Preparing psychologists to link systems of care in managing and preventing children's health problems

OBJECTIVE: To describe the need for innovations in training to link health, educational, and family systems and to illustrate how this can be accomplished through child-oriented psychology training programs. METHODS: We describe multiple pathways for the preparation of child-oriented psychologists to link health, educational, and family systems, in keeping with the National Institute of Mental Health guidelines for preparing professionals in child and adolescent psychology. These pathways include training embedded in graduate programs specializing in clinical child, pediatric, school, community, and family psychology. This article highlights a training initiative for preparing child-oriented psychologists based in a school psychology program. RESULTS: A partnership between Lehigh University and The Children's Hospital of Philadelphia has been developed to prepare school psychologists to coordinate community-based systems of care to promote positive educational and health outcomes for children. This program emphasizes both intervention and prevention and provides a set of integrated experiences in both health care and educational settings. CONCLUSIONS: We highlight components of this program relevant to the preparation of pediatric psychologists. We identify and discuss potential challenges in establishing training programs for the preparation of professionals to link health, school, and family systems.     

Training graduate-level pediatric psychology researchers at Case Western Reserve University: meeting the challenges of the new millennium

OBJECTIVE: To describe the challenges in training graduate-level pediatric psychology researchers for successful careers and to discuss solutions. METHODS: We reviewed experiences in training graduate students at Case Western Reserve University to identify key challenges in research training and potential strategies to meet them. RESULTS: We identified the following key challenges: stimulating graduate students' career interest in pediatric psychology research; teaching students about the pragmatic challenges of conducting research in pediatric settings, specialized research design, and data analytic issues; helping students to develop essential research skills; developing opportunities for student research-related collaborations; helping students develop professional identities as researchers; and developing and supporting their research careers beyond graduate school. CONCLUSIONS: Useful strategies for meeting these challenges include involving an interdisciplinary faculty in research training; developing specialized training methods that focus on critical research skills such as writing and data analysis; peer support; and involvement with multiple mentors who are successful researchers. Pediatric psychologists should also develop opportunities for the next generation of researchers by facilitating research job options and leadership opportunities.     

Integrating research into clinical internship training bridging the science/practice gap in pediatric psychology

Existing literature highlights a critical gap between science and practice in clinical psychology. The internship year is a "capstone experience"; training in methods of scientific evaluation should be integrated with the development of advanced clinical competencies. We provide a rationale for continued exposure to research during the clinical internship year, including, (a) critical examination and integration of the literature regarding evidence-based treatment and assessment, (b) participation in faculty-based and independent research, and (c) orientation to the science and strategy of grantsmanship. Participation in research provides exposure to new empirical models and can foster the development of applied research questions. Orientation to grantsmanship can yield an initial sense of the "business of science." Internship provides an important opportunity to examine the challenges to integrating the clinical evidence base into professional practice; for that reason, providing research exposure on internship is an important strategy in training the next generation of pediatric psychologists.     

Development of a global curriculum for professional psychology: implications of the Combined-Integrated model of doctoral training

This article considers the development of a global training curriculum and qualification in professional psychology, with particular emphasis on the Combined-Integrated (C-I) model. The C-I model exposes professional psychology trainees to two or more of the practice areas (i.e., clinical, counseling, school/educational). The authors argue that the C-I approach is one that is well suited to the development of a global training curriculum due to its emphasis on broadly training psychologists as well as its respect for diversity and integration of various theoretical and professional orientations. A survey of training programs in 16 countries/regions on six continents found significant variation in training, minimal qualifications, and roles of the professional psychologist. The authors recommend that an international group of psychologists develop a regionally flexible, but common, training curriculum and qualification that would include a five- to six-year competency-based qualification. Ways in which the C-I training model may serve to integrate and globalize professional psychology are discussed.     

