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The Dembo-Wright Lecture provided a forum to discuss how innovation occurs in general and in rehabilitation psychology. The 21st Century will rely upon the creation and enhancement of knowledge. Universities, industries and professional disciplines are challenged to develop models that nurture their development of knowledge jobs that create new systems or products. A new model of nurturing innovation: The Rainforest, relies upon creating ecosystems that bring together and support the critical groups allowing instances that propel spontaneous growth of sustainable enterprises. Over the last 3 decades, rehabilitation psychology has seen disruptive-yet productive-innovation when thought leaders in the field have introduced ideas that move the discipline to entirely new areas of discussion. For rehabilitation psychology, consideration of new models of practice that address the huge needs of the developing world are warranted. The complexity of nurturing innovation in differing environments must be addressed. Progress to date indicates that understanding and defining the interface between machines and humans will be critical to the future of rehabilitation psychology. (PsycINFO Database Record

PURPOSE Changes in the health care environment have brought challenges and opportunities to the field of psychology. Practitioners have been successful in modifying service models to absorb losses of financial support for behavioral health care, due to managed care and public policy changes, while simultaneously managing the growing need for these services. However, in this reactive mode of responding to evolutions in the health care system, the field of psychology has at times lost sight of the long-term vision required to promote psychology's inclusion in the health care system of the future. In particular, a focus on training psychologists and ensuring the availability of funding to support these activities must be a priority in planning for the future. This article provides an overview of federal programs that currently offer funding for psychology training, as well as other opportunities for federal funding that have been unrealized. Details regarding advocacy efforts that were required to secure available sources of funding are given, followed by consideration of strategies for taking advantage of existing resources and prioritizing advocacy for additional funding. CONCLUSION Funding for psychology training provides an avenue for increasing the number of well-trained psychologists who can serve patients' mental and behavioral health needs and thereby improve health outcomes. Moreover, capitalizing on available funding opportunities for psychology training and promoting efforts to expand these opportunities will help ensure that the field of psychology is positioned to remain an important contributor to the health care system of the future.

The federal government has played a significant role in the financing the education of healthcare professionals since the introduction of Medicare in 1965. However, professional psychology's limited ability to argue the critical nature of its services to the welfare of the nation, and its lack of national workforce information and policy, has hindered its inclusion in Medicare's Graduate Medical Education (GME) program. This paper discusses the evolution and current status of healthcare workforce policy in the United States, and the implications for psychology and the training of future professionals. Also described are recent efforts by the American Psychological Association (APA) and a few psychologists to include professional psychology in the GME program. The importance of organized psychology's sustained involvement in national health policy is emphasized.

The US Congress faces a host of health issues that demand immediate attention. Many of these issues are of considerable importance to those persons with spinal cord injury (SCI), including the rising cost of health care and health insurance, the current budget shortfalls facing state governments, and the need for a Medicare prescription drug program. Persons with disabilities are becoming increasingly dependent on public forms of insurance, like Medicare and Medicaid, and are bearing a disproportionate share of service curtailment. Other issues relevant to persons with disabilities and health care providers are prospective payment reimbursement implementation for rehabilitation, the reauthorization of the Rehabilitation Act, and the New Freedom Initiative. Considering the political climate and the importance of such issues, the need for advocacy among professionals and consumers is greater than ever.

Objective. Research in the areas of pediatric rheumatology and pediatric chronic illness has emphasized comprehensive models of adaptation involving risk and resistance factors. This study examined adaptation, within this framework, among a large sample of children with chronic illness and children without chronic illness. Methods. A comprehensive battery of adaptation measures was administered to a sample of 107 children with juvenile rheumatoid arthritis, 114 children with insulin-dependent diabetes mellitus, and 88 healthy controls. Results. Medical diagnosis was associated with mothers' depression and a composite measure of parental (mother and father) distress and passive coping. Children's emotional and behavioral functioning was not related to medical diagnosis, but mothers' depression and parental distress were associated with child behavior problems. Conclusion. Because parental distress was associated with child functioning, interventions to ameliorate parental distress may have beneficial effects on the children's behavior and on parents' reactions to their children.

