“Honoring Somebody that Society Doesn't Honor”: Therapists Working in the Context of Poverty

Although it has been widely acknowledged that people living in poverty are underserved by mental health professionals, little is known about the experiences of psychotherapists who are currently working with poor clients. What can we learn from these clinicians that may help us more effectively prepare trainees for work in the context of poverty? This qualitative investigation analyzed narrative data from 10 therapists regarding their work with poor clients. Participants revealed perceptions of the challenging (and rewarding) nature of this work, the inadequacies of their training to meet these demands, and the damaging influence of social stigma within their clients’ lives and presenting problems, as well as on clinicians’ own occupational status.     

Extending Training in Multicultural Competencies to Include Individuals Identifying as Lesbian,Gay, and Bisexual: Key Choice Points for Clinical Psychology Training Programs

Traditional models of multicultural training for professional psychology have focused primarily on racial and ethnic minorities and have not included competencies focused on individuals identifying as lesbian, gay, and bisexual (LGB), despite documented evidence of health disparities for sexual minorities. Ways to adapt models based on Sue's (1992) 3 × 3 competencies (attitudes and beliefs, knowledge, and skills across the dimensions of awareness of one's own cultural influences and biases, understanding the client perspective, and appropriate interventions for an individual client) for LGB health are described. This includes the addition of an action/advocacy dimension. Six key choice points for clinical psychology training programs adding LGB competency to a multicultural competency training component are outlined. Potential challenges and solutions for expanding multicultural training are discussed.     

Trainee clinical psychologists' adaptation and professional functioning: a longitudinal study

Clinical psychology training is a professionally formative period, which provides an opportunity to enable trainees to learn good self‐care skills and mature approaches to learning. If realized, this can support lifelong learning and high levels of professional functioning. This study sought to use transactional coping theory and experiential learning theory to improve our understanding of what factors predict changes in psychological adaptation and professional functioning over the course of clinical psychology training. A mixed prospective within‐persons and cross‐sectional between‐persons design was used. A sample of 183 trainee clinical psychologists (60.2% response rate) from 15 British clinical psychology training programmes participated at time one, 167 of whom participated at time 2 a year later (91.3% of the time 1 sample). They completed measures of appraisal, coping, social support and professional functioning at times 1 and 2. Path analyses suggested that trainees who appraised the demands of training as manageable, and reported greater access to appropriate support, engaged in less avoidance coping, reported fewer problems of psychological adaptation and were more likely to approach the task of learning and working appropriately and resiliently. Implications for clinical psychology training are suggested. Copyright © 2003 John Wiley & Sons, Ltd.     

The Hierarchical Clustering of Clinical Psychology Practicum Competencies: A Multisite Study of Supervisor Ratings

Competency evaluation rating forms are widely used to assess a range of global and specific psychology practitioner competencies during and at the end of clinical placements. Surprisingly, there is little research examining the dimensional structure or the hierarchical clustering of items on these ratings. The current, multisite study examined supervisor ratings of clinical psychology trainees (N = 204) on the Clinical Psychology Practicum Competencies Rating Scale (CΨPRS). Based on the proximity criterion chosen, hierarchical clustering yielded either nine clusters or four super clusters: Good Practitioner Attributes and Conduct, Scientist Practitioner and Professional Management, Assessment and Intervention, and Psychological Testing. The study also tracked the developmental trajectory of competency attainment. CΨPRS ratings differentiated groups between early but not between later stages of training. Measurement issues and implications for training and practice are discussed.     

Cultural competency 2.0: exploring the concept of "difference" in engagement with the other

Cultural competency efforts have received much attention in medical education. Most efforts focus on the acquisition of knowledge and skills about various groups based on race and ethnic identity, national origins, religion, and the like. The authors propose an approach, "Cultural Competency 2.0," that does not reject such efforts but, rather, adds a more critical and expanded focus on learners' attitudes and beliefs toward people unlike themselves. Cultural Competency 2.0 includes learners' examination of the social position of most U.S. medical students, Bourdieu's concept of habitus, and the phenomenon of countertransference to come to new critical insights on learners' attitudes, beliefs, and, ultimately, interactions with all patients. Suggestions are offered for how and where Cultural Competency 2.0 can be used in the curriculum through narrative medicine, particularly through the development of reading practices that unmask illusions of "pure" objectivity often assumed in clinical settings, and that make visible how words and images constrain, manipulate, or empower individuals, groups, ideas, or practices.The authors argue that these educational approaches should be sustained throughout the students' clinical experiences, where they encounter patients of many kinds and see clinicians' varied approaches to these patients. Further, these educational approaches should include assisting students in developing strategies to exercise moral courage within the limitations of their hierarchical learning environments, to strengthen their voices, and, when possible, to develop a sense of fearlessness: to always be advocates for their patients and to do what is right, fair, and good in their care.     