Society of pediatric psychology task force report: recommendations for the training of pediatric psychologists

OBJECTIVE: To provide an overview of the types of training experiences considered most important to the development of competency in pediatric psychology. METHODS: This is the work of a task force commissioned by the Society of Pediatric Psychology, Division 54 of the American Psychological Association. RESULTS: Twelve topic areas, adapted from Roberts et al. (1998), deemed important for obtaining knowledge and expertise in pediatric psychology, were identified. These topics include life span developmental psychology; life span developmental psychopathology; child, adolescent, and family assessment; intervention strategies; research methods and systems evaluation; professional, ethical, and legal issues pertaining to children, adolescents, and families; issues of diversity; the role of multiple disciplines in service-delivering systems; prevention, family support, and health promotion; social issues affecting children, adolescents, and families; consultant and liaison roles; and disease process and medical management. Each area is briefly described and recommendations for obtaining training in these areas are offered. CONCLUSIONS: The Society of Pediatric Psychology offers this document as a comprehensive review of the ideal types of training experiences most important to developing competencies in pediatric psychology. These recommendations can be used by graduate students and graduate programs in shaping a training plan for students interested in pediatric psychology training.     

Internship and postdoctoral training in pediatric and clinical child psychology: a survey

A survey was designed to obtain data from pediatric psychology,clinical child psychology, and combined training centers. Sixtyprogram directors provided identifying characteristics aboutthe facility, application information for internship and postdoctoraltraining, information on clientele and case load of trainees,and specific training information. In addition, respondentsprovided definitions of the two areas and suggested differentiatingfeatures. It was concluded that the similarities are more numerousthan are the differences in training. Definitions suggest that(a) clinical child psychology has broader application than pediatricpsychology despite the latter's broader principles of application,and (b) pediatric psychologists rely heavily on the traditionalskills and techniques of clinical child psychology. The onlydifferentiating features identified were in terms of medicallyrelated populations of children served, collaboration with healthcare disciplines, and a specialized focus of viewing psychologicaldifficulties within the medical culture by pediatric psychologists.     

Pediatric Psychology: Perspectives and Training Implications

With a clinical case as illustration, the range of clinicaland teaching demands made upon the pediatric psychologist isexplored. The roles of the pediatric psychologist in a medicalsetting as a data-gatherer, liaison-teacher, and "process consultant"among the professional disciplines engaged in child health careare described. The implications of these role demands for trainingin pediatric psychology are examined. It is proposed that preparationfor these functions requires that the pediatric psychologisthave basic training in clinical child psychology, child development,and in a broad range of psychometric assessment techniques.The ability to utilize consultation models of differing complexitiesis a necessary component in such training. In addition, thepediatric psychologist will require a solid background in research.This emerging model of practice, when compared to the traditional"practitioner-scientist" model, is described as the "practitioner-consultant-scientist"model.     

Competent Poverty Training

Despite numerous calls to the discipline, attention to poverty and social class remains minimal in psychology even though most human experience is significantly affected by social ranking. As a result, educators lack models for training in the context of poverty. Recent and concerted efforts to define and implement competency‐based models for the practice of professional psychology have resulted in the creation of Competency Benchmarks (American Psychological Association, 2011). Here, these Competency Benchmarks frame the integration of best practices in working with poor and working‐class clients with what we know about what constitutes good training. The result is a competency‐based approach for those who are training psychologists‐to‐be to work effectively with economically challenged clients.     

Assessment in Clinical Psychology: A Perspective on the Past, Present Challenges, and Future Prospects

Assessment emerged during the early twentieth century with the development of tests for assessing characteristics such as intelligence, personality, and suitability for employment. The long, interwoven relationship between clinical psychology and assessment began to change during the 1970s when many clinical psychologists became more involved in behavioral therapy and moved away from psychological testing and with the expanding role of managed care in the mental health services. Clinical assessment broadened into forensic, medical, and personnel applications with psychologists expanding professional roles. The status of assessment was reviewed and some challenges were highlighted. The potential for assessment to contribute to the understanding of mental health problems through collaborative cross-cultural study of psychopathology was suggested with the growing development of clinical psychology internationally.     

