have expanded opportunities for psychology trainees to practice as part of interprofessional teams \\u003csup\\u003e4\\u003c/sup\\u003e.\\u003c/p\\u003e\\n\\u003cp\\u003eThis trend towards integration is also evident in Puerto Rico, where clinical psychologists' roles were historically compartmentalized \\u003csup\\u003e5,6\\u003c/sup\\u003e. Training programs in Puerto Rico, like those in the United States, traditionally emphasized siloed practice models and limited student exposure to interprofessional collaboration. In 2008, the Primary Care Psychology Program (PCPP) established a training program to address the growing need for psychological services in medical practices \\u003csup\\u003e7\\u003c/sup\\u003e. The program partners with a network of primary care clinics, immunology clinics, and general hospitals to provide interprofessional internship opportunities for clinical psychology students. The PCPP adopts the Primary Care Behavioral Health model of service \\u003csup\\u003e8\\u003c/sup\\u003e to train psychologists in collaborative, team-based care approaches essential for effective intervention in primary care settings.\\u003c/p\\u003e\\n\\u003cp\\u003eThe inclusion of clinical psychology interns within healthcare teams represents a progressive step toward interprofessional care. The importance of clinical psychology internships extends beyond skill development, they also play a role in shaping the perceptions and skills of other healthcare professionals \\u003csup\\u003e9–11\\u003c/sup\\u003e. Interns contribute to patient care and team dynamics, potentially influencing how their role is viewed within the healthcare setting. Although research has advanced in exploring the perceptions of physicians and healthcare professionals about integrating behavioral health \\u003csup\\u003e12–14\\u003c/sup\\u003e,\\u0026nbsp;few studies explore the perceptions of healthcare professionals practicing alongside clinical psychology trainees \\u003csup\\u003e15\\u003c/sup\\u003e. Understanding these perceptions may be important for enhancing interprofessional training and collaboration.\\u003c/p\\u003e\\n\\u003cp\\u003eGiven this backdrop, the study aims to explore healthcare professionals’ perceptions of integrating clinical psychology interns in Puerto Rican healthcare settings. The specific aims are: (a) assess the perceptions of physicians and nurses regarding the integration of clinical psychology interns into healthcare teams in Puerto Rico, and (b) identify potential differences in perceptions based on profession, years of experience, and years working at the current site.\\u003c/p\\u003e\"},{\"header\":\"Methodology\",\"content\":\"\\u003cp\\u003eThis study employs an exploratory, retrospective secondary data analysis of an existing dataset, initially collected through an annual survey to evaluate the performance of clinical psychology interns. Utilizing secondary data analysis facilitates an efficient and cost-effective exploration of research questions through existing data \\u003csup\\u003e16\\u003c/sup\\u003e. This approach is complemented by exploratory data analysis utilized to summarize the data and identify underlying patterns that may inform future hypotheses \\u003csup\\u003e17,18\\u003c/sup\\u003e. The data that support the findings of this study are not publicly available. However, data can be made available from the authors upon reasonable request and with the permission of the Primary Care Psychology Program and Ponce Research Institute.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eData Collection\\u003c/p\\u003e\\n\\u003cp\\u003eThe survey data was collected between 2020 and 2021. During this period, the PCPP had 17 doctoral clinical psychology interns assigned to seven primary care clinics and one general hospital. \\u0026nbsp;These facilities serve low-income, underserved populations across seven municipalities on the island. Each site integrates clinical psychology interns and has at least one on-site clinical psychology supervisor.\\u003c/p\\u003e\\n\\u003cp\\u003eThe PCPP coordinator distributed a survey link via email or messaging service to all healthcare professionals working at each clinic. Survey responses were stored anonymously in the program\\u0026rsquo;s database.\\u003c/p\\u003e\\n\\u003cp\\u003eSample\\u003c/p\\u003e\\n\\u003cp\\u003eThe survey data includes 91 responses.\\u0026nbsp;Survey respondents are nurses and physicians from family medicine, internal medicine, general medicine, emergency medicine, pediatrics, and obstetrics. Family medicine physicians and nurses were the most represented professions in the sample, with 33% and 32% respectively. The\\u0026nbsp;distribution of respondents\\u0026rsquo;\\u0026nbsp;professions is summarized in Table I.