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APPIC Internship Member Update: Characteristics and Challenges

APPIC Internship Member Update: Characteristics and Challenges. Eugene D’Angelo, PhD, ABPP 1 Katherine Frost, BA 2 Emily Norkett 3 May 3rd, 2014 1 Harvard Medical School, Boston Children’s Hospital 2 Binghamton University, Boston Children’s Hospital 3 Williams College.

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APPIC Internship Member Update: Characteristics and Challenges

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  1. APPIC Internship Member Update: Characteristics and Challenges Eugene D’Angelo, PhD, ABPP1 Katherine Frost, BA2 Emily Norkett3 May 3rd, 2014 1 Harvard Medical School, Boston Children’s Hospital 2 Binghamton University, Boston Children’s Hospital 3 Williams College "Creating a Culture of Competence in Psychology Training and Education" 2014 APPIC Conference Austin, Texas May 1-3, 2014

  2. Disclosures Portions of this presentation were supported by: • Linda and Timothy O’Neill Foundation • Tommy Fuss Foundation • John and Geraldine Weil Foundation Conflicts of Interest: None

  3. The Update Process • The 2012-13 APPIC Membership Directory was reviewed to look at whether there were distinguishing characteristics between accredited and non-accredited member programs in their general characteristics, locations, and formal rotations providing experience with underserved populations. • A secondary review was made of the non-accredited programs that identified themselves as have no more than two fulltime psychologists in their program. • Programs were then reviewed by type to determine whether distinguishing characteristics between accredited and non-accredited member programs are unique to certain types of internship site.

  4. APPIC Member Accredited and APPIC Member Non-Accredited Programs Demographic Differences

  5. APPIC Member Accredited by APPIC Member Non-Accredited Comparison of APA and CPA Program Characteristics (part 1) * p < .001.

  6. APPIC Member Accredited by APPIC Member Non-Accredited Comparison of APA and CPA Program Characteristics (part 2) * p < .001.

  7. APPIC Member Accredited by APPIC Member Non-Accredited Comparison of APA and CPA Program Characteristics (part 3) * p < .001.

  8. APPIC Member Accredited by APPIC Member Non-Accredited Comparison Summary • Full time staff ( 16.20 vs. 6.85) • Part time staff ( 3.81 vs. 1.49) • Full time stipend amount (26,326 vs. 21,749) • Number of applications per program (123.95 vs. 49.59) • Number of applicants interviewed (38.43 vs. 21.56) • Total number of interns (5.01 vs. 3.58) • There were no significant differences found in either minimum AAPI intervention (431.14 vs. 417.39) or assessment (134.85 vs. 173.15) hours.

  9. APPIC Member Non-accredited programs Specifics

  10. 87.9% of the non-accredited APPIC member programs reported matching with interns from accredited doctoral programs in the 2012 Match. 76% reported the same for the 2011 Match.

  11. US States with the Largest Number of APPIC Member Non-accredited Programs

  12. Most Common Types of APPIC Member Non-accredited Internships (APA and CPA)

  13. Training Differences APPIC Member Accredited versus APPIC Member Non-Accredited Programs

  14. Binomial percentage of featured training emphasis in APPIC Member accredited and non-accredited programs (APA and CPA) *p < .05. **p < .001.

  15. Small APPIC Member Non-Accredited Programs (No more than two full-time equivalent psychologists) Demographics

  16. Small APPIC Member Non-accredited Programs (APA and CPA Accredited compared to Non-accredited Member Programs) • * p < .01. • ** p < .001.

  17. Small Programs continued • ** p < .001.

  18. US States with the Largest Number of Small APPIC Member Non-accredited Programs (Only two psychologists)

  19. Types of Small APPIC Member Non-accredited Internships

  20. Small APPIC Member Non-Accredited Programs Program Specifics and Comparisons

  21. Full comparison- percentage of featured training emphasis in APPIC member accredited and non-accredited small programs **p < .001.

  22. Internship Program Types APPIC Member Accredited and Non-accredited programs

  23. Community Mental Health Center- Training emphases in APPIC Member Accredited and Non-Accredited Programs

  24. Medical School- Training emphases in APPIC Member Accredited and Non-Accredited Programs

  25. Consortium- Training emphases in APPIC Member Accredited and Non-Accredited Programs * p < .05.

  26. University Counseling Centers- Training Emphases in APPIC Member Accredited and Non-Accredited Programs * p < .05.

  27. Veterans Affairs Medical Center- Training emphases in APPIC Member Accredited and Non-Accredited Programs * p < .05.

  28. Child/Adolescent Psychiatric or Pediatrics- Training emphases in APPIC Member Accredited and Non-Accredited Programs * p < .05.