Society of pediatric psychology presidential address: opportunities for health promotion in primary care

OBJECTIVE: To set an agenda for health promotion in primary care settings. METHODS: This is a review of the scientific bases of child development as applied to pediatric psychology and health promotion. RESULTS: Primary care is an ideal setting for health promotion because there is a "hidden morbidity" of children with unrecognized and untreated behavioral and developmental problems that, if unresolved, may lead to psychiatric and physical disorders and increased use of the health care system. Although pediatric psychologists endorse the importance of health promotion, there are few examples in the literature involving pediatric psychologists. Recommendations are provided for a proactive agenda for health promotion programs involving pediatric psychologists in primary care. CONCLUSIONS: With conceptual homes in clinical and developmental psychology, expertise in theories of clinical and child development, scientific methods, and collaborative relationships with pediatricians, pediatric psychologists are in a unique position to develop and evaluate health promotion programs for use in primary care.     

Exploring the personal and professional impact of reflective practice groups: a survey of 18 cohorts from a UK clinical psychology training course

Objectives: Given the importance of reflective practice within clinical psychology and a lack of empirical research, this study aimed to investigate the personal and professional impact of reflective practice groups (RPGs) for former trainees. Design: This study followed an analytic survey design utilizing a convenience sample of qualified clinical psychologists from a UK training programme. Methods: A RPG questionnaire (RPGQ) was developed for the purposes of the study. Following initial pilot work, 297 qualified psychologists were invited to complete the RPGQ. Results: One hundred and twenty‐four psychologists (42%) completed the RPGQ. Factor analysis yielded two underlying constructs labelled ‘value’ and ‘distress’. The RPGQ demonstrated significant internal and test–retest reliability. The majority rated the RPGs as valuable for personal and professional development and learning about group processes. Just under half however reported distress as a result of the groups. Whilst some trainees, who reported distress, were able to view the challenges positively, one‐sixth were not. Potency of facilitation and group size significantly predicted levels of perceived value and distress. Conclusions: In view of the ethical issues raised by compulsory RPGs, recommendations were made to keep group sizes within an average of 10–13, utilize facilitators with sufficient training in group processes and ensure additional methods of reflective practice development are available. Further suggestions and recommendations for future research in relation to coping and personal learning style were also made. Copyright © 2009 John Wiley & Sons, Ltd. Key Practitioner Message:

• This study has addressed a significant gap in the clinical psychology literature in relation to the personal and professional impact of reflective practice groups during training.
• It was found that whilst, in retrospect, the majority of former trainees found the challenges of reflective practice groups worthwhile, a significant minority did not.
• Group size, potency of facilitation and previous RPG experience significantly predicted levels of perceived value and distress.
• There is now a need for more research in order to explore the mechanisms involved to maximize potential for value from reflective practice groups.

     

Clinical psychology: Emergent trends and future applications

The scientist-professional model offers an important heuristic and functional perspective for clinical psychology as an independent, autonomous discipline within general psychology. Alternative models of training may be inadequate for preparing future generations of clinical psychologists to deal in a competent and innovative fashion with the expanding set of roles and emerging applications in research and practice. These include behavioral medicine, group technologies, and primary prevention. Practical implications of these developments are discussed from the perspective of a scientist-professional.     

The Kubie "solution": an idea before its time?

Interpreted in historical context, Kubie's 1948 proposal to move the professional aspects of clinical psychology training and the awarding of the doctorate into the medical-school environment was an attempt to remedy a critical shortage of psychotherapists while maintaining medical control over the professional practice of psychology. The proposal failed, in part, because medicine had no legitimate claim to either training or regulating clinical psychologists. A parallel was drawn between that post-war situation and the current one in which many psychological practitioners are pressing for prescribing privileges in regard to psychoactive drugs, and similarities and important differences are noted between the two conditions. The requirement that medicine be involved importantly in the psychopharmacologic training of psychologists poses an acute problem concerning the maintenance of professional independence.     

Theory and concepts of prevention science as applied to clinical psychology.