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable I\\u0026nbsp;\\u003c/strong\\u003ePercentage of professions represented in the study\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\" width=\\\"390\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 40%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003eProfession\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003en\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003e\\u003cstrong\\u003e%\\u003c/strong\\u003e\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 40%;\\\"\\u003e\\n \\u003cp\\u003eFamily medicine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003e30\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003e33.0\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 40%;\\\"\\u003e\\n \\u003cp\\u003eNursing\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003e29\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003e31.9\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 40%;\\\"\\u003e\\n \\u003cp\\u003eGeneral medicine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003e17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003e18.7\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 40%;\\\"\\u003e\\n \\u003cp\\u003eInternal medicine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003e6.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 40%;\\\"\\u003e\\n \\u003cp\\u003ePediatrics\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003e6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003e6.6\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 40%;\\\"\\u003e\\n \\u003cp\\u003eEmergency medicine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003e3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"bottom\\\" style=\\\"width: 30%;\\\"\\u003e\\n \\u003cp\\u003e3.3\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eNote: \\u003cem\\u003ePercentages are calculated based on the total number of participants.\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eMost surveyed professionals reported practicing their profession for of 1 to 5 years, with the next largest group having practiced for 16 to 20 years, as detailed in Table II. Additionally, over half of the respondents have been working at their current primary care site for 0 to 5 years, with the following most common range being 6 to 10 years.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable II\\u0026nbsp;\\u003c/strong\\u003eDistribution of the sample by years in the profession and years working at the current site\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 40%;\\\"\\u003e\\n \\u003cp\\u003eYears working in the profession\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd colspan=\\\"2\\\" style=\\\"width: 40%;\\\"\\u003e\\n \\u003cp\\u003eYears working at the site\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003en\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003en\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e0-5 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e31\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e34.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e54.9%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e6-10 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e16\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e17.6%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e17\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e18.7%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e11-15 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e11\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e12.1%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e14\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e15.4%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e16-20 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e18\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e19.8%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e2\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e2.2%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003eMore than 21 years\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e15\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e16.5%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e8\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 20%;\\\"\\u003e\\n \\u003cp\\u003e8.8%\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003eNote: \\u003cem\\u003ePercentages are calculated based on the total number of participants.\\u003c/em\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eMeasure\\u003c/p\\u003e\\n\\u003cp\\u003eThe survey instrument used in this study was developed in 2019 (unpublished data) to capture healthcare professionals\\u0026rsquo; perceptions of the integration efforts of PCPP interns in primary care settings.\\u0026nbsp;It incorporates eight quantitative Likert-scale questions, each coded from 1 (strongly disagree) to 5 (strongly agree), and one qualitative, open-ended question.\\u0026nbsp;The questions are based on the GATHER framework, a core component of the Primary Care Behavioral Health (PCBH) model \\u003csup\\u003e8\\u003c/sup\\u003e.\\u0026nbsp;The GATHER framework consists of six components: Generalist, Accessibility, Team-based, High productivity, Educator, and Routine, which collectively describe the integration of behavioral health into primary care settings (see Table III for survey questions).\\u003c/p\\u003e\\n\\u003cp\\u003eThe survey instrument demonstrated high internal reliability (Cronbach\\u0026apos;s Alpha = 0.951), and the factor analysis confirmed high loadings of all items on a single factor (ranging from 0.731 to 0.951). These measures suggest excellent internal consistency measuring the same underlying construct of \\u0026ldquo;integration\\u0026quot;.