Psychologists Pathway for Development

1. Psychologists Pathway for Development Submitted by Melodie Schaefer, Psy.D., Chair, Division II (Education & Training) Board of the California Psychological Association; Board Member, California Psychological Association Chair California Psychology Internship Council (CAPIC) DRAFT

2. Psychologist Workforce Estimated Needs • Currently there are approximately 19,485 psychologists in California (2013 CPA data) • The projected increase in positions for psychologists will be increasing by as much as 20% nationally (Amer. Psychological Assn., n.d., 2011) • There is a need for an increase in the number of psychologists treating those in rural areas (Am. Psychological. Assn., 2007) • There is a need to increase the presence of psychologists working in behavioral health (Runyan, 2001). DRAFT

3. Psychologists - Current State • Doctoral level educational programs within the state of California have the capacity to provide well-trained psychologists to meet the workforce needs in providing psychological/ mental health services, including target geographic and specialty areas. • Currently (2013), 36 degree programs (Psy.D., Ph.D.) are located at regionally-accredited institutions, and 12 non-regionally accredited programs. DRAFT

4. Psychologists - Current State, Continued • The California Psychology Internship Council (CAPIC) was founded in 1991 as a consortium of doctoral programs and internship agencies, adding postdoctoral program members a few years ago. Founders recognized that by working together they could increase the quality of professional psychology training throughout the entire education trajectory, as well as better train psychologists to serve population needs within the state of California DRAFT

5. Psychologists - Current State, Continued • CAPIC is comprised of 36 Psychology Doctoral Degree Program members and 144 Psychology Internship Programs, and 20 Postdoctoral Training Programs, all located within California. • In 2012 466 doctoral programs interns were placed at internships within California (sans APA & APPIC) • The majority of interns are placed at agencies funded all or in-part by state/county mental health • Over approximately 500,000 hours of on-site support and 250,000 of direct services are provided by these interns annually to consumers of Mental Health Services state-wide DRAFT

6. Psychologists - Current State, Continued • CAPIC’s mission: promote excellence in professional psychology training & mental health services by the following: • Collaborating with all stakeholders & professional psychology orgs. in furthering quality of professional psychology training; • Serves as a leader in centralizing predoc internship training; • Promotes standards & innovation in professional psychology training to provide clinical services to the state's diverse communities; • Collaborates and advocates for access to training stipends for psychology interns & training resources for agencies; and • Develops ethical internship training environments that are sensitive to issues of diversity and culture. DRAFT

7. Psychologists - Current State, Continued CAPIC/MHSA Psychology Intern Stipends: • CAPIC has awarded stipends over the past five years to 181 clinical psychology students committed to working in the California public mental health system. • In 2013-14 CAPIC will award an additional 35 FTE stipends to another cadre of psychology doctoral students committed to working in the California public mental health system. DRAFT

8. Psychologists - Current State, Continued • Stipend recipients have been successful throughout 2008 to present (funded years of program to date), in obtaining post-doctoral positions in the state mental health system, showing a need for psychologist positions throughout the state. • CAPIC has developed 14 online training modules focused on the Resiliency-Recovery Model, to support doctoral psychology interns, focused on the mental health concerns of consumers in California • Additional trainings are underway on Integrated Healthcare relevant to mental health DRAFT

9. Psychologists - Current State, Continued • CAPIC/MHSA stipend recipients represent the diversity of California’s population, and in particular the unserved/ underserved & underrepresented mental health client populations. • Ethnic diversity of interns increased from 46% in Year 1 (2008-2009) to 63% Year 5 (2012-2013). • Languages other than English rose to 50% among intern stipend recipients. • Those interns with a rural upbringing rose to 13% from 8%, indicating a continued need to recruit students from rural communities into the field of Psychology DRAFT

10. Psychologists - Current State, Continued • Overall diversity (e.g. ethnicity, language competency, and rural upbringing) of CAPIC/MHSA stipend recipients significantly increased since this program began indicated in following chart. • One exception - stipend recipients’ use of public mental health services, which dropped from its high of 51% last year (Year 4, not shown) 21% in Year 5 (shown). • Geographic distribution of psychology interns stipend recipients is shown in the 2nd chart. DRAFT

11. Psychologists - Current State, Continued DRAFT

12. Psychologists - Current StateCalifornia Geographic Distribution -CAPIC/MHSA Stipend Interns DRAFT

13. Psychologists Services in Behavioral Healthcare • Psychologist provide a wide range of valuable skills/services & that contribute to meeting the needs of consumers and are relevant to integrated healthcare. These include: • On-site consultation, assessment & intervention • Address challenges in treatment compliance • Assess & intervene w/ client/family behavior problems, relationships & other struggles that impact mental and overall health & functioning DRAFT

14. Psychologists Services in Behavioral Healthcare • Assist clients in better managing diet, exercise and medication and in learning strategies for self-monitoring & goal setting • Use screening tools & primary prevention programs to detect mental health conditions early • Present educational sessions for clients & staff on relevant issues (ex: disease management) • Assist in client management of chronic disease conditions • Specialized skills in treating children/adolescents/ adults; substance abuse; depression; anxiety D RAFT

15. Psychologists Services in Behavioral Healthcare • Design & use evaluation methods (ex: continous quality improvement measures & consumer satisfaction surveys • Develop and implement evidence-based practices to address emotional & behavioral health problems • Program design & evaluation • Improving the functioning of systems including families, workplaces & communities DRAFT