  29. State/County/Other Public Hospital- Training emphases in APPIC Member Accredited and Non-Accredited Programs * p < .05.

  30. Program specifics- summary and further questions • In general, with the exception of empirically supported treatments, APPIC member accredited and non-accredited program training emphases tend to be similar. • Program differences likely stem from amounts of available resources. • How do you generate and sustain resources to support the transition to accreditation?

  31. The Challenge is to Balance Economic Viability of Internship Programs with the Need to Maintain Quality Training Experiences Accreditation Stipends Outcomes Staffing Training Standards Programming Quality Training Programs More Internship Positions

  32. Sustainability: Funding to Maintain Program Viability “Show me the money!!” Jerry McGuire, 1996

  33. Whose Responsibility is it to pay for Internship Training? • Academic programs? • Insurance companies? • Internship settings? • Federal Government? • Interns? • Consumers?

  34. Prioritizing the Financial Stability for Internship Training

  35. A Setting Must Determine Its Motivation to Offer Accredited Internship Training • What are the reasons to consider becoming an accredited training site? • What type of internship program is most viable in this community? Is there a possibility for consortium programming to occur or should it be a “stand alone” internship site? • What are the standards of “quality in training” that the setting espouses? How did they develop these standards? How close are they to the standards for accreditation, particularly for the designation: “accredited, on contingency” basis? • What personnel (particularly, psychologists) does the setting have available to provide quality training? Do they have competencies in clinical supervision and in training? • Has the setting estimated the costs for quality training prior to creating the program?

  36. The Search for Financial Support for Training • Will interns need to generate revenues in order to maintain program viability? (2011 APPIC Member Survey : 65% do not generate revenues from intern services) • Will the MCE’s in that community reimburse for supervised intern services? • What non-clinical revenues can be created to sustain the internship program including potential feasibility of receiving local or state grants, contracts, non-billing support? • Are there federal funds that can be accessed for the community setting (for example, funding for community health centers or integrated care models) that might also support internship training services?

  37. Determining the Cost of Internship Training • Fixed costs of internship training • Loss/gains for both clinical service delivery and reimbursement • The role of non-revenue funds that may offset costs in internships found in community health settings

  38. Estimating the Fixed Costs of Internship Training • Intern salaries and benefits • Program expenses (hiring training staff, costs of supervision, teaching seminars, meetings with interns, career counseling) • Administrative secretarial support • Office space and building expenses (office furniture, rental of space, utilities, parking, etc) • Instruments/materials used by interns (assessment equipment, books, etc.) After: Klein, D & Nicholson, I (2006). Costs of predoctoral clinical psychology internship training in a Canadian health care setting. Canadian Psychology/PsychologieCanadienne,47, 333-342.

  39. Financial Balance Sheet for Internship Programs Are Influenced by… • Number of hours from staff schedules for supervision • Amount of time staff are “released” from clinical responsibilities to teach seminars • Number of direct service hours required to be provided by both staff and trainees Schauble, P., Murphy, M, Cover-Paterson, C, & Archer, J (1989). Cost effectiveness of internship training programs: Clinical service delivery through training. Professional Psychology, 20, 17-22.

  40. The Bottom Line: Impact of Training on Clinical Productivity • To what extent does an organization’s participation in internship training reduce staff clinical revenues/service delivery? • Can interns generate sufficient revenue/services to offset the loss of revenues/services for staff who participate in internship training? Is that an appropriate model to consider?

  41. The Importance of Non-service Revenues for Training Programs • Service contracts with community agencies (e.g., school systems, community agencies, court systems) • Contracts with departments in community hospitals to provide consultative services • Community service grants (State and local)

  42. The Calculated Risk of Internship Training (Intern revenues + non-clinical revenue income) –(Fixed costs of training + loss of staff revenues) = Internship Program Financial Viability

  43. Challenges to Negotiate in Moving from Non-accredited to Accredited Internships • There is no “one size fits all” financial strategy. • Strategies need to be site specific, linked to the motivation for being an internship site, and provide direct value to the larger organization. • Sustainability is related to covering the overall expenses of training. • Programs benefit from “mentoring” to move to accreditation----it makes the experience feel less arduous and more doable. • Once the strategy for financial viability is established, a program can apply for possible grant funding for the self-study, application fees, etc. through the APA Internship Stimulus funds.

  44. Thank You For Your Participation! Contact Information: eugene.dangelo@childrens.harvard.edu

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