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable III\\u0026nbsp;\\u003c/strong\\u003eSurvey Questions Mapped to the GATHER Theoretical Framework\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003cp\\u003eSurvey Question\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003cp\\u003eGATHER Framework Component\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003col\\u003e\\n \\u003cli\\u003eI have discussed cases with the psychology interns\\u003c/li\\u003e\\n \\u003c/ol\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003cp\\u003eTeam-based\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003col start=\\\"2\\\"\\u003e\\n \\u003cli\\u003eI have seen patients along with the psychology interns\\u003c/li\\u003e\\n \\u003c/ol\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003cp\\u003eTeam-based\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003col start=\\\"3\\\"\\u003e\\n \\u003cli\\u003eI know the psychology interns by name\\u003c/li\\u003e\\n \\u003c/ol\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003cp\\u003eTeam-based\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003col start=\\\"4\\\"\\u003e\\n \\u003cli\\u003eIt is easy for me to refer patients to the interns\\u003c/li\\u003e\\n \\u003c/ol\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003cp\\u003eAccessibility, High Productivity\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003col start=\\\"5\\\"\\u003e\\n \\u003cli\\u003eI am satisfied with the contributions of the interns\\u003c/li\\u003e\\n \\u003c/ol\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003cp\\u003eEducator\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003col start=\\\"6\\\"\\u003e\\n \\u003cli\\u003eThe clinical services are enhanced by the presence of interns\\u003c/li\\u003e\\n \\u003c/ol\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003cp\\u003eGeneralist Approach, Routine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003col start=\\\"7\\\"\\u003e\\n \\u003cli\\u003eInterns are accessible and open to feedback\\u003c/li\\u003e\\n \\u003c/ol\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003cp\\u003eAccessibility\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003col start=\\\"8\\\"\\u003e\\n \\u003cli\\u003eI want to continue collaborating with the Primary Care Psychology Program\\u003c/li\\u003e\\n \\u003c/ol\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 50%;\\\"\\u003e\\n \\u003cp\\u003eTeam Based, Routine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eQualitatively, responders provided open-ended comments detailing their experiences and perceptions of the psychology interns\\u0026apos; contributions to patient care and clinical operations. The specific prompt read: \\u0026ldquo;Please include any other comment regarding your satisfaction with the Primary Care Psychology Internship Program\\u0026rdquo;.\\u003c/p\\u003e\\n\\u003cp\\u003eDescriptive Analysis\\u003c/p\\u003e\\n\\u003cp\\u003eDescriptive statistics were used to analyze the distribution of professional roles among respondents, years of experience in the profession, years at the clinical site, and average scores for each survey question.\\u003c/p\\u003e\\n\\u003cp\\u003eInferential Analysis\\u003c/p\\u003e\\n\\u003cp\\u003eNon-parametric tests were utilized due to their suitability for ordinal and non-normally distributed data. The Kruskal-Wallis Test assessed differences in perceptions based on years of experience and years at the current clinical site. All survey items were analyzed to identify significant differences between groups. A Mann-Whitney U Test was used to conduct post hoc analysis of the questions with statistically significant scores. This analysis enabled the identification of specific groups responsible for the statistical differences.\\u003c/p\\u003e\\n\\u003cp\\u003eQualitative Analysis\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors employed thematic analysis to examine qualitative data obtained from 48 responses to the open-ended survey question. The first author developed a coding scheme by manually categorizing responses into distinct themes. A second independent researcher also coded the data to ensure reliability. Inter-rater reliability was assessed using Cohen\\u0026rsquo;s Kappa.\\u003c/p\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eHealthcare Professional\\u0026rsquo;s Perceptions of Psychology Integration\\u003c/p\\u003e\\n\\u003cp\\u003eThe analysis revealed consistently high levels of satisfaction among all professions. Table IV shows the score averages for each survey question across the surveyed professions. Collectively, 97.8% of the surveyed professionals agreed (12%) or strongly agreed (86%) with the statement \\u0026ldquo;I am satisfied with the contributions of the interns.\\u0026rdquo; Similarly, 97% agreed (19%) or strongly agreed (79%) that their services were enhanced by the intern services.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eTable IV\\u0026nbsp;\\u003c/strong\\u003eAverage scores from surveyed professional groups on collaboration with psychology interns\\u003c/p\\u003e\\n\\u003ctable border=\\\"1\\\" cellspacing=\\\"0\\\" cellpadding=\\\"0\\\"\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.3883%;\\\"\\u003e\\n \\u003cp\\u003eSurvey Question\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003eFamily Medicine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003eGeneral Medicine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003eInternal Medicine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003eEmergency Medicine\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003ePediatrics\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003eNursing\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.3883%;\\\"\\u003e\\n \\u003cp\\u003eI have discussed cases with the psychology interns\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.93\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.94\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e3.