16. Psychologists - Future Need • Continued emphasis on educating psychologists & students on the ACA and how to integrate psychologists skills within the Integrated Healthcare environment • Develop or expand special training programs in integrated healthcare for doctoral level psychology programs & mentorship opportunities in field • FQHCs lack understanding of billing for services provided by psychologists/mental health • Address the cost of education impacting graduate students, deterring some from pursuing a degree DRAFT

17. Psychologists - Future Need • Educate other disciplines on the unique skills psychologists can provide to the mental/ behavioral healthcare team • Recruitment of students from rural communities • To encourage psychologists to work in rural areas • Incorporate training and education on the Recovery and Resiliency Model into existing curriculum • Address challenges in getting through hiring process for DMH/PMH positions DRAFT

18. Psychologists - Future Need • To develop Telepsychology capabilities to better reach rural and homebound consumers • Reductions in mental health funding has impacted the ability of psychologists to provide supervision & training due to work overloads & reduced number of psychologists • Address reduction in # of internships statewide due to fiscal issues & impact on training opportunities • Increase the number of bilingual & under-represented doctoral trained psychologists in CA DRAFT

19. Psychologists Pathway –Sources Consulted • California Psychological Association • Division II (Education & Training) Board of the California Psychological Association • California Psychology Internship Council • American Psychological Association • Education Directorate • Practice Directorate • Personal Communication w/ LA Cty DMH Psychologists DRAFT

20. Psychologists Pathway –Sources Consulted • American Psychological Association (n.d.). Careers in Psychology. Retrieved ffromhttp://www.apa.org/careers/resources/guides/careers.aspx • Runyan, C.N. (2011). Psychology can be indispensable to health care reform and the patient-centered medcial home. Psychological Services, 8, 53-68. doi: 10.1037/a0023454 DRAFT

21. Psychologists Pathway –Sources Consulted • Report by The Center for Health Policy, Planning & Research for the American Psychological Association, October, 2007. • Report from the CDC DRAFT

22. Psychologists Workforce Pathway Pre-Training Health Professions Education Workforce • Target Groups: • Incumbent Workers • High School and Community College Students • Career Changers • Displaced Workers • Undergraduates • Immigrant Health Professionals • Graduate Public Health Students • Students w/ diverse backgrounds • Veterans • Bilingual students K-12 Education Shortage of internship positions in county mental health departments in rural settings Reductions in MH funding resulting in less supervision & training for interns entering career path; Lack of psychologists in rural areas Doctoral Psych. Training Program Access Academic Preparation & Entry Support Financial & Logistic Feasibility Financing & Support Systems Training Program Retention Hiring & Orientation Career Awareness Retention & Advancement Assessment Internships Cultural Sensitivity and Responsiveness MH Billing at FQHCs confusing at sites which impacts use of psychologists Outreach to encourage and inform Target Groups to enter field & career opportunities Lack of understanding of ways that psychologists can enhance public mental health Quality, Diverse Health Workforce Rising cost of education; Recruiting Diverse & Bilingual students Insufficient career awareness among rural and underserved populations

23. Recommendations to Address Identified Barriers - Psychologists DRAFT

24. Recommendations to Address Identified Barriers DRAFT

25. Recommendations to Address Identified Barriers - Psychologists DRAFT

26. Recommendations to Address Identified Barriers - Psychologists DRAFT

27. Existing Education and Training Capacity - Psychology • CAPIC has developed 14 online training modules to assist doctoral psychology interns in increasing their knowledge of clinical issues related to community mental health in California. The modules include: • Module Introduction • Goals and Learning Objectives • Reading List • Video Introduction (5 minutes) • Video Lecture (1 hour) • PowerPoint Presentation of Lecture Materials • Study Questions and Online Discussion Board • Course Evaluation and • Multiple-Choice Examination DRAFT

28. Existing Education and Training Capacity - Psychology Module Topics are as follows: • Recovery and Recovery Oriented Care, • Homelessness & Poverty: Mental Health Needs and Treatments for the Homeless Mentally Ill • Supportive Employment as an Evidence Based Practice for the Severely and Chronically Mentally Ill • Severe Mental Disorders: Treatment and Systems of Care, • Poverty, SES, Health, and Health Care: Epidemiology and the Needs of Public Mental Health Clients, • Advocacy and Public Policy in Professional Psychology • Supervision in Professional Psychology DRAFT

29. Existing Education and Training Capacity - Psychology • Cognitive Behavioral Interventions in the Treatment of Substance Abuse • Trauma and Substance Abuse: Considerations in Assessment and Treatment • Substance Abuse and Working with Families: Special Consideration for Treatment • Health & Mental Health: Assuring Needed Care to All • Evidenced Based Practice in Public Mental Health Settings • Working Effectively with Culturally Diverse Populations in the Public Mental Health System • Pharmacology for Clinicians: A CAPIC Workshop DRAFT

30. Existing Education and Training Capacity - Psychology • In addition, many doctoral psychology programs are, or planning on integrating information on integrated healthcare, recovery-resiliency, trauma, addictions, psychopharmacology and other relevant education and training into their existing curriculum. • The California Psychological Association, Division II Board and LA Cty Psychological Association have developed and presented trainings on ACA DRAFT