The use of the repertory grid technique to examine staff beliefs about clients with dual diagnosis

Aim: This paper reports a study exploring how individual psychiatric staff construes clients with psychosis who misuse substances. Background: A dual diagnosis of substance misuse is common in clients with psychosis. Previous studies have suggested that psychiatric staff feel ill‐equipped to work with these clients, and hold negative views of them, affecting client care and recovery. Understanding staff attitudes can inform training and practice. Method: Twelve psychiatric nursing staff working in an inpatient service for adults with enduring mental health difficulties in England were interviewed. Using a repertory grid technique, staff were asked to describe clients and acquaintances who did and did not misuse substances, themselves and colleagues. Findings: All staff made critical judgements of some clients, particularly clients with dual diagnosis, but were less judgemental towards acquaintances who misused substances. Staff who used fewer dimensions to construe people appeared to make a clear distinction between clients and non‐clients. This distinction was not apparent for staff with more cognitively complex construct systems. Specific factors that could be implicated in the organization of individuals' construct systems included personal experience of services as a carer; these staff made less distinction between clients and non‐clients. Conclusion: Further training is needed for staff working with clients with a dual diagnosis. Training packages need to consider the personal experiences and views of staff. Reducing the boundaries between staff and clients might enable staff to better understand the actions of clients and improve client care. Copyright © 2009 John Wiley & Sons, Ltd.     

Quid pro quo: fee for services delivered in a psychology training clinic

The present study evaluated the use of a sliding-fee scale at a training clinic for doctoral students in clinical psychology. A chart review of 209 individual therapy clients and a follow-up telephone interview of 87 of these clients were conducted. Results of the chart review revealed a client group of relatively low income, with only a very small number receiving social assistance or a disability pension. The follow-up survey found that the large majority of clients were satisfied with the fees charged. Service use (i.e., frequency and number of sessions), client satisfaction with services, and treatment outcome did not vary with out-of-pocket costs incurred by clients. Overall, findings suggest that training clinics can charge fees without affecting services, although future research needs to examine the extent that fee charging by training clinics may be an obstacle to service access for the poorest segments of the population.     

Listening to the Voices of the Poor and Disrupting the Silence About Class Issues in Psychotherapy

By its very nature, a life of poverty is harmful to the emotional well‐being of poor and working‐class women and men. Psychology, for the most part, has unwittingly played a part in this oppression by pathologizing the poor and maintaining barriers to mental health care. This article presents findings from qualitative studies that illustrate lived experiences and insights from poor and working‐class people in the community at large and in the therapeutic settings in particular. Drawing from these narratives, recommendations are made to psychologists who seek to subvert the normative silence around class issues and take on the work of providing class‐aware services to men and women in poverty.     

Is neighborhood poverty harmful to every child? Neighborhood poverty,family poverty,and behavioral problems among young children

This longitudinal study investigates the association between neighborhood poverty and behavioral problems among young children. This study also examines whether social environments mediate the relationship between neighborhood poverty and behavioral problems. We used data from the third and fourth waves of the Fragile Families and Child Wellbeing study to assess behavioral problems separately for children who experienced no family poverty, moved out of family poverty, moved into family poverty, and experienced long‐term family poverty. Regression models assessed the effect of neighborhood poverty on behavioral problem outcomes among children aged 5 years, after controlling for sociodemographic characteristics and earlier behavioral problems. Results showed an association between neighborhood poverty and lower social cohesion and safety, which lead to greater externalizing problems among children with long‐term family poverty living in high‐poverty neighborhoods compared with those in low‐poverty neighborhoods. Policies and community resources need to be allocated to improve neighborhood social environments, particularly for poor children in high‐poverty neighborhoods.     

Telemental health training in the Veterans Administration Puget Sound Health Care System

As a pioneer of training in the field of psychology, the Veterans Affairs (VA) HealthCare System serves as a leader in the training in and provision of Telemental Health (TMH) services in the United States. To meet goals toward continued expansion of these services, the VA TMH training program includes both web-based didactic courses and a skills competency test at a basic level with supervision and consultation in TMH for more advanced training and is available to staff psychologists and psychologist trainees. Despite these efforts, barriers for training in and implementation of TMH occur at the provider, system, and patient level. At the national level, the VA is actively working to resolve these barriers and we share site-specific examples implemented by the VA Puget Sound Health Care System promoting access through TMH team to further address barriers to training and implementation.     