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e5.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.41\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.3883%;\\\"\\u003e\\n \\u003cp\\u003eI have seen patients along with the psychology interns\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.57\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.53\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.50\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e3.33\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e5.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.03\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.3883%;\\\"\\u003e\\n \\u003cp\\u003eI know the psychology interns by name\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.77\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.65\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e3.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.83\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.3883%;\\\"\\u003e\\n \\u003cp\\u003eIt is easy for me to refer patients to the interns\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.90\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.88\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.83\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e3.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e5.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.45\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.3883%;\\\"\\u003e\\n \\u003cp\\u003eI am satisfied with the contributions of the interns\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.93\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.94\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.83\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e3.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e5.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.3883%;\\\"\\u003e\\n \\u003cp\\u003eThe clinical services are enhanced by the presence of interns\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.87\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.88\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e3.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e5.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.55\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.3883%;\\\"\\u003e\\n \\u003cp\\u003eInterns are accessible and open to feedback\\u003c/p\\u003e\\n \\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e5.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.80\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.83\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e3.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e5.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.66\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd valign=\\\"top\\\" style=\\\"width: 20.3883%;\\\"\\u003e\\n \\u003cp\\u003eI want to continue collaborating with the Primary Care Psychology Program\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.97\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.94\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.83\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e3.67\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e5.00\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd style=\\\"width: 13.2686%;\\\"\\u003e\\n \\u003cp\\u003e4.62\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n\\u003c/table\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eNote.\\u003c/em\\u003e The survey questions were scored on a Likert scale, where 1 meant strongly disagree and 5 meant strongly agree.\\u003c/p\\u003e\\n\\u003cp\\u003eDifferences in perceptions by profession, years of experience, and years at the current site\\u003c/p\\u003e\\n\\u003cp\\u003eThe Kruskal-Wallis test results revealed significant differences in two of the eight survey questions. Significant differences were observed across professions in response to question one, \\u0026ldquo;I have discussed cases with the psychology interns\\u0026rdquo; item (\\u003cem\\u003eH\\u003c/em\\u003e = 20.82, \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt;.001). The post-hoc pairwise comparisons using the Mann-Whitney U test revealed significant differences between family medicine and nursing (\\u003cem\\u003eU\\u003c/em\\u003e = 251.0, \\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt;.001), general medicine and nursing (\\u003cem\\u003eU\\u003c/em\\u003e = 140.5, \\u003cem\\u003ep\\u003c/em\\u003e = 0.003), and nursing and pediatrics (\\u003cem\\u003eU\\u003c/em\\u003e = 45.0, \\u003cem\\u003ep\\u003c/em\\u003e = 0.034). Physicians from family medicine, general medicine, and pediatrics tend to hive higher ranks than the nursing and emergency medicine professionals.