Excellence in Counseling Center Training: Preparing for Psychology’s Future Juntunen 2012 ACCTA

Learning Objectives  To become familiar with changes in expectations for training in professional psychology, particularly related to health service psychology competencies and training requirements.  To identify the unique opportunities for counseling centers in the integrated care movement.  To recognize the ways in which competencies, accreditation, and licensure expectations are linked in assuring future excellence in the practice of psychology.

Overview  Macro-system Contextual Factors  Governmental and Financial Press  Outcomes-based Accountability  Professional Factors  Psychology Work Force and Training Issues  Competency Assessment  Changing Expectations  Accreditation and Licensure  Health Service Psychology Competencies  ACCTA Comments on the HSP competencies  Application for Individual Centers

Government & Financial Press  Affordable & Accountable Health Care  Patient-centered care  Integrated and team-based health care  Increased attention to prevention  Funding for Training  Parity issues for psychology interns  Government recognizes accreditation  Advocacy is critical

Accountability & Excellence  To whom are we accountable?  Public – Clients, students, parents, taxpayers  Students and Supervisees  Regulatory Boards  Government Agencies  Other?  Who Defines Excellence?

We must set the Standard for Excellence in Psychology  “We cannot lay claim to quality without addressing accountability.” Eaton, 2012  Our accountability measures include  Accreditation  Peer review  Regulatory Boards  Training Outcomes?  Client Outcomes?

Professional Press on Excellence  Psychology Work Force and Training Issues  State of the psychology work force  Demand and supply  Variable standards across programs and jurisdictions  Competency Assessment  Foundational and Functional Skills  Increased focus on outcomes  Increased focus on quality of “hours”

**Rodolfa, E. R., Bent, R. J., Eisman, E., Nelson, P. D., Rehm, L., & Ritchie, P. (2005). A cube model for competency development: Implications for psychology educators and regulators. Professional Psychology: Research and Practice, 36,

But Questions Remain  How do we take quality assurance and quality improvement into our own hands?  What is the value added of doctoral training?  What do we want psychologists to be ready to do in 2020? 2050?

Look to the future  “A good hockey player plays where the puck is. A great hockey player plays where the puck is going to be.” Gretzky  What is the relationship between psychology and the “puck” of health care and health care reform?

Vision  The education and training of psychologists to provide health care services is founded on the integration of science and practice. Their preparation is conducted in APA accredited doctoral and APA accredited internship programs with clearly defined learning outcomes. The competencies demonstrated by these graduates serve to identify them as health professionals whose distinctive contributions to health care are recognized and respected by other health professions, policymakers and the public. Regulators of practice have confidence in the education and training enterprise to be self-regulating through a rigorous quality assurance mechanism overseen by the profession.  Psychologists who provide health care services engage in evidence based practice that is patient centered, culturally competent, effective and informed by population based data. They are skilled in collaboration with other health professionals and demonstrate a commitment to lifelong learning and continuous quality improvement in their practice. They are grounded in psychological science and integrate knowledge from other areas such as biology and sociology into their practices as appropriate. They are not only critical consumers of psychological research, but able to conduct scientific research, especially practice-based outcomes research and program evaluation. From Belar, 2011

Move Forward by Changing Expectations for Training  Accreditation as the indicator of meeting minimal standards of quality  External peer review as a given  Transparency about learning objectives and outcomes  Credibility as a health care profession  Psychology stands alone.

BEA Statement on Accreditation November 2011  To prepare competent psychologists to participate in the health care arena and to expand psychology’s role in advancing health (APA strategic goal 2), BEA affirms that health service psychologists (HSPs) must be trained in APA/CPA accredited doctoral and APA/CPA accredited internship programs.  BEA also affirms that graduation from an APA/CPA accredited doctoral and APA/CPA internship training program must be a prerequisite for licensure for independent practice as health service psychologists.