A South African perspective on community psychology practice competencies

The appropriateness of the paradigm underlying competency frameworks and their specific application in the list of definitions developed by a Task Group of Society for Community Research and Action (SCRA) for US community psychologists need further consideration. This paper considers the technicist and behavioural roots of some of these concepts, illustrating tensions when applying them to community psychology. It then proposes a competency perspective from the global South. Drawing from focus group discussions with, and written reflections from, postgraduate Master's students in training as clinical and counselling psychologists, this paper builds inductively from the recorded data. Following a template analysis of the material, four integrating themes were evident. The distinctive nature of community psychology is highlighted through the themes: relational foundations, activity evolution, self-management and the awareness and influences of processes. Proposals for an alternative framework (“RASP”) are based on its emergence from the applications of learning to practice, emphasising community-based principles. The importance of reflection as the basis for the learning is highlighted. The imperatives to foreground social justice and to enable reflexive thinking on action are discussed, along with concepts based on Humanist and Social Constructivist paradigms, to lead to more interactive and inclusive processes in work on competencies.     

BOOK REVIEW: Preventing Childhood Disorders,Substance Abuse,and Delinquency

Discusses (a) what roles the specialty of clinical child psychology fulfills and how societal and professional changes have enhanced the need for the specialty, (b) how the field defines itself, (c) how models of training are conceptualized for the specialty, and (d) how some training programs implement specialty training with broad, interdisciplinary components. Clinical child psychology is a professional field of research and practice that, when adequate training is provided, properly deserves a places as a specialty.The dangers of overspecialization and narrowness are more likely present in traditional clinical (adult) psychology than in clinical child psychology, especially when the clinical child training is done in a broadly comprehensive and integrated manner.     

Using the PRACTICE mnemonic to apply cultural competency to genetics in medical education and patient care.

Medical education curricula increasingly are incorporating courses on cultural competency and skills development in working with ethnically diverse patient populations as well as courses on genetics and genomics. The authors support these efforts and believe the next step is integration of genetics into cultural competency programs and similarly, cultural competency into genetics curricula. In this paper, the authors describe the work of the Genetics in Primary Care Faculty Development Working Group on Cultural Competency, a federally-funded initiative to prepare generalist faculty to teach genetics as part of ambulatory education. Over a 12-month period, this team wrote a module on cultural competency and nine new clinical cases, and developed the PRACTICE mnemonic (prevalence, risk, attitude, communication, testing, investigation, consent, empowerment) to help health care professionals integrate cultural competency skills in genetics into primary care. More specifically, the PRACTICE mnemonic integrates information emerging from experts in health disparities and doctor-patient communication to build a comprehensive model for addressing the relevance of culture and ethnicity in the delivery of genetic services. Lastly, this paper illustrates a systematic method of covering key areas of cultural competency through discussion of a patient with a genetic disorder as well as presents an argument as to why cultural competency is highly relevant to the delivery of genetic services especially as part of generalists' clinical practice.     

A randomised controlled trial of a blended learning education intervention for teaching evidence-based medicine

Background

Few studies have been performed to inform how best to teach evidence-based medicine (EBM) to medical trainees. Current evidence can only conclude that any form of teaching increases EBM competency, but cannot distinguish which form of teaching is most effective at increasing student competency in EBM. This study compared the effectiveness of a blended learning (BL) versus didactic learning (DL) approach of teaching EBM to medical students with respect to competency, self-efficacy, attitudes and behaviour toward EBM.

Methods

A mixed methods study consisting of a randomised controlled trial (RCT) and qualitative case study was performed with medical students undertaking their first clinical year of training in EBM. Students were randomly assigned to receive EBM teaching via either a BL approach or the incumbent DL approach. Competency in EBM was assessed using the Berlin questionnaire and the ‘Assessing Competency in EBM’ (ACE) tool. Students’ self-efficacy, attitudes and behaviour was also assessed. A series of focus groups was also performed to contextualise the quantitative results.

Results

A total of 147 students completed the RCT, and a further 29 students participated in six focus group discussions. Students who received the BL approach to teaching EBM had significantly higher scores in 5 out of 6 behaviour domains, 3 out of 4 attitude domains and 10 out of 14 self-efficacy domains. Competency in EBM did not differ significantly between students receiving the BL approach versus those receiving the DL approach [Mean Difference (MD)=?0.68, (95% CI–1.71, 0.34), p=0.19]. No significant difference was observed between sites (p=0.89) or by student type (p=0.58). Focus group discussions suggested a strong student preference for teaching using a BL approach, which integrates lectures, online learning and small group activities.

Conclusions

BL is no more effective than DL at increasing medical students’ knowledge and skills in EBM, but was significantly more effective at increasing student attitudes toward EBM and self-reported use of EBM in clinical practice. Given the various learning styles preferred by students, a multifaceted approach (incorporating BL) may be best suited when teaching EBM to medical students. Further research on the cost-effectiveness of EBM teaching modalities is required.