Many psychologists are finding new opportunities for practice in primary care settings. These settings challenge many aspects of traditional practice and require adaptation and innovation. Psychologists must consider changes in their site of practice, treatment duration, type of intervention, and role as part of a health care team. This article describes the culture of primary care medicine and offers 10 practical tips for the adaptation of psychological practice to primary care. Primary care is now the linchpin of the new health care delivery system. This focus on primary care creates both threats to the conventional independent practice of psychology and new opportunities for collaboration and direct participation in the delivery of primary care services. In terms of threat, a psychologist whose solo or small-group practice has focused predominately on private, office-based psychological assessment and psychotherapy faces increasing economic pressures created by market-driven reforms, managed care, and other limits to traditional fee-for-service psychological services (Frank & VandenBos, 1994). Managed care systems increasingly rely on primary care providers (including physicians in family n'~edicine, general internal medicine, pediatrics, and sometimes obstetricsgynecology) to screen and triage patients with a wide range of medical and psychological problems. These physicians are the gatekeepers for referral to all specialists, including psychologists. In terms of opportunity, psychologists who shift their practices to work closely with these providers as part of an integrated delivery system are most likely to continue to deliver services to a wide variety of patients (Shortell, Gillies, & Anderson, 1994).

Return to work following spinal cord injury is achievable for many individuals. Interdisciplinary rehabilitation teams are ideally suited to facilitate an individual's efforts at overcoming the numerous barriers involved in returning to gainful, competitive employment. Many of these barriers are person-specific (i.e., education level), and multifaceted assessment and comprehensive vocational planning are suggested. Other barriers, such as economic disincentives and poor access to needed services, are less easily overcome. Rehabilitation professionals are encouraged to become familiar with recent health and disability policy (i.e., Americans with Disabilities Act) and become proactive in policy formation. There is a significant need for development and testing of model programs to enhance return to work for individuals with spinal cord injury.

Neuropsychological assessment is a standard procedure for rehabilitation patients with cognitive dysfunction. However, the use of neuropsychological evaluations in rehabilitation settings is limited as the most commonly used measures were originally developed for diagnostic purposes with an emphasis on localization/lateralization of lesions and description of brain-behavior relationships. As a result, the functional (versus diagnostic) utility of neuropsychological evaluations is questionable at best. Furthermore, neuropsychological evaluation in rehabilitation settings will continue to be of limited utility as long as INS-APA Division 40 guidelines continue to emphasize training in neurologic and neuroanatomic factors, with minimal attention to rehabilitation issues and resources. Several factors necessitate the use of neuropsychological evaluations for functional rather than diagnostic purposes, including advances in neuroradiological evaluation, the growth of rehabilitation facilities given increased survival rates for brain injured patients, and an associated greater need for psychological services for these patients. Suggestions are offered for improving the functional utility of neuropsychological evaluations, as well as more effective ways to train neuropsychologists in rehabilitation issues and interventions.

Managed care has affected the delivery of services in all health care sectors, although its impact on rehabilitation has been slower to take effect. These changes have required clinicians to provide more efficient services that are demonstrated to have an impact on functional outcome. However, in order to be reimbursed for specific rehabilitation services, such as cognitive rehabilitation, it is necessary for clinicians to become more knowledgeable regarding managed care, service delivery, and reimbursement issues. This article describes the impact of managed care on health care in general and on rehabilitation specifically. In addition, current billing procedures and reimbursement issues as they relate to cognitive rehabilitation are discussed, and suggestions for ways to secure reimbursement are presented for all disciplines providing cognitive rehabilitation services.

The administrative structure of academic health centers is reviewed, with a view to understanding the issues of marketing psychological services within that setting. The slow changes at academic health centers to new practice styles requires psychology to formulate a market strategy addressing the traditional specialist model and another plan responsive to the emerging model emphasizing primary care. Market targets for psychologists include administration, physicians, and patients. Presently, the Association of Medical School Psychologists is working with the Association of Academic Health Centers to design a marketing program targeting leaders at academic health centers.

State Medicaid programs are rapidly converting fee-for-service health delivery systems to managed care for people with disabilities. In theory, managed care models of health delivery will substantially improve the quality of care for people with disabilities, but in reality, few successful models exist. This period of transition holds both opportunities and challenges for psychologists in medical settings. Because Medicaid reforms for people with disabilities may herald similar reforms for both the public and the private sectors, psychology's response will determine its role in the future of health care delivery for this population. Changes in training and increased attention to outcomes research, innovations in practice, and advocacy will be the keys to success.

