Closing the Gaps: Developmental Psychopathology as aTraining Model for Clinical Child Psychology

Espouses developmental psychopathology as a framework for training our future leaders due to its emphasis on an ecological, transactional lifespan perspective, as well as interdisciplinary bridging and policy focus. This perspective, used as a framework for questioning and thinking about the complex interplay of psychological and social phenomena, provides a method for closing the gaps in training future psychologists as it allows for the development of niche expertise under an umbrella of the broader, ecological perspective. In an increasingly complex world of shrinking mental health dollars and growing severity of mental health problems for families and youth, clinical psychologists are needed more than ever to solve social problems. The current training paradigms in clinical child psychology programs need redirection and clarification for future psychologists to contribute meaningfully to science, practice, and policy. This article provides background in the history and influence of the developmental psychopathology perspective, as well as future implications for doctoral training programs in clinical psychology.     

The role of clinical psychologists in community mental health teams

A questionnaire survey was undertaken to examine the perception of psychology services in community mental health teams (CMHTs). All mental health professionals other than psychologists in four CMHTs were surveyed (55). They were asked about their awareness of the activities of psychologists in their teams and their future expectations. In addition they were asked questions related to the functioning of the team and the role of the psychologist. Of the participants 96% responded. Consultancy and psychological assessment were viewed as core roles by team members. There were variations between teams in their current perceptions and expectations of psychology services, and in their perception of the functioning of their team and the role of the psychologist. Team functioning and the perception of the role of the psychologists were found to be significantly associated. Greater clarity about the role of the clinical psychologist and the functioning of CMHTs is required. © 1997 John Wiley & Sons, Ltd.     

A naturalistic comparison of the effectiveness of trainee and qualified clinical psychologists

Objective. To compare the effect of clinician type on the outcome for adult mental health clients treated by trainee and qualified clinical psychologists. Design. Naturalistic, non‐random between‐participants group design: a group of 60 adult mental health out‐patients treated by trainees and a matched group of 60 patients treated by qualified clinical psychologists. Method. Participants completed a range of established measures at assessment and outcome of their treatment during routine clinical practice. Results. Significant improvements in mental health were made for both groups from assessment to outcome; however, no significant effect of clinician type was evident. Conclusions. A variety of factors (e.g. quantity of supervision) contributing to trainee effectiveness are identified and discussed.     

To Be or Not to Be Board Certified? A Question of Quality and Identification for Psychologists

Achieving board certification in psychology is an important step in a psychologist's professional development. Board certification serves as a quality indicator for consumers, employers, and other stakeholders while providing enhanced opportunities for psychologists who complete the peer‐review process that leads to it. This commentary provides an update on trends in board certification in psychology and explores the roles and benefits of board certification as well as barriers to pursuing board certification. Board certification is an important issue to consider because more mental and physical healthcare clinicians and researchers are now embracing the biopsychosocial model. Board certification could well help with maximizing reimbursement or clinical opportunities, as well as produce a greater understanding of the biobehavioral underpinnings of comorbid mental and physical disorders. Specialist data from the American Board of Professional Psychology and membership data from the American Psychological Association were reviewed across specialty areas. The work was archival and involved no human subjects, and therefore, this study was exempt from review by the Institutional Review Board of the University of Minnesota. There are currently 4,198 board certifications across the 15 boards of the American Board of Professional Psychology. These represent a relatively small proportion (less than 4%) of U.S. licensed psychologists. The numbers correlate positively with membership levels in corresponding APA divisions. Between 2011 and 2015, there was a 25.8% increase in the number of board‐certified psychologists. Board certification appears to be undergoing a period of rapid growth among psychologists. This trend appears to reflect multiple factors, including an increased number of boards representing expanding areas of specialization in the field, a growing interest in board certification as part of increasing quality emphasis within healthcare, and psychologists' desire to distinguish themselves in a competitive marketplace. Board certification in diverse areas, including clinical health psychology, affords various professionally and personally rewarding linkages and opportunities.     