 BEA will work on capacity building initiatives to support development of APA accredited internship programs to address the internship imbalance and improve access to APA accredited internships for students in APA accredited doctoral programs. This capacity building is especially important where APA accredited internships have not been common. BEA encourages the CoA to develop procedures for a time-limited pre-accreditation status under the auspices of APA accreditation that fosters development of emerging internship programs.  BEA looks forward to working with the Board of Professional Affairs (BPA), the Committee for the Advancement of Professional Practice (CAPP), the Association of State and Provincial Psychology Boards (ASPPB) and the Council of Chairs of Training Councils (CCTC) to advance these initiatives in order to assure quality in education and training, expand funding for education and training, and ensure the inclusion of psychology in the evolving health care environment.  Unaccredited programs that train HSPs are expected to obtain APA/CPA accreditation in a timely fashion, no later than 2015 for doctoral programs and 2019 for internship programs.

Health Service Psychology  Psychologists are recognized as Health Service Providers if they are duly trained and experienced in the delivery of preventive, assessment, diagnostic and therapeutic intervention services relative to the psychological and physical health of consumers based on:  1) having completed scientific and professional training resulting in a doctoral degree in psychology;  2) having completed an internship and supervised experience in health care settings; and  3) having been licensed as psychologists at the independent practice level. (APA, 1996)

Health Service Psychology Education Collaborative  Charged to examine E & T in Professional Psychology and chart a course for future  Endorsed the Interprofessional Education Collaborative’s (IPEC) Core Competencies for Interprofessional Collaborative Care  Fearless Leaders  Cynthia Belar  Cathi Grus  APA  Carol Goodheart  Janet Matthews  Celiane Rey-Casserly  Michael Roberts  CCTC  Sharon Berry  Clark Campbell  Cindy Juntunen  Liz Klonoff  COGDOP  Frank Andrasik & Theresa Lee  Margi Gatz  Ellen Mitchell

HSP is NotHSP does  Health Psychology  Medical Model  Restricted to traditional health care settings  Remedial only  Include all health care related interventions  Emphasize prevention and health  Occur in most professional psychology settings

Key Issues identified by HSPEC  The competencies of psychologists who provide health services should be clearly articulated and understood by faculty, students, regulators and the public.  There should be guidelines for minimal qualifications to enter doctoral programs that prepare health service psychologists.  Psychology needs to articulate and evaluate the competencies for each level in the sequence of education and training of health service psychologists, as well as examine the sequence itself.  There needs to be increased focus on competency assessment in psychology education and training for the delivery of health care services.  The future of health service psychology rests on the integration of science and practice. Education and training should be an integrative endeavor, both within and across content and levels in the curriculum as well as across the activities of research and provision of health services.  Psychology needs to establish the standard of self-regulation for education and training in the profession  Psychology needs more research relevant to the preparation and roles of health service psychologists and must have an ongoing, comprehensive workforce analysis.

HSP Competencies  I. Science  II. Professionalism  III.Relational  IV.Applications  V.Education  VI.Systems

Science Competencies Scientific Knowledge & Methods  Be knowledgeable about the biological, cognitive, affective, social, and lifespan developmental bases of behavior; be able to critically evaluate relevant literature, and apply that knowledge in practice.  Be knowledgeable about psychological research methods, techniques of data collection and analysis, and apply that knowledge in practice.  Be knowledgeable about psychological clinical research findings fundamental to the provision of health care services, and apply that knowledge in practice.  Be knowledgeable about current information technology and apply that knowledge in practice.  Be familiar with research on how biological, psychological, social, cultural, and economic factors affect health and behavior, disease, treatment outcomes, and wellness, and how to apply that knowledge in practice. Research/Evaluation  Critically evaluate relevant health and behavior research related to populations to be served.  Conduct research that contributes to the scientific and professional knowledge base or evaluates the effectiveness of various professional activities in health care and health promotion.  Use research skills for program development and evaluation as well as for quality improvement related to health care services.  Be familiar with health research methods.

Professionalism Competencies Professional Values and Attitudes  Behave in ways that reflect the values and attitudes of psychology, including integrity, accountability, lifelong learning, and concern for the welfare of others.  Value principles of safe, effective, patient-centered, timely, and equitable care and use them as guidelines for health care practice.  Value and communicate to the public and other health professionals one’s identity as a psychologist.  Value collaboration with other health professions and team based care. Individual and Cultural Diversity  Exhibit awareness, sensitivity, and skills to work professionally with diverse individuals, groups, and communities that represent various cultural and personal backgrounds and characteristics defined broadly and consistent with relevant APA practice guidelines.  Be knowledgeable about the literature on diversity factors and health disparities and apply that knowledge in practice.  Exhibit awareness, sensitivity, and skills to work with diverse individuals across the health professions.