\\u003c/p\\u003e\\n\\u003cp\\u003eThe second significant difference was found in question two \\u0026ldquo;I have seen patients along with the psychology interns\\u0026rdquo; (\\u003cem\\u003eH\\u003c/em\\u003e = 11.27, \\u003cem\\u003ep\\u003c/em\\u003e = .046). The post hoc analysis revealed significant differences between family medicine physicians and nurses (\\u003cem\\u003eU\\u003c/em\\u003e = 307.0, \\u003cem\\u003ep\\u003c/em\\u003e = .031) and between nurses and pediatricians (\\u003cem\\u003eU\\u003c/em\\u003e = 36.0, \\u003cem\\u003ep\\u003c/em\\u003e = 0.015). Family medicine physicians and pediatricians reported conducting dual interviews more frequently than nursing professionals.\\u003c/p\\u003e\\n\\u003cp\\u003eThe Kruskal-Wallis test revealed significant differences in questions three (\\u003cem\\u003eH\\u003c/em\\u003e = 14.77; \\u003cem\\u003ep\\u003c/em\\u003e = .005) and four (\\u003cem\\u003eH\\u003c/em\\u003e= 10.18; \\u003cem\\u003ep\\u003c/em\\u003e = .037) based on the number of years working at the clinic. Post-hoc pairwise comparisons using the Mann-Whitney U for question three, \\u0026ldquo;I know the psychology interns by name\\u0026rdquo; revealed statistically significant differences between participants with 0-5 years and 11-15 years at the clinic (\\u003cem\\u003eU\\u003c/em\\u003e = 196.0, \\u003cem\\u003ep\\u003c/em\\u003e = .001). Professionals with fewer years at the clinic (0-5 years) had higher mean ranks compared to those with more years (11-15 years), indicating that those with fewer years at the clinic are more likely to know the psychology interns by name.\\u003c/p\\u003e\\n\\u003cp\\u003eSimilarly, for question four \\u0026ldquo;It\\u0026rsquo;s easy for me to refer patients to the interns\\u0026rdquo; the Mann-Whitney U test revealed a statistically significant difference in the scores between participants with 0-5 years and 11-15 years at the clinic (\\u003cem\\u003eU\\u003c/em\\u003e = 259.0, \\u003cem\\u003ep\\u003c/em\\u003e = .046). Participants with fewer years at the clinic (0-5 years) had higher mean ranks compared to those with more years (11-15 years) suggesting that those with fewer years at the clinic find it easier to refer patients to the psychology interns.\\u003c/p\\u003e\\n\\u003cp\\u003eThe Kruskal-Wallis test revealed no significant differences in any of the survey questions based on years of experience in the profession.\\u003c/p\\u003e\\n\\u003cp\\u003eThematic Analysis of Qualitative Feedback\\u003c/p\\u003e\\n\\u003cp\\u003eFive main themes emerged from the analysis: positive patient impact, professionalism and competence, collaboration and teamwork, flexibility and availability, and general praise. The results of the inter-rater reliability analysis indicated a high level of agreement between the two researchers with Cohen\\u0026apos;s Kappa calculated at 0.758 (\\u003cem\\u003ep\\u003c/em\\u003e \\u0026lt;.001).\\u0026nbsp;Below is a description of the results obtained from the thematic analysis by categories, supported by verbatim comments from respondents.\\u003c/p\\u003e\\n\\u003cp\\u003ePositive Patient Impact\\u003c/p\\u003e\\n\\u003cp\\u003eThis theme highlights the positive effects of psychology interns on patients. Many respondents noted that patients felt better understood and more comfortable when interacting with interns, emphasizing their positive influence on patient care. Example: \\u0026quot;As part of the family medicine team I have seen the excellent contribution the psychology interns are being for the program and the patients\\u0026quot; reported by a family medicine physician.\\u003c/p\\u003e\\n\\u003cp\\u003eProfessionalism and Competence\\u003c/p\\u003e\\n\\u003cp\\u003eResponses on this category reflect the high regard for the professional conduct, competence, and skill of psychology interns. Respondents described psychology interns as \\u0026quot;excellent professionals\\u0026quot; and \\u0026quot;very competent.\\u0026quot; Example. \\u0026quot;Very pleased to work with responsible, dedicated, and professional psychology interns.\\u0026quot; reported by a family medicine physician.\\u003c/p\\u003e\\n\\u003cp\\u003eFlexibility and Availability\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eThis theme highlighted the interns\\u0026rsquo; ability to adapt to various clinical environments and respond to dynamic needs. Example: \\u0026quot; \\u0026hellip; disponibilidad al momento de ser necesario y de buena ayuda para el equipo interdiciplinario.\\u0026rdquo; [availability at the moment if necessary and a great help for the interdisciplinary team.], reported by a nurse.\\u003c/p\\u003e\\n\\u003cp\\u003eCollaboration and Teamwork\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003eResponses in this category focused on valuing teamwork and collaborative efforts involving psychology interns, acknowledging them as integral members of the primary care team. Example: \\u0026ldquo;It is a pleasure for me the interrelate with the interns. It\\u0026rsquo;s a mutual learning experience..\\u0026rdquo;\\u0026nbsp;reported by an internal medicine physician.\\u003c/p\\u003e\\n\\u003cp\\u003eGeneral Praise\\u003c/p\\u003e\\n\\u003cp\\u003eThis theme encompassed positive acknowledgments that didn\\u0026apos;t fit neatly into\\u0026nbsp;other categories, such as \\u0026ldquo;Excellent\\u0026rdquo; and \\u0026ldquo;Excellent resources to our clinic\\u0026rdquo;. These comments provided a general idea of the appreciation of the healthcare professional, although without specification of what they valued.