Investing in our future: unrealized opportunities for funding graduate psychology training

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.     

Some foundations and directions for applied developmental psychology

Applied developmental psychology (ADP) is an “umbrella” discipline which includes a range of psychological sciences and professions committed to use of the data base and methods of developmental psychology to address problems in education, health, human services and public policy. ADP emerges now as a manifestation of increasing recognition of the limits of developmental psychology's traditional models and paradigms, increasing recognition of our appropriate role in social problem-solving and public policy formation and an employment market which reflects these awarenesses. Consideration of clinical psychology as an ADP provides examples of synergies and distinctions helpful in defining ADP. The “linkage” concept inherent in a “scientist-practitioner” model is emphasized as a key in this definition and as a basis for designing appropriate doctoral training programs in ADP.     

Training in health psychology: An international look

With the progression of health psychology as a new field in psychology specific training programs are more and more needed. A survey of the training situation of health psychology in Northern America, Europe, Australia, and New Zealand highlighted a lack of formalized training programs in most countries except the United States and Canada, as well as an enormous variety between countries on standards of training, and on the differentiation of health psychologists from clinical psychologists.

For the qualification of health psychology as an independent psychological discipline a plea is made for international standardization of quality control and suggestions for the content of formalized training programs in health psychology are given.     

Professional training of child psychologists

The present authors address the need for specialized professional training for psychologists who primarily work with the problems of childhood. It is argued that the area of child psychology is an amalgam of selected components of developmental, educational, and clinical psychology, and further that it is sufficiently discrete to warrant specialized training programs for child psychologists. Questions concerning the particular content of such training, and the level at which the training should take place, are raised. Various options regarding the answers to these questions are discussed, and a specific recommendation is presented.     

Citizenship and Community Mental Health Care

Citizenship is an approach to supporting the social inclusion and participation in society of people with mental illnesses. It is receiving greater attention in community mental health discourse and literature in parallel with increased awareness of social determinants of health and concern over the continued marginalization of persons with mental illness in the United States. In this article, we review the definition and principles of our citizenship framework with attention to social participation and access to resources as well as rights and responsibilities that society confers on its members. We then discuss our citizenship research at both individual and social‐environmental levels, including previous, current, and planned efforts. We also discuss the role of community psychology and psychologists in advancing citizenship and other themes relevant to a citizenship perspective on mental health care and persons with mental illness.     

Interprofessional Education: Preparing Psychologists for Success in Integrated Primary Care

Rapidly occurring changes in the healthcare arena mean time is of the essence for psychology to formalize a strategic plan for training in primary care settings. The current article articulates factors affecting models of integrated care in Academic Health Centers (AHCs) and describes ways to identify and utilize resources at AHCs to develop interprofessional educational and clinical integrated care opportunities. The paper asserts that interprofessional educational experiences between psychology and other healthcare providers are vital to insure professionals value one another’s disciplines in health care reform endeavors, most notably the patient-centered initiatives. The paper highlights ways to create shared values and common goals between primary care providers and psychologists, which are needed for trainee internalization of integrated care precepts. A developmental perspective to training from pre-doctoral, internship and postdoctoral levels for psychologists in integrated care is described. Lastly, a call to action is given for the field to develop more opportunities for psychology trainees to receive education and training within practica, internships and postdoctoral fellowships in primary care settings to address the reality that most patients seek their mental health treatment in primary care settings.     

Ethical issues in the research and practice of applied developmental psychology

Within the last decade, applied developmental psychology (ADP) has emerged as a new subspecialization within traditional graduate programs in developmental psychology. Current definitions of ADP range from a primarily research-oriented discipline to a superordinate discipline under which clinical, educational, and school psychology organize applications of the developmental data base. This work draws upon several common themes to arrive at a broad definition of ADP. We outline reasons for developmental psychology's entrance into the “decade of applied research,” the broad spectrum of activities currently characterizing ADP, and training programs proposed to prepare students for these activities. The extension of developmental psychology into applied areas requires attention to the ethical issues encountered across the full spectrum of ADP activities. We present a perspective of ethical issues whose framework is predominantly applied developmental psychology. Our approach focuses on ethical concerns associated with both knowledge generation and knowledge application. In so doing, we raise issues concerning the need for applied developmentalists to address questions concerning the impact of planned methods on development in normal and atypical populations, consultation to institutions and public policy makers, competencies required to conduct developmental education programs, and utilization of developmental assessment techniques.     

Comment on “The Self‐Care of Psychologists and Mental Health Professionals” (Dattilio, 2015)

Professor Frank Dattilio's article “The Self‐care of Psychologists and Mental Health Professionals” provides an overview of stress and related mental health problems among psychologists, and a proposition that psychologists are not vigilant in regard to self‐care. Dattilio offers a range of self‐care strategies and recommendations, and highlights self‐care practices within various psychology frameworks, and concludes with some “healthy tips” for managing stress. In my commentary I underscore Dattilio's message that self‐care is of critical importance in psychology practice, given the responsibility of caring for others inherent in the work psychologists undertake. However, I raise additional points of consideration and suggest an alternative approach to addressing the self‐care needs of the profession. My commentary makes the following points: (a) the need to distinguish between psychology trainees and practising qualified psychologists when addressing stress and self‐care requirements in the profession; (b) the importance of developing a culture of self‐care among psychologists by providing self‐care instruction during training; (c) the need to temper research findings on stress and mental health among psychologists by the methodological weakness of the studies in this area; (d) adhering to the recent call from colleagues to shift from a focus on pathology and punishment to a positive acceptance, mindfulness, and values‐based approach for encouraging self‐care among psychologists; (e) the use of a systematic framework for organising the presentation of self‐care strategies that makes them more accessible; and (f) an appeal to professional bodies to take their responsibility in promoting self‐care in the profession.     

A new role for psychologists--hospital ethics committees

Over the past decade psychology has begun to appreciate that it represents more than "merely mental health care" and has become increasingly involved in the generic health care arena. The participation of psychologists in Hospital Ethics Committees (HECs) is presented as a professional activity for which psychologists are particularly well suited. The clinical mission of HECs, the historical importance of ethical considerations to psychology, and the field's specific training and psycho-social expertise suggest valuable contributions that psychologists can make in this particular area. Further, as psychology actively increases its participation in HECs, other professional disciplines outside of the mental health field will systematically have the opportunity to become more familiar with psychology and its clinical and research expertise.     

The Acculturation of Community Psychology: Is There a Best Way?

In this paper I describe a community psychology perspective on acculturation and adjustment of immigrants and refugees and suggest that this field of acculturation research has in turn something to offer heuristically as we consider our identity and training for future generations of community psychologists over the next 50 years. I suggest that honoring our heritage, maintaining our disciplinary identity as community psychologists, and sustaining doctoral programs that offer training specific to community psychology are crucial for our survival as a field and is not antithetical to, and is indeed necessary for, interdisciplinary collaborations.     

Psychology in Medical Settings in Thailand

This article explores the development of psychology as a profession in Thailand, its challenges, and future trends. There are currently very few Thai psychologists who are active in the medical fields in comparison to other health care professions. Being held back by limited education and training, many psychologists see their future career as less than promising. The lack of professional licensing standards and dominance of psychiatry further limit their career advancement. However, tremendous opportunities await those who persevere to expand their roles beyond the traditional assessment, treatment, and research models. A small number of them have ventured out into unexplored territories such as behavioral medicine, AIDS counseling, health promotion, and prevention of mental health problems. There is a strong potential for Thai psychologists to make significant contributions in these areas. It is clear that higher standards of education and more rigorous training are needed if this goal is to be realized in the near future.     

The Future of Psychology in Medical Specialities: Introduction to the Special Issue

The continuing evolution of the health care delivery system in the United States presents threats and opportunities to psychologists in medical settings. This special issue explores the future of psychology in psychiatry, family medicine, rehabilitation, geriatric medicine, and pediatric medicine. The challenges facing neuropsychology and pain management are explored also. Finally, the professional issues of ethics in managed care, psychology in the public sector, and training future psychologists are addressed. Each paper summarizes concerns and provides recommendations for clinical practice, research, and training.     

Conceptualization and Treatment of Social Withdrawal in the Schools

Social withdrawal represents a class of behavior problems that are not as frequently referred by teachers in school settings as are disruptive, acting-out behaviors. Approximately 15% of all children referred to school psychologists and other mental health professionals in the schools are socially withdrawn. This paper provides several definitions of social withdrawal from a social skills perspective and presents a four-fold classification system of children's social skills deficits. Assessment procedures for identifying socially withdrawn children are briefly reviewed. Four social skills training strategies (i.e., modeling, coaching, peer-mediated interventions, and group contingencies) are reviewd and the relative efficacy of each are evaluated. Several commercially-available social skills training curricula designed for school settings are described at the conclusion of this paper.     

Training of interns and practicum students at community mental health centers

The training of interns and practicum students has become a significant part of the overall program of CMHCs over the last decade. Although many centers provide innovative training in areas consistent with the philosophies of community mental health/community psychology, CMHCs consider the outstanding training which they provide to be in the traditional clinical areas. The fact that the revolution envisaged by the early proponents of the CMH/CP ideology has become transformed into an evolution is not cause for dismay but rather constitutes a study in social change. The planned incorporation of additional CMH/CP components into training programs augurs well for the future. However, the future of training programs is dependent on the extent to which the profession as a whole marshals its resources to not only maintain but increase the financial resources required for maintaining our network of training facilities—CMHCs along with other facilities.     

Issues in training clinical health psychologists

The author describes general issues in the training of clinical health psychologists and provides an overview of specific content needed in core health psychology and clinical health psychology assessment and intervention. Special attention is given to training in professional, personal, ethical and legal issues of practice.     

Federal Funds to Train Clinical Psychologists for Work with Underserved Populations: The Bureau of Health Professions Graduate Psychology Education Grants Program

This paper describes the Bureau of Health Professions (BHPr) Graduate Psychology Education program (GPE), which supports projects that train health service psychologists for work with underserved populations. BHPr history and funding criteria are discussed, as are those of BHPr's parent organization, the Health Resources Service Administration. BHPr objectives and methods for support of clinical psychology training parallel those that BHPr has used to support training in other heath professions. The paper also describes three psychology internship training programs in academic medical settings that competed successfully for BHPr GPE funding in 2002. The three training projects differ significantly in training rotation sites, target populations with which trainees work, and the other health care professions that partner with psychology in interdisciplinary training—but they are similar in that each project provides an example of a program that effectively satisfied BHPr criteria for expanding psychology's scope of practice with underserved populations.     

Interdisciplinary research and interprofessional collaborative care in a memory clinic for rural and northern residents of western Canada: Unique training ground for clinical psychology graduate students

Abstract: In Canada, interprofessional education (IPE) and interdisciplinary health research initiatives are beginning to transform the academic health sciences, including graduate training programs for clinical psychologists. In response to mandates and directives from national health policy and research funding bodies, academic training programs are re‐structuring course offerings, practicum training experiences, and research activities to better prepare students for their future roles within interdisciplinary research groups and collaborative patient‐centred clinical teams. As an example of this transformative movement in IPE, described herein are the recent training initiatives in the Graduate Program in Clinical Psychology at the University of Saskatchewan, and the role of clinical neuropsychology in an innovative interprofessional rural and remote memory clinic.     

Improving Medicare coverage of psychological services for older Americans

Professional psychology's ability to meet older Americans' psychological needs and to simultaneously thrive as a profession will be closely tied to the federal Medicare program over the coming decades. Despite legislative changes in the 1980s providing professional autonomy to psychologists and expanding coverage for mental health services, Medicare coverage policies, reimbursement mechanisms, and organizational traditions continue to limit older Americans' access to psychological services. This article describes how psychologists can influence Medicare coverage policy. Specifically, the authors examine widely unrecognized policy processes and recent political developments and analyze the recent creation of a new Medicare counseling benefit, applying J. W. Kingdon's (1995) well-known model of policy change. These recent developments offer new opportunities for expanding Medicare coverage of psychological services, particularly in the areas of prevention, screening, and early intervention. The article provides an analysis to guide psychologists in engaging in strategic advocacy and incorporating psychological prevention and early intervention services into Medicare. As Medicare policy entrepreneurs, psychologists can improve the well-being of millions of Americans who rely on the national health insurance program and, in so doing, can help shape the future practice of psychology.     

Clinical Psychology in India

Scientific Psychology in India has seen steady development since its inception in the early 1900s. With clinical psychology developing as an independent profession, clinical psychologists have been functioning in various roles, offering a wide range of services in consultation, training, research, and private practice on multidisciplinary teams as well as in independent practice. This paper focuses on the historical roots of clinical psychology in India and highlights the role of clinical psychologists in the general mental health care and the contributions made by the profession in a wide range of public and private health care settings. Ancient Indian systems of Medicine, mental health care and psychotherapy in India, and training-related and organizational issues are discussed. This paper reflects on the growth and development of clinical psychology that has occurred in India in spite of current difficulties and the challenges that lie ahead.     

Counselling Older Adults Living in Residential Aged Care Settings: Four Illustrative Case Studies

The role of psychologists and other mental health professionals in long‐term care settings is undefined in Australia. Graduate psychology students receive little training in clinical geropsychology, and residential aged care providers do not routinely employ psychologists within such settings. Further, despite high rates of depression, neurocognitive problems, and other mental health problems, residents are rarely referred for evidence‐based psychological treatment. This article presents four case studies showing how psychology services may be employed in such settings within the context of a postgraduate psychology placement programme. These case studies emphasise the importance of engagement, the use of flexible and individualised treatment approaches, and the involvement of family and professional carers in the provision of psychological services. Psychology services in residential settings can have a positive impact on the care of older adults and their families.