Professionalism (cont.) Ethical, Legal Standards and Policy  Abide by the current version of the APA Ethical Principles of Psychologists and Code of Conduct and engage in ethical decision-making in collaboration with others.  Be knowledgeable about the professional standards associated with health care practice.  Be knowledgeable about and adhere to the local, state, and federal laws governing health care practice.  Be knowledgeable about health care policies that are relevant to health care systems and the delivery of services Reflective Practice/Self-Assessment/Self Care  Engage in reflective practice conducted with personal and professional self-awareness, including attention to one’s health behaviors and well-being, and their potential impact on practice.  Conduct self-assessments designed to continuously improve health services offered.

Relational: Interpersonal Skills and Communication  Relate effectively and professionally with patients, colleagues, and communities.  Relate effectively with professionals from other disciplines and demonstrate competence in interprofessional collaborative practice.  Communicate clearly and appropriately in written and oral form with patients, colleagues, other health professionals, and the public.

Applications Competencies Evidence-based practice  Engage in evidence-based practice that integrates “the best available research with clinical expertise in the context of patient characteristics, culture, and preferences” (APA Presidential Task Force on Evidence-Based Practice, 2006, p 273.).  Incorporate local population-based information and relevant research findings in the provision of health care services. Assessment  Conduct assessments of psychological and behavioral components of physical and mental health to diagnose problems and assess strengths as a basis for planning prevention, treatment, or rehabilitation.  Use an assessment approach model that includes attention to biological, psychological, social, lifespan, and cultural components of health.  Provide assessments grounded in the science of measurement and psychometrics, and the clinical research related to the assessment of health, behavior, and psychosocial aspects of physical conditions.  Communicate findings from psychological assessments in language appropriate for the patient, family, and health care professionals.  Be able to conceptualize cases integrating common medical, dental, and other health findings, including their potential impact on assessment and interpretation of psychological data for populations to be served.

Applications (cont.) Intervention  Provide evidence-based psychological approaches in the prevention, treatment, and rehabilitation of common health, mental health, and developmental problems.  Be knowledgeable about theories, models, and effective practice in psychotherapy.  Monitor patient’s response to delivered interventions and modify as needed.  Educate patients, families, caregivers, and communities about health and behavior to facilitate behavior change, including promotion and prevention.  Seek consultation and refer to other health care professionals for problems outside one’s training and experience.  Provide health promotion services in individual, group, and community settings.  Be knowledgeable about effectiveness and costs of psychological treatment options appropriate to the particular clinical context.  Be familiar with common medical, dental, and other health treatments, as well as complementary and alternative treatments, and their sequelae for the populations to be served. Consultation  Provide consultative psychological services to patients and their families, other health care professionals, and systems related to health and behavior.

Education Competencies Teaching  Provide training and supervision to psychology trainees and to other health professionals in relevant health care services.  Provide training in the application of psychological science to the delivery of health care services and the improvement of the health care system. Supervision  Be knowledgeable about theories, models, and effective practices in supervision.  Apply this knowledge to the supervision of direct service delivery by psychology trainees, trainees from other health professions, and, as appropriate, of services provided by other health care professionals.

Systems Competencies Interdisciplinary/Interprofessional Systems  Be knowledgeable about the core competencies for interprofessional practice, including: values/ethics across professions as well as those for interprofessional practice, roles/responsibilities, interprofessional communication, and teams/teamwork. Apply that knowledge in collaborative practice.  Be knowledgeable about the outcomes literature associated with the delivery of services by health care teams.  Use health informatics, including electronic health records, to communicate with other health professionals and patients as appropriate.  Be familiar with various types of health care systems and service delivery models and their implications for practice.

Systems (cont.) Professional Leadership Development  Appreciate the role of a psychologist as an autonomous, knowledgeable team member and leader in health care.  Be familiar with professional roles in management and administration of health care research, services, and systems and be prepared for further leadership development. Advocacy (local, state and national)  Advocate for psychology’s role as a science and a profession in health care.  Advocate for research that contributes to the evidence base to support practice and for evidence-based practice.  Advocate for quality health care at the individual, institutional, community, and systems level in public and private sectors.  Advocate for equity and access to quality health care services for patients.