\\u003c/p\\u003e\\n\\u003cp\\u003eThe qualitative analysis underscored psychology interns\\u0026apos; positive impact in clinical settings, particularly emphasizing patient care, professionalism, flexibility, and teamwork.\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cp\\u003eThe findings from this exploratory study provide valuable insights into the positive impact that psychology trainees can have on their healthcare colleagues. The favorable perceptions held by nurses and physicians toward the integration of clinical psychology interns in Puerto Rican primary care settings are encouraging. These results align with previous studies that demonstrate how behavioral health professionals are positively perceived by physicians and enhance physicians' commitment to mental health, as well as their perceived ability to manage patients' mental health needs \\u003csup\\u003e\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eThe qualitative feedback supports the quantitative findings, underscoring the value of clinical psychology interns. The themes identified in the analysis\\u0026mdash;professionalism, competency, adaptability, flexibility, collaboration, and teamwork\\u0026mdash;reflect key competencies in health service and primary care psychology \\u003csup\\u003e\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e,\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e\\u003c/sup\\u003e.\\u003c/p\\u003e \\u003cp\\u003eDespite the overall positive feedback, notable differences in perceptions between nurses, family physicians, general physicians, and pediatricians warrant further investigation. The reduced frequency of dual interviews involving interns and nurses highlights potential underlying dynamics that could benefit from targeted interprofessional training strategies. Additionally, the higher familiarity of newer clinic staff with interns\\u0026rsquo; merits deeper exploration to enhance integration strategies effectively.\\u003c/p\\u003e \\u003cp\\u003eAlthough the findings are promising, several limitations should be considered when interpreting the results. The study's reliance on a secondary analysis of survey data, initially collected for evaluating interns, might introduce biases reflective of the survey's original intent. The anonymity of the survey responses precludes the ability to track longitudinal changes which would provide richer insights. Additionally, the sample size, while sufficient for exploratory analysis, restricts the generalizability of the findings. Moreover, the dependence on self-reporting may introduce response bias, with participants potentially offering socially desirable responses.\\u003c/p\\u003e \\u003cp\\u003eFuture research should include more detailed questions to allow for a nuanced understanding of healthcare professionals' perceptions. Expanding the participant pool to include other healthcare roles and integrating additional quantifiable measures could offer a more comprehensive view. Furthermore, employing a longitudinal design would also be beneficial, tracking shifts in perceptions over time to better understand the dynamics of integration.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eImplications for Behavioral Health\\u003c/h2\\u003e \\u003cp\\u003eThe integration of clinical psychology interns into primary care teams offers promising implications for behavioral health services, particularly in underserved and low-income populations. By fostering interprofessional collaboration, psychology trainees help address mental health needs in primary care settings, where behavioral health services are often limited. The high levels of satisfaction reported by healthcare professionals suggest that psychology interns play a vital role in enhancing patient care and team dynamics, contributing to a more holistic approach to healthcare delivery.\\u003c/p\\u003e \\u003cp\\u003e The results align with the broader trend outlined in the introduction\\u0026mdash;the shift toward the integration of health service psychology in primary care settings. As the healthcare system continues to embrace interprofessional models, psychology trainees will play a critical role in shaping the future of behavioral health services. The positive experiences highlighted in this study suggest that continued efforts to refine integration strategies will benefit patients and further solidify psychology's role as a core component of modern healthcare.\\u003c/p\\u003e \\u003cp\\u003eThe findings also underscore the importance of continuing to develop training programs that emphasize interprofessional collaboration and the Primary Care Behavioral Health (PCBH) model. As primary care clinics increasingly adopt integrated care models, the inclusion of psychology trainees offers a sustainable way to improve behavioral health outcomes. Their involvement has the potential to broaden access to mental health services and strengthen the capacity of healthcare teams to manage complex patient needs.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u0026nbsp;\\u003c/strong\\u003eThis work was supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of the BHWET and GPE awards. The contents are those of the authors and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government.