Intro: Welcome to UAB MedCast, a continuing education podcast for medical professionals, providing knowledge that is moving medicine forward. Here's Melanie Cole.

Melanie Cole, MS (Host): Welcome to UAB MedCast. I'm Melanie Cole. And today, we're highlighting the role of a rehabilitation psychologist on an interdisciplinary rehab team. Joining me is Dr. Casey Azuero. She's the Director in the Division of Rehabilitation Psychology at UAB Medicine. Dr. Azuero, thank you so much for joining us today. Why don't you start by telling us what is a rehabilitation psychologist?

Dr. Casey Azuero: A rehabilitation psychologist is a psychologist with specialty training focused on the study and application of what we know in Psychology and our knowledge and skills on behalf of individuals with disabilities and chronic health conditions, focused all on maximizing their health, independence, choice, function, and social participation across the lifespan.

Overall, rehabilitation psychologists are concerned with individuals from a systemic, holistic perspective, considering all the factors of the person, the context, the relationships in which the person is involved or needs to be involved, the team of treatment providers, as well as the full range of the person's characteristics, such as gender, temperament or personality, intellectual and cognitive skills, and developmental factors throughout the lifespan from earliest childhood through late adulthood.

Melanie Cole, MS: Well, I would imagine, Dr. Azuero, when you mentioned the word context, that it would certainly depend on the person's abilities or lack of abilities, as you mentioned, cognitive or physical. Really, those psychosocial aspects of any type of ability or disability based on an accident or something that they've lived with all their life has really got to be fluid for you, yes?

Dr. Casey Azuero: Absolutely.

Melanie Cole, MS: What kind of training would be required then to become a rehabilitation psychologist based on the fact that you have to really adapt to whatever the patient's needs are at that time?

Dr. Casey Azuero: Typically, we have a doctorate degree in Clinical Psychology or Counseling Psychology, that training includes the development as a scientist and a clinician with extensive training in healthcare settings, it's typically the background of someone who would then go on to further specialize in postdoctoral training focused on how to engage in clinical practice, consultation with other providers, program development, research, teaching and educating others, administration and advocacy skills, all related to persons with disability and chronic health conditions, just like you were saying. So, how to take that background training and really hone that in in a more focused way. So in order to demonstrate that a psychologist has the training and experience to work with these specialized populations, there's the opportunity to obtain specialty board certification, just like as in medicine, as a rehabilitation psychologist, which a few of us in the state of Alabama have.

Melanie Cole, MS: So, what settings would we typically find in clinical settings a rehabilitation psychologist? There must be many places for You and a team such as yours.

Dr. Casey Azuero: With that kind of breadth of coverage in our training, we can be found many places doing a variety of tasks. Rehabilitation psychologists work in acute care settings and hospitals and healthcare centers, inpatient, as well as outpatient physical rehabilitation units and centers, assisted living, and long-term care facilities, as well as specialty clinics like pain clinics and sports injury centers, rehabilitation facilities, and community agencies serving individuals with specific disabilities or chronic health conditions, things like cerebral palsy, multiple sclerosis, brain injury, HIV, and deafness and blindness.

Rehabilitation psychologists may be also seen working full or part time in universities or colleges as faculty focused on teaching research and/or administration. While others may work in or consult with industry, provide expert legal testimony, or conduct assessments and evaluations for insurance agencies. They may work for private facilities or non-profit organizations or for government facilities such as VA hospitals or centers or offices of social security disability determination. Some rehabilitation psychologists work in private practice which can also stretch their reach from a model of a singular office practice or span across diverse settings doing a broad range of clinical tasks focused on persons, again, with varying disabilities and illness. While others may just focus in on one particular area of practice.

But similar to other clinical providers, rehabilitation psychologists who do provide clinical services, they're required to be licensed in order to provide services in their state or provincial province of practice and to receive reimbursement for services from health insurance payers.

Melanie Cole, MS: In the many clinical settings in which a rehabilitation psychologist is most useful, how do you add to the care of an injured patient? or ill patient, as you mentioned, chronic illnesses, such as MS or Parkinson's, and then there's traumatic brain injury and/or accident or post surgery. Tell us how you work with patients and their families. How do you add to what they're already getting?