ACCTA Comments  We are in agreement that there is much value in conceptualizing the training of professional psychologists within the training of heath care providers. The integrated health care model is in use in many practice settings and has been a significant factor in reducing stigma related to mental health care and in supporting collaboration and consultation across health service providers.  In addition, adoption of this model influences the allocation of health care resources and helps to answer the question “Who is a health service provider?” for legislatures and other funders.

ACCTA Comments  Many of the competencies developed for Health Service Psychologists (HSPs) appear to emphasize and describe activities that are more reflective of health care systems/medical settings than educational settings. A university or school may provide health care but it is not, per se, a health care system.  Psychologists, and thus trainees, in university settings are indeed health care providers, and approximately 25% of our member programs are in combined units with their campus health centers. However, many of our Centers have missions related to fostering psychological development and the improvement/maintenance of academic functioning, rather than a focus on “health and disease,” and our training models reflect this.  In addition, many of our centers are committed to and engage in community outreach, education and prevention, not only in areas of health promotion, but in the promotion of social justice and multicultural awareness and inclusion on our campuses.

ACCTA Comments (cont.)  ACCTA further asserts the position that training in multicultural psychology and social justice is an essential competency for all psychologists, as indicated by APA accreditation guidelines, as well as a component of effective healthcare, particularly as historical neglect of such training has resulted in adverse medical and psychological health consequences for those in traditionally underserved populations. These core activities do not seem to be adequately reflected in the current draft document.

ACCTA Comments (cont.)  In general, concerns have been expressed related to how UCC internships would train toward competencies that may not accurately reflect the context or mission of our particular training sites.  It is unclear how trainees would also incorporate the level of familiarity with medical assessments and treatments that appear to be called for in these competencies, or how settings that do not utilize such assessments or treatments would train in this area. Questions were raised as to whether our profession would be better served by owning our own areas of expertise while promoting the value of generous collaboration and consultation with other health care providers.

Impact of ACCTA Comments  Broad and inclusive definition of health service psychologist reiterated  Emphasis on prevention and health promotion, as well as developmental concerns  Introduction provides more context relevant to diversity of settings  Increased inclusion of health disparities and sociocultural factors

Opportunities and Challenges  Making “health” more inclusive  Interprofessional credibility  Increasing attention to behavioral and mental health concerns  Stigma reduction  Others?

Critical Role of Counseling Centers  Capstone clinical training for large percentage of HSPs  Regularly engaged in interprofessional collaboration  Systems knowledge & Teamwork skills  Communication with communities being served  Emphasis on holistic client-centered care

Questions before Breakouts

Taking it Home  Considering the context of your home campus,  Who needs to understand the HSP competencies and interprofessional care model?  How will you describe/sell it to them?  What are the barriers?  What are the opportunities?

Key References  American Psychological Association. (1996). Recognition of health service providers. Approved Council Resolution. C.(17). Washington, DC: American Psychological Association.  Belar, C.D. (2011). Reflection on a vision. Monitor on Psychology, 42, p47.  Eaton, J. (2012, September). Promoting quality: It’s what leaders do. Retrieved from eaton.pdfhttp:// eaton.pdf  IPEC (2011). Core Competencies for Interprofessional Collaborative Practice. Washington, DC: Interprofessional Education Collaborative.  Rozensky, R. H (2012, April). Implications of the Affordable Care Act and Health Care Reform for quality education in professional psychology: Developing a quality workforce. Retrieved from ders- CEU/Rozensky%20Implications%20to%20Affordable%20Health%20Care/APPIC- TALKRozensky.pdf ders- CEU/Rozensky%20Implications%20to%20Affordable%20Health%20Care/APPIC- TALKRozensky.pdf  **Rodolfa, E. R., Bent, R. J., Eisman, E., Nelson, P. D., Rehm, L., & Ritchie, P. (2005). A cube model for competency development: Implications for psychology educators and regulators. Professional Psychology: Research and Practice, 36,