This article provides an overview for this special issue on prevention science in clinical psychology. A brief historical perspective on prevention in clinical psychology is presented. An even greater emphasis on prevention in the future is related to changes in the current health-care system and their likely impact on psychological practice as we move into the next century. Conceptual and theoretical models of the prevention enterprise are addressed with a distinction drawn between health promotion and disease prevention in the areas of mental disorders and general physical health. The classification of preventive interventions is discussed and methodological challenges to outcomes research are outlined. The article concludes with a discussion of training and public policy implications and a brief overview of the other articles included in this special issue on prevention science.     

Family systems practice in pediatric psychology

OBJECTIVE: To present a pediatric psychology consultation treatment framework based on family systems and developmental theories. METHODS: After reviewing background relevant to family systems interventions, a five-step protocol (referral, assessment, collaboration, outcome) for consultation is presented, using case examples from our pediatric oncology service, to illustrate joining, focusing, promoting competence and collaboration with patients, families, and staff. RESULTS: Using protocols based on family systems frameworks, pediatric psychologists can offer systems-oriented consultation to patients, families, and healthcare teams. CONCLUSIONS: Further development and evaluation of family systems protocols are necessary to understand the efficacy of these approaches and their role in training and practice.     

Community psychology as a model for the new private practice of psychology

The continuing increase in graduates from training programs in psychology when coupled with the decline of publicly supported mental health facilities or funds will lead more psychologists to offer services privately. At the same time, the private practice of psychology is changing, and a community psychology model may be useful in the development and offering of services. The community concepts of prevention, crisis intervention, and consultation can be related to family, work, and health in the development of some of the services that will become more prevalent in private practice.     

Teaching evidence-based practice: implications for psychology

A movement advocating the use of evidence-based practice (EBP) is increasingly influencing health care and the practice of psychology. Thus, teaching evidence-based practice in psychology (EBPP) is critical to the preparation of future health service psychologists. In this article, the authors address common myths associated with EBP, propose core components involved in teaching EBPP, and describe an example of how such training can be incorporated into a professional psychology education and training curriculum.     

Training competent psychologists in the field of child maltreatment

Child maltreatment is a serious threat to children's physical and psychological well-being; therefore, it is critically important to develop high-quality educational programs to train psychologists in effectively addressing child abuse and neglect. Various health care disciplines and areas within the field of psychology have established competencies as a guide for student training curricula; however, none have been established for the area of child maltreatment. The present article presents training competencies for the field of child maltreatment that have been developed from a program designed to train psychology graduate students to practice and conduct research in child maltreatment. The competencies have been divided into eight core areas including assessment, treatment, multidisciplinary collaboration, advocacy, ethics, research, research ethics, and professional development.     

General practice, primary care, and health service psychology: concepts, competencies, and the Combined-Integrated model

The profession of psychology is being impacted profoundly by broader changes within the national system of health care, as mental and behavioral health services are being recognized as essential components of a comprehensive, preventive, and cost-efficient primary care system. To fully define and embrace this role, the discipline of professional psychology must develop a shared disciplinary identity of health service psychology and a generalized competency-based model for doctoral education and training. This very framework has been adopted by Combined-Integrated (C-I) doctoral programs in professional psychology, which train across the practice areas (clinical, counseling, and school psychology) to provide a general and integrative foundation for their students. Because C-I programs produce general practitioners who are competent to function within a variety of health service settings, this innovative training approach has great potential to educate and train psychologists for a changing health care marketplace.     

Health Psychology 2000:The Development of Professional Health Psychology: European Federation of Professional Psychologists' Associations (EFPPA) Task Force on Health Psychology Final Report

This Final Report of the European Federation of Professional Psychologists' Associations (EFPPA) Task Force on Health Psychology defines the nature and scope of health psychology and its possible future development to the year 2000 and beyond. Training needs and objectives are specified for professional health psychologists working in Europe. Practical and policy implications of medical progress and societal changes are discussed. The future development of health psychology as a profession depends on putting theory and policy into practice through the implementation of high quality training. Currently there are relatively few European countries where this has yet happened. Training programmes need to be introduced in all European countries within the framework of each member- country's national laws, regulations and practices.