Severe Mental Illness Needs Empirically Supported Assessment and Treatments

This commentary describes the prevailing mental health-care paradigm as hindering the advantageous and sensible utilization of psychologists in the treatment of individuals with severe mental illness (SMI). The commentary suggests that the failure to utilize clinical psychology in treating SMI is part of a longstanding trend toward the narrow viewing of SMI as exclusively biological conditions requiring medical treatment exclusively. In neglecting a host of treatment interventions, a broad knowledge base of empirically supported treatments, and specific assessment skills available to clinical psychologists, an opportunity is missed to better enhance the lives of the individuals with SMI and even facilitate the effectiveness of biological interventions. This commentary raises the troubling implications of the underutilization of psychologists in the care of those with SMI, including the moral imperative raised by our absence, the neglect of the development and implementation of effective psychological interventions, and the erroneous message this absence sends about what it is that psychologists practice and who they are able to help. This commentary describes some of the ways in which clinical psychologists have contributed to the care of SMI and argues that the expertise of clinical psychologists in empirically supported assessment and treatment is a resource that should not be deprived to members of society desperately in need of treatments if we are to continue to reduce suffering and enhance quality of life. This commentary elucidates some ways in which members of the profession of clinical psychology can meet their ethical obligation to take part in the treatment of SMI.     

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.     

Addressing the Needs: Guidelines for Training Psychologists to Work with Children,Youth, and Families

A need exists for criteria for training psychologists who work with children, youth, and families. Recognizing that the provision of competent services is directly related to training for those services, a set of recommendations was adopted by the Executive Committee of the Division on Child, Youth, and Family Services. This paper outlines these recommended experiences and coursework with their rationale for child development and lifespan developmental psychology, child and adult psychopathology, mental retardation and developmental disabilities; specialized child assessment techniques; child psychotherapy and behavior change; parent, family, and school intervention techniques; specialized clinical practice in child, parent, and family therapy; research methods in child psychology; ethics and legal issues related to children, youth, and families; and subspecialties within psychology for children, youth, and families. Examples of training programs meeting these recommended training criteria are discussed.     

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.     

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.     

Clinical psychology service users' experiences of confidentiality and informed consent: A qualitative analysis

Objectives. To explore and describe the experience of clinical psychology service users in relation to the processes associated with confidentiality and the generation of informed consent in individual therapy. Design. A qualitative interview‐based study employing interpretative phenomenological analysis was conducted with service users. User researchers were active collaborators in the study. Methods. A focus group of four users was convened to explore issues related to confidentiality and consent, which then informed the development of the semi‐structured interview schedule. Twelve users of community mental health clinical psychology services were interviewed by user researchers. A user researcher and a clinical psychologist undertook joint analysis of the data. A second clinical psychologist facilitated reflexivity and wider consideration of validity issues. Results. Four main themes were identified from the data: being referred; the participant's feelings, mental health difficulties, and their impact; relationships with workers and carers; and autonomy. Conclusions. The meaningfulness of processes of discussing confidentiality, and generating informed consent, can be improved by psychologists placing a greater emphasis on choice, control, autonomy, individual preferences, and actively involving the user in dialogue on repeated occasions.     

Special considerations when conducting forensic psychological evaluations for immigration court

Immigrants are more likely to experience mental health symptoms due to the trauma and persecution they often experience before arrival, and the stress of migration. In addition, as immigration policies have become more restricted in the United States, larger numbers of immigrants are facing deportation, proceedings, and/or detention. This has increased the demand for psychologists who are needed to conduct forensic psychological evaluations in immigration courts. Psychologists can aid immigration courts in a number of ways, including by providing evidence of trauma in asylum seekers or in victims of human trafficking, or by assessing competency to participate in immigration proceedings, or risk for violence. Through a case sample, this paper highlights special considerations when conducting cross-cultural forensic assessments in immigration court and illustrates some ways in which clinical psychologists can apply their knowledge to immigration proceedings by developing expertise in the areas of multicultural psychology and forensic assessment.     

A community psychology framework for participating in mental health policy making

Psychologists are becoming more and more sensitized to the influence of mental health policy on the delivery of psychological services and, simultaneously, to the role they can or ought to play in the mental health policy-making process. Traditional and potential roles for psychologists in this process are identified and classified by means of a community psychology framework. The centrality of values in these roles is identified, and conceptual tools are presented for understanding the relationship between psychologists and policy makers. Implications for research, training, and practice are drawn.     

Psychologists on the faculties of United States schools of medicine: Past, present and possible future

This review covers the growth in the numbers of psychologists in U.S. medical schools from only a few individuals in 1910 to the present 2500 of them. Also described are the developments in: (1) administrative organizations of these faculty psychologists (e.g., in departments of psychiatry, behavioral science, pediatrics, medicine, neurology, rehabilitation medicine, and even autonomous departments of medical psychology), (2) their present faculty ranks, (3) salary levels, and (4) responsibilities, as well as perceived power relationships in which psychologists find themselves relative to other disciplines. Finally, some possible patterns in the future development of medical psychology during 1980–1990 are sketched, with speculations on the influence current developments in behavioral medicine and behavioral health may have on the future of medical psychology.     