\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting Interests:\\u003c/strong\\u003e The authors declare that there are no conflicts of interest regarding the publication of this manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eEthics approval:\\u003c/strong\\u003e This study was conducted in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The research protocol was reviewed and approved by the Ponce Medical School Foundation Institutional Review Board at Ponce Health Sciences University approval # 2403191296.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eInformed Consent Statement:\\u0026nbsp;\\u003c/strong\\u003eThis study utilized secondary data originally collected as part of program evaluation activities for the Primary Care Psychology Program. The data collection process was not specifically designed for research purposes, and as such, the study did not involve direct engagement with human subjects. Consequently, obtaining informed consent from individual participants was not feasible. The Institutional Review Board (IRB) at Ponce Health Sciences University reviewed and approved the study, including its use of de-identified secondary data. All reasonable steps were taken to ensure the confidentiality and privacy of the data throughout the research process. For additional questions or concerns about the ethical considerations of this study, please contact Dr. Nydia Cappas at\\u0026nbsp;\\u003ca href=\\\"mailto:ncappas@psm.edu\\\"\\u003encappas@psm.edu\\u003c/a\\u003e or the Ponce Health Sciences University IRB at 787-840-2575, ext. 4758.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eData availability statement:\\u003c/strong\\u003e The data used in this study were collected from an annual survey conducted from 2020 to 2021. These data are utilized internally by the program for decision-making and improvement purposes. As such, the data are not publicly available. However, they may be made accessible upon request to the corresponding author, subject to approval by the program administrators and adherence to data privacy regulations.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthor contribution statement:\\u003c/strong\\u003e All authors contributed to the study conception and design. The first draft of the manuscript was written by Nydia Cappas, and Nydia Ortiz contributed to the manuscript preparation and concept. Data preparation and analysis were performed by Viviana Hoyos, Valerie Toro, and Nydia Cappas. All authors commented on previous versions of the manuscript, read, and approved the final manuscript.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\n \\u003cli\\u003eBelar CD, Grus CL, Andrasik F, et al. Professional psychology in health care services: A blueprint for education and training. \\u003cem\\u003eAmerican Psychologist\\u003c/em\\u003e. 2013;68(6):411-426. doi:10.1037/a0033265\\u003c/li\\u003e\\n \\u003cli\\u003eChristian E, Krall V, Hulkower S, Stigleman S. Primary Care Behavioral Health Integration: Promoting the Quadruple Aim. \\u003cem\\u003eN C Med J\\u003c/em\\u003e. 2018;79(4). doi:10.18043/ncm.79.4.250\\u003c/li\\u003e\\n \\u003cli\\u003eLaderman M. Behavioral Health Integration: A Key Component of the Triple Aim. \\u003cem\\u003ePopul Health Manag\\u003c/em\\u003e. 2015;18(5):320-322. doi:10.1089/POP.2015.0028\\u003c/li\\u003e\\n \\u003cli\\u003eSerrano N, Cordes C, Cubic B, Daub S. The State and Future of the Primary Care Behavioral Health Model of Service Delivery Workforce. \\u003cem\\u003eJ Clin Psychol Med Settings\\u003c/em\\u003e. 2018;25(2):157-168. doi:10.1007/s10880-017-9491-1\\u003c/li\\u003e\\n \\u003cli\\u003eBoulon-D\\u0026iacute;az F. La Psicolog\\u0026iacute;a como profesi\\u0026oacute;n en Puerto Rico: desarrollo y nuevos retos. \\u003cem\\u003eRev Puertorriquena Psicol\\u003c/em\\u003e. 2006;17(1):216-240. Accessed April 26, 2024. https://www.repsasppr.net/index.php/reps/article/view/503\\u003c/li\\u003e\\n \\u003cli\\u003eBernal G. 60 Years of Clinical Psychology in Puerto Rico. \\u003cem\\u003eRevista Interamericana de Psicolog\\u0026iacute;a\\u003c/em\\u003e. 2013;47(2):211-226.\\u003c/li\\u003e\\n \\u003cli\\u003eCappas NM, Reyes-Estrada M, Toro V, et al. Integrating Behavioral Health Care into HIV/AIDS Care Clinics in Puerto Rico. \\u003cem\\u003eRev Puertorriquena Psicol\\u003c/em\\u003e. 2017;28(2):284-293. Accessed February 6, 2018. http://www.ojs.repsasppr.net/index.php/reps/article/view/368/329\\u003c/li\\u003e\\n \\u003cli\\u003eReiter JT, Dobmeyer AC, Hunter CL. The Primary Care Behavioral Health (PCBH) Model: An Overview and Operational Definition. \\u003cem\\u003eJ Clin Psychol Med Settings\\u003c/em\\u003e. 2018;25(2):109-126. doi:10.1007/S10880-017-9531-X\\u003c/li\\u003e\\n \\u003cli\\u003eTorrence ND, Mueller AE, Ilem AA, Renn BN, DeSantis B, Segal DL. Medical provider attitudes about behavioral health consultants in integrated primary care: A preliminary study. \\u003cem\\u003eFamilies, Systems, \\u0026amp; Health\\u003c/em\\u003e. 2014;32(4):426-432. doi:10.1037/FSH0000078\\u003c/li\\u003e\\n \\u003cli\\u003eWard W, Zagoloff A, Rieck C, Robiner W. Interprofessional education: Opportunities and challenges for psychology. \\u003cem\\u003eJ Clin Psychol Med Settings\\u003c/em\\u003e. 2018;25(3):250-266. doi:10.1007/S10880-017-9538-3\\u003c/li\\u003e\\n \\u003cli\\u003eRobiner WN, Hong BA, Ward