This study examined the relationships of the dispositional variables of hope, positive affectivity (PA), and negative affectivity (NA) with disease status and illness-related psychosocial functioning in a sample of 45 young adults with insulin-dependent diabetes mellitus (IDDM). Canonical analyses revealed one significant canonical function between the dispositional and psychosocial outcome variables. Primary contributors to the relationship were higher NA and lower PA and maladaptive emotional behavior. A linear multiple regression analysis using hope and affectivity as predictors failed to account for a significant proportion of variance in objective disease status as measured by hemoglobin A 1C (HbA1C). The results support previous findings that affectivity may relate to self-reported, disease-related outcome, but not necessarily to objective measures of health status. Future studies of adaptation to chronic illness should consider including measures of illness-related behaviors (e.g., adherence), as well as subjective and objective measures of health status.

The current study examined anger expression styles and their relationship to levels of depressed mood and aggressive behavior in male and female children and adolescents. Measures of anger, anger expression, and depressed mood were collected from both children and their parents. Hierarchical multiple regressions revealed that anger expression significantly predicted sadness but not aggression for females, after accounting for age and anger level. Among males, anger expression was important in predicting aggression but not sadness, whereas age and anger level best predicted sadness. These results suggest that age, anger level, and anger expression may be risk factors for depression and aggression among children and adolescents. Sex appears to be an important factor in anger expression styles and related depression and aggressive behavior.

Rehabilitation medicine represents a substantial area of growth in the healthcare industry over the course of the last two decades. Historically characterized by collaborative, interdisciplinary team approaches and the inclusion of family members in treatment, rehabilitation medicine targets restoration of functional abilities in individuals with debilitating illness or injury. Interestingly, systems /biopsychosocial frameworks that have been incorporated into other areas of medicine have been underutilized in the rehabilitation context. Systems theory and biopsychosocial approaches to rehabilitation medicine appear to have considerable value and utility in this field, particularly in light of current and proposed healthcare reform. We argue that the systems perspective, which has enjoyed success in the area of family systems medicine, can be further extended into the rehabilitation context. A systems perspective as applied to the rehabilitation setting is provided in the present article, and recommendations are made for increased involvement by systemstrained professionals from clinical, re

Because the federal government is the largest payer of all health costs, unbridled increases in the health workforce have profound fiscal implications. Recent efforts to control health spending through modifications of health delivery systems are related to the consequences of the unlimited production of health professionals. However, the federal government has established processes to review physician workforce changes, and these mechanisms have become important in accessing federal training monies. Psychologists have no concerted workforce policy and receive little federal training money. Moreover, other health professionals have attained statutory authority to perform and provide the same services as psychologists. This diffusion of professional functions impedes the ability to assess the status of the workforce and the development of psychology as a health profession.

As demographics shift to include more elderly populations and those living with chronic medical conditions, costs for health care services continue to escalate. As a result, health care systems around the world increasingly struggle to provide cost-effective, coordinated, and quality health care to those they serve. Significant policy, procedural, and practice changes are essential in solving these growing problems. With experience in interdisciplinary teams, rehabilitation psychologists and other psychological providers have a clear vantage point from which to help guide movement toward an integrated health care model that values health promotion, prevention, and collaborative care. Psychologists can be an integral part of this new “interdisciplinary team,” but, as a profession, we must advocate for this inclusion and position ourselves to take on this new role through education and training.

Head injury constitutes a significant public health concern. Despite increasing recognition of the morbidity and mortality associated with head injury, there exist few statewide estimations of the prevalence and public perception of head injury. Knowledge of the public's perception can facilitate the funding and planning for the treatment and rehabilitation of persons with head injury. This study was undertaken for this purpose by the Missouri Head Injury Advisory Council and consisted of a stratified sampling of 1123 Missourians in a statewide telephone poll. The results revealed that the general public has an accurate perception of head injury and that knowledge improved as a function of direct experience with head injury.

Challenged by relentless increases in health care spending, state governments have been forced to experiment with health care system reform. Medicaid has been expanded by Congress, forcing states to provide a broader array of health benefits to more recipients. As states consider reform, federal limitations mandated by Medicaid and by the Employee Retirement Income Security Act (ERISA) of 1974 on state activity pose significant obstacles. ERISA sharply limits a state's ability to raise revenue to fund these health programs. Several states have responded to these limitations by seeking waivers. Despite these obstacles, 8 states already have enacted comprehensive health reform measures, and virtually every state is considering legislative reform.