2009 Education Leadership Conference: Preparing tomorrow’s health workforce
By Rebecca A. Clay
The theme of this year’s Education Leadership Conference — Preparing Tomorrow’s Health Workforce — could not be more timely for both APA and the nation, according to APA Chief Executive Officer Norman B. Anderson, PhD, who welcomed nearly 150 participants to the eighth annual event.
APA’s first-ever strategic plan includes advancing psychology’s role in health as one of the association’s three main priorities. “We want to be on the front lines of health and the health care movement,” Anderson explained. APA is also working hard to ensure that psychology has a role in a reformed health care system.
Exploring ways to prepare that workforce was the goal of this year’s conference, which took place October 3–6, 2009, in Washington, DC. Like the previous conferences, the event’s purposes were threefold: to address issues of mutual concern to educators at all levels of education and training, promote a shared identity among educators in psychology, and influence public policy about education in psychology and psychology in education.
“This is an opportunity for you to identify promising practices that can be shared with your organizations and the educational community,” APA Board of Educational Affairs (BEA) Chair Louise A. Douce, PhD, told the participants, who represented psychology education and training organizations, psychological membership organizations, APA divisions, and APA governance groups.
Cynthia D. Belar, PhD, executive director of APA’s Education Directorate, kicked off the conference. “Let me begin by reminding us of our potential for contributions to health,” she said, citing as just one example psychology’s relevance to every health problem identified by the International Classification of Diseases.
Yet historically, she said, much of psychologists’ training has focused on just one aspect of health — the treatment of mental disorders. As the recent APA Presidential Summit on the Future of Psychology Practice made clear, education and training must recognize psychology’s broader role in health.
To achieve that potential, said Belar, psychology must train psychological scientists to create knowledge in such areas as assessment, prevention, and treatment of mental and physical disorders, informatics, health care safety,
clinical decision making, and disparities. Researchers must also learn how to work with other disciplines. “A siloed approach to research training will not meet future needs,” Belar emphasized. “Graduate programs housed in or affiliated with academic health settings are perhaps best poised for these endeavors.”
Psychology must also prepare practitioners to provide health services, said Belar, acknowledging the critical role
of clinical health psychology. General doctoral training often neglects to pay enough attention to the integration of knowledge about the biological, psychological, and social bases of health and disease with knowledge about the biological, psychological, and social bases of behavior, she said. Integrating that information into curricula requires a multidisciplinary approach to teaching, and training to provide direct health care should include an internship in an interdisciplinary site providing both psychological and physical care. Some argue that all practitioners should learn to conduct practice-based research, if only to improve the quality of their services. “While some might argue that psychology’s curriculum is getting too ‘medicalized,’...other health professions are actively seeking to ‘psychosocialize’ their curricula — and are doing so with the help of many psychologists,” said Belar.
Psychologists also have a key role to play in educating other health care professionals, said Belar. Initially focused
on educating medical students, psychologists are now involved in training dentists, pharmacists, public health personnel, emergency medical technicians, hospital administrators, and various types of technicians. A key goal is to promote psychological literacy within this health workforce, something that undergraduate faculty will play a critical role in achieving.
Health care reform’s emphasis on primary care will likely accelerate these efforts, said Belar. The fact that fewer than 300 psychologists work in the nation’s 7,146 federally qualified community health centers is just one of the challenges psychology faces. More important is psychology’s identity problem. “The provision of mental health services is an extremely important part of psychological practice, but we need a broader definition that can be directly linked to the education and training received and the competencies of our graduates if we are to maximize our potential,” she concluded.
Academic health