     

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.     

Identifying self-assessed competencies and areas for improvement within community pharmacist-preceptors support during pre-registration training

Background

Competency frameworks that prompt personal and professional development have become an important component of lifelong learning; they are driven by healthcare professionals’ need for development and professional recognition. This study aimed to evaluate the self-assessed competencies of community pharmacist-preceptors by using Croatian Competency Framework (CCF) and to identify competencies to be improved. The secondary aim was to explore the association between community pharmacists’ characteristics (i.e. age, education etc.) and self-assessed competency performance.

Methods

The study subjects were community pharmacist-preceptors who provide support to and mentor student trainees enrolled in pre-registration training for pharmacy students. At the beginning of their mentorship, the pharmacist-preceptors assessed their competencies on a four-point Likert scale by using the Croatian Competency Framework (CCF), a validated tool for assessment and self-assessment of community and hospital pharmacists. Data were collected via e-mail in the period from October 2015 to April 2016.

Results

Of the 260 community pharmacists approached, final analysis included 223 respondents. The response rate was 85.8%. Community pharmacist-preceptors assessed themselves as the most competent in competencies pertaining to the cluster “Organization and management competencies” (M?=?3.64, SD?=?0.34), while they considered themselves as the least competent in the competencies pertaining to the cluster “Pharmaceutical public health competencies” (M?=?2.75, SD?=?0.77). Younger pharmacists with a postgraduate qualification who worked for large pharmacy chains in the capital city area and who had been in their current posts for a shorter period perceived themselves to be more competent.

Conclusion

This research represents the first analysis of the CCF in practice and identifies community pharmacist-preceptor competencies that require improvement. Consequently, areas for additional professional education were defined. Implementing modalities to measure and support development of preceptors’ competences is essential for improvement of student training programmes.

     

Responding to Clinical Psychology Practicum Competencies: An APPIC Perspective

This article offers a commentary by representatives of the Association of Psychology Postdoctoral and Internship Centers (APPIC) on the 2015 article written by Gonsalvez et al. related to the assessment of clinical competencies in clinical psychology practicum students. The four competency “super clusters” derived by Gonsalvez et al. result from a unique empirical hierarchical clustering approach and are sure to add important knowledge to the field. This commentary generalizes from clinical psychology education and training in Australia to the United States, expands from practica to internship and postdoctoral training, and reflects on some relevant APPIC issues and initiatives. Future research is also suggested.     

Health and disease in context: a community-based social medicine curriculum.

Despite the increasing attention paid to the role of social forces in determining health, most physicians finish their training ill-prepared to address these issues. The authors describe their efforts to fill that training gap for internal medicine residents at Oregon Health and Science University through a community-based social medicine curriculum, designed in 2006 in conjunction with community partners at Central City Concern (CCC), an organization addressing homelessness, poverty, and addiction in downtown Portland, Oregon. The challenge was to develop a curriculum that would (1) fit within the scheduling constraints of an established categorical internal medicine residency program, (2) give all internal medicine residents a chance to better understand how social forces affect health, and (3) help show how they, as health professionals, might intervene to improve health and health care. The authors maintain that by developing this curriculum with community partners--who took the lead in deciding what residents should learn about their community and how they should learn it--the residency program is providing a relatively brief but extremely rich opportunity for residents to engage the personal, social, and health-related issues experienced by clients served by CCC.The authors first provide a brief overview of the curriculum and describe how the principles and practices of community-based participatory research were used in its development. They then discuss the challenges involved in teaching medical residents about social determinants of health, how their academic-community partnership approaches those challenges, and the recently established methods of evaluating the curriculum.     

Development of a competency based training programme to support multidisciplinary working in a combined biochemistry/haematology laboratory

The aim of this study was to develop a competency based training programme to support multidisciplinary working in a combined biochemistry and haematology laboratory. The training programme was developed to document that staff were trained in the full range of laboratory tests that they were expected to perform. This programme subsequently formed the basis for the annual performance review of all staff. All staff successfully completed the first phase of the programme. This allowed laboratory staff to work unsupervised at night as part of a partial shift system. All staff are now working towards achieving a level of competence equivalent to the training level required for state registration by the Council for Professions Supplementary to Medicine. External evaluation of the training programme has included accreditation by the Council for Professions Supplementary to Medicine and reinspection by Clinical Pathology Accreditation (UK) Ltd. The development of a competency based training system has facilitated the introduction of multidisciplinary working in the laboratory. In addition, it enables the documentation of all staff to ensure that they are fully trained and are keeping up to date, because the continuing professional development programme in use in our laboratory has been linked to this training scheme. This approach to documentation of training facilitated a recent reinspection by Clinical Pathology Accreditation (UK) Ltd.