Suicide Prevention in Older Adults

Older adults have high rates of suicide in the United States and worldwide; rates vary markedly by gender, race, and ethnicity. Ceropsychology practice guidelines (e.g., American Psychological Association [APA], 2004 ) indicate the need for assessment and treatment practices specific to older adults, as the phenomenology of mental disorders and psychotherapeutic change processes may shift across the lifespan. Inadequacies in the available knowledge base and in the education and training of clinicians have slowed progress in suicide research and hindered the development of a healthcare workforce that is deeply dedicated to suicide prevention. Inadequate knowledge stems from inattention to demographic differences, definitional imprecision and conceptual conflation, lack of research focus on older adults, and the exclusion of at-risk patients from clinical trials. The near absence of rigorous training and education in suicidology among clinical psychologists amplifies these problems. This article also reviews the empirical literature on suicide risk, noting in particular the roles of mood disorders, suicidal ideation and behavior, adjustment to life events, lack of social integration, personality traits, and access to lethal means. Suggestions are offered for improving risk assessment, the treatment of at-risk patients, and the development of prevention programs. Implications for training and education in clinical psychology are briefly discussed, and directions for future research are offered.     

How should clinical psychologists approach complementary and alternative medicine? Empirical,epistemological, and ethical considerations

As complementary and alternative medicine (CAM) practices are often recommended for mental health problems, many clients in clinical psychology will be in receipt of such treatments from other practitioners. Some psychologists have argued that CAM and psychology are natural bedfellows, given their sharing of philosophies (e.g., holism), professional orientations (e.g., person-centeredness), and theoretical positions (e.g., mind-body connectionism). It has specifically been argued that the practices of CAM could productively be appropriated, or at least promoted, by clinical psychologists. However, other commentators have criticized CAM for comprising therapies that, by definition, are both intrinsically unscientific and lacking in empirical evidence. This article examines the current standing of CAM from empirical, epistemological, and ethical perspectives. CAM treatments are found to be based on heterogeneous epistemologies and to suffer from poor records in empirical efficacy research. Attention is given to possible psychological explanations for CAM's popularity in the face of poor evidence for efficacy. It is argued that, given the likely incompatibility of CAM with clinical psychology's positivist scientific ethos, CAM practices should not be integrated into clinical psychology at this time.     

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.     

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.     

Twenty-first century graduate education in clinical psychology: a four level matrix model

Clinical psychology is positioned to play key roles in mental and physical health issues of 21st century America. In this regard, however, the present Boulder model of educating clinical psychologists is not preparing our graduates to meet the diverse demands of either today's or tomorrow's marketplaces. Accordingly, we introduce a new, four level "matrix model" for the education of future clinical psychologists. The core focus of the proposed matrix model is on the weaknesses and strengths of people in their personalities and their environments. Moreover, this matrix model operates at the individual, interpersonal, institutional, and societal-community levels of analyses. The details and implications of this proposed educational curriculum are described.     

Computerized psychological test usage in APA-accredited training programs

Despite the advantages of computerized psychological assessment and the proliferation of assessment software, many psychologists still do not use computerized assessment, and its utilization has not increased during the past decade. Two-hundred-fifty-one APA-accredited training programs in clinical and counseling psychology were surveyed concerning their use of computerized psychological assessment. Directors reported a median of only three computerized tests used in their training programs. Twenty-five percent of the respondents reported no computerized psychological tests in their training programs. The computerized tests most-often used in psychology programs were compared to results of surveys of psychological tests most-often used in clinical practice.     

Computers in clinical assessment: historical developments, present status, and future challenges

Computerized testing methods have long been regarded as a potentially powerful asset for providing psychological assessment services. Ever since computers were first introduced and adapted to the field of assessment psychology in the 1950s, they have been a valuable aid for scoring, data processing, and even interpretation of test results. The history and status of computer-based personality and neuropsychological tests are discussed in this article. Several pertinent issues involved in providing test interpretation by computer are highlighted. Advances in computer-based test use, such as computerized adaptive testing, are described and problems noted. Today, there is great interest in expanding the availability of psychological assessment applications on the Internet. Although these applications show great promise, there are a number of problems associated with providing psychological tests on the Internet that need to be addressed by psychologists before the Internet can become a major medium for psychological service delivery.