W. Psychologists\\u0026rsquo; Contributions to Medical Education and Interprofessional Education in Medical Schools. \\u003cem\\u003eJ Clin Psychol Med Settings\\u003c/em\\u003e. 2021;28(4):666-678. doi:10.1007/S10880-020-09730-8/METRICS\\u003c/li\\u003e\\n \\u003cli\\u003eKaitz JE, Ray S. Psychologist and physician inter-professional collaborative experiences in primary care integration. \\u003cem\\u003eJ Clin Psychol Med Settings\\u003c/em\\u003e. 2021;28(3):436-446. doi:10.1007/S10880-020-09733-5\\u003c/li\\u003e\\n \\u003cli\\u003eNutting R, Ofei-Dodoo S, Wipperman J, Allen AD. Assessing Family Medicine Physicians\\u0026rsquo; Perceptions of Integrated Behavioral Health in a Primary Care Residency. \\u003cem\\u003eFam Med\\u003c/em\\u003e. 2022;54(5):389-394. doi:10.22454/FAMMED.2022.541800\\u003c/li\\u003e\\n \\u003cli\\u003eEde V, Okafor M, Kinuthia R, et al. An Examination of Perceptions in Integrated Care Practice. \\u003cem\\u003eCommunity Ment Health J\\u003c/em\\u003e. 2015;51(8):949. doi:10.1007/S10597-015-9837-9\\u003c/li\\u003e\\n \\u003cli\\u003eLamparyk K, Williams AM, Robiner WN, Bruschwein HM, Ward WL. Interprofessional Education: Current State in Psychology Training. \\u003cem\\u003eJ Clin Psychol Med Settings\\u003c/em\\u003e. 2022;29(1):20-30. doi:10.1007/S10880-021-09765-5\\u003c/li\\u003e\\n \\u003cli\\u003eKelly MM, Martin-Peters T, Farber JS. Secondary Data Analysis: Using existing data to answer new questions. \\u003cem\\u003eJournal of Pediatric Health Care\\u003c/em\\u003e. 2024;38(4):615-618. doi:10.1016/J.PEDHC.2024.03.005\\u003c/li\\u003e\\n \\u003cli\\u003eSchinka JA, Velicer WF, Weiner IB. Handbook of psychology: Research methods in psychology, Vol. 2, 2nd ed. \\u003cem\\u003eHandbook of psychology: Research methods in psychology, Vol 2, 2nd ed\\u003c/em\\u003e. Published online 2012:800.\\u003c/li\\u003e\\n \\u003cli\\u003eBehrens JT. 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Published online April 10, 2023:25-42. doi:10.1037/0000340-003\\u003c/li\\u003e\\n\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[{\"identity\":\"3feaa1e8-b8e9-4f22-ab38-e0cb65b30fe1\",\"identifier\":\"10.13039/100000102\",\"name\":\"Health Resources and Services Administration\",\"awardNumber\":\"D40HP33357; M01HP31325\",\"order_by\":0}],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"Ponce Health Sciences University\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Healthcare Professionals’ Perceptions, Interprofessional Collaboration, Primary Care Psychology, Integrated Healthcare\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-5499934/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-5499934/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003eThis study explores healthcare professionals' perceptions of integrating clinical psychology interns in primary care settings in Puerto Rico. The authors conducted an exploratory study using secondary survey data from 2020 to 2021, involving 91 participants from medical and nursing professions in seven primary care clinics and one general hospital. Quantitative measures included a survey based on the GATHER framework of Primary Care Behavioral Health. Survey responses were based on a 5-point Likert scale. Qualitative data were analyzed for themes. Quantitative data showed high satisfaction with the interns across disciplines, with an average score of 4.75. The Kruskal-Wallis test revealed significant differences between professions in two survey items: \\\"I have discussed cases with psychology interns\\\" (H = 20.82, p \\u0026lt; .001) and \\\"I have seen patients with psychology interns\\\" (H = 11.27, p = .046). Post-hoc Mann-Whitney U tests indicated significant differences between family medicine and nursing (\\u003cem\\u003eU\\u003c/em\\u003e = 251.0, \\u003cem\\u003ep\\u003c/em\\u003e\\u0026lt;.001), general medicine and nursing (\\u003cem\\u003eU\\u003c/em\\u003e = 140.5, \\u003cem\\u003ep\\u003c/em\\u003e = 0.003), and nursing and pediatrics (\\u003cem\\u003eU\\u003c/em\\u003e = 45.0, \\u003cem\\u003ep\\u003c/em\\u003e = 0.034). Additional significant differences were found in familiarity with interns and ease of referring patients based on years working at the clinic. Qualitative analysis of open-ended responses identified themes of professionalism, flexibility, collaboration, and positive patient impact. The findings highlight the positive perceptions of healthcare professionals regarding the integration of clinical psychology interns, reflecting the effective advancement of interprofessional care. Limitations and implications for behavioral health are discussed.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Integrating Clinical Psychology Interns in Primary Care: Perceptions from Healthcare Providers in Puerto Rico\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-11-29 09:02:52\",\"doi\":\"10.21203/rs.3.rs-5499934/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"2152ac0e-b25d-4238-952c-906d8575ad7b\",\"owner\":[],\"postedDate\":\"November 29th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2024-11-29T09:02:52+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-11-29 09:02:52\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-5499934\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-5499934\",\"identity\":\"rs-5499934\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}