Dr. Casey Azuero: In working together, we work best. So, we are typically alongside providers with other training, and other disciplines. So, we're on interdisciplinary or multidisciplinary teams of professionals, as well, as you said, as the person injured or ill and their care partners. Focused on broadening opportunities and facilitating maximum individual functioning, including participation in those social relationships and activities, recreation, education, employment, and access to the community in general.

So, as you can imagine, if you're a medical provider focused on the health of a person, being able to understand the context in which they want to go and participate can be very helpful and so working with a provider who has come to learn and know those parts of a person can be very helpful as consultation.

And in acute care setting, which in part is where I work, this may include helping the patient participate fully in their medical care. Perhaps they have lower education attainment and an assessment for their health literacy or literacy overall might help facilitate their education and learning in this new diagnosis or disease process that they find themselves in.

And an inpatient rehabilitation hospital setting, the focus is on helping them and their care partners get the most out of their rehabilitation experience. So, this includes providing assessments related to their intellectual and cognitive skills, understanding their history and the context they bring to this environment. Because by learning about their social and education history, substance use history, psychiatric history, and experiences with mental health care and health care overall, along with their medical history, we can create a treatment plan that focuses on capitalizing on their strengths and coping, as well as teaching them new skills that they need given their new circumstances. We also continue to assess their neurologic recovery, engagement in health related behaviors and mood symptoms throughout their rehabilitation, stay, or hospitalization, and provide community-based resources that may help them in their transition to their next setting as well.

Melanie Cole, MS: What an important job that you have, Dr. Azuero. In what ways do you support other members of the rehab team? How are you working together with physical therapy, occupational therapy, any physicians that might be involved, or nurse navigators? Tell us how you're all working together for this multidisciplinary approach and when a patient or caregiver might want to request the support of a rehabilitation psychologist.

Dr. Casey Azuero: In the biopsychosocial model used typically in healthcare and what we use at UAB, rehabilitation psychologists provide insights into that patient's psychological state, helping them understand how emotional factors may impact their recovery process, offer strategies to address mental health care concerns that could hinder the rehabilitation progress and facilitate communication between the team and the patient and their care partner regarding their psychological needs and coping mechanisms. This allows the other team members to really focus in on their respective areas of expertise in this holistic model.

For example, like you mentioned, physical therapy. If someone was involved in a car accident and are feeling anxious about getting back into a car, a rehabilitation psychologist may co-treat with a physical therapist. While they're teaching the patient and care partner how to transfer into a vehicle, we can be there alongside helping the patient use skills to manage their anxiety. Also, we help our fellow team members learn new skills that may help them better engage with individuals they are working with, as well as understanding the background and context that a person brings to this environment, that may matter to them and how we communicate.

Why might a patient or caregiver want to request a rehabilitation psychologist? We have found that patients and caregivers often prefer to keep care within a rehabilitation facility because it provides a structured environment with physical, occupational, and speech therapists and medical staff, allowing for a focused approach to recovery that helps them build trust and rapport and enable them to track progress effectively while feeling supported throughout their journey in rehab, especially when dealing with complex medical conditions requiring intensive therapy. This continuity of care can lead to better long-term outcomes compared to fragmented care across different healthcare settings.

 In working with rehabilitation psychologists, they are working with someone with specialized expertise and understanding of the recovery process and mental health care application toward individual needs and conditions within that context.

Melanie Cole, MS: Do you have any final thoughts for other providers when they're thinking about engaging the services of a rehabilitation psychologist, what you'd like them to know?

Dr. Casey Azuero: We are here to help. We love working and communicating within teams and helping coordinate care in a way that keeps patients and families first and are always happy to come alongside to maximize the overall experience of our patients that we serve.

Melanie Cole, MS: thank you so much, Dr. Azuero, for joining us and telling us about the breadth of services that you offer at UAB Medicine. Thank you again. And for more information, please visit our website at uabmedicine.org/physician. That concludes this episode of UAB MedCast. I'm Melanie Cole. Thanks so much for joining us today.