Presentation on theme: "Introduction Psychologists’ contributions to rehabilitation and recovery for serious mental illness: A survey of training and doctoral education Felice."— Presentation transcript:
Introduction Psychologists’ contributions to rehabilitation and recovery for serious mental illness: A survey of training and doctoral education Felice Reddy and William D. Spaulding University of Nebraska-Lincoln The emergence of psychiatric rehabilitation (PR) and the recovery movement have generated new and expanded roles for clinical psychologists in services for people with serious mental illness (SMI). PR is increasingly understood as a technology well suited to the values and goals of recovery (Anthony, 1993). In contrast to a more traditional theoretical orientation and service approach, which targets diagnostic assessment, symptom reduction through pharmacological treatment, and case management, PR includes training in case formulation, social and living skills, education in wellness and illness management, assistance for families, and vocational training and support. These are highly relevant to the values and goals of recovery, and are heavily informed by psychological considerations and techniques. Similarly, the recovery concept leads to new agendas for psychological research on the nature of mental illness and the nature of recovery (Silverstein & Bellack, 2008). Today, recovery and PR provide a new and important context in which to evaluate the training and education of psychologists. However, the proportion of psychologists in SMI services today is substantially less than previous decades. Understanding the reasons why a minority of clinical psychologists pursue work with SMI, and why the percentage that does focus on this population is decreasing has significant implications for advancing the progress of PR as well as improving the incentives and perceptions of work in SMI treatment. There are three objectives of the present study: 1) Assess the training and education resources relevant to SMI, PR, and recovery that are currently available in clinical psychology doctorate programs. 2) Analyze the degree to which new psychologists are prepared and willing to practice in rehabilitation- and recovery-oriented service systems for people with SMI. 3) Generate hypotheses about what can and should be done to optimize preparation of psychologists for SMI services in general, and in rehabilitation- and recovery-oriented services in particular. Methods A survey designed to assess SMI-focused aspects of training programs was sent to 164 directors of CUDCP clinical psychology doctoral training programs. This yielded 111 responses from directors or faculty members to whom the task was delegated, a response rate of 68%. Given that the majority of the accredited clinical programs graduate between four and twenty students per year, with seven being the mode (CUDCP); there were approximately 1132 students represented in the present study. Faculty that identify SMI as area of primary interest Response% of respondents “None” 39% “One” 34% “More than one” 27% Exposure to psychiatric rehabilitation services Amount of experience% of respondents None9% Minimal exposure47% Substantial exposure38% Integrated experience5% 70% of programs provide at least an exposure level (100 hours) of supervised practicum training in formal psychological assessment of adults with SMI. 67% reported their students could get at least 100 hours of supervised experience in individual psychotherapy with adults with SMI. 47% reported their students can get at least 100 hours supervised training in functional assessment, case formulation, treatment planning and progress evaluation as a member of an interdisciplinary team serving adults with SMI 18% offer students the opportunity to be involved in program management, system administration, program evaluation, mental health policy or service planning for services for adults with SMI. 51% of the responding programs graduate at least one student per year primarily interested in research, clinical services and/or policy/administration for SMI. 41% graduate at least one student per year who expects to practice as a clinician or administrator in the service of people with SMI. If it is the case that the students indicated in each of these estimates are not overlapping in both categories then this yields an estimated minimal production rate of about.9 new clinical psychology Ph.D.’s per program per year. Results Discussion In summary, the past and present survey data provide qualified support for the hypothesis that unavailability of education, training and exposure in CUDCP clinical psychology programs is a potential barrier to psychologists choosing SMI-related careers. On one hand, there are many programs where graduate students can get exposure to core faculty with SMI interests, get relevant research experience, and get practicum exposure or experience in clinical settings that serve people with SMI. On the other hand, relatively few programs have specialized coursework pertinent to SMI. Even fewer report having an ongoing research group or seminar that would provide the key foundation for a major interest or career path. The particular areas of noticeable weakness in areas relevant to understanding the sociological aspects of SMI are administrative and related leadership skills, and the consumer perspective. Improvement in these areas will be particularly important if PR and the recovery movement continue to create new roles and opportunities for psychologists. There are some changes that clinical psychology training programs could undertake to increase the competence of clinical psychologists in the various roles spurred by PR and the recovery movement. These changes include: 1) More coursework on psychosocial treatment techniques having particular relevance to the needs of people with SMI. 2) More coursework in mental health program management, administration and policy, including particular attention to services for people with SMI. 3) More attention in conventional coursework to application of familiar methods, e.g. case formulation and treatment planning, to the particular context of SMI. 4) More coursework on and exposure to the consumer perspective, the concept of recovery and sociological aspects of mental health pertinent to SMI. By failing to utilize the opportunity we have to adequately train psychologists to promote the concept of recovery for those with serious mental illness, we fail not only our psychologist colleagues who developed and validated EBPs, we fail some of our most vulnerable members of society and their efforts to live full lives within the community. Visit the Severe Mental Illness Research Group website at the University of Nebraska-Lincoln: http://www.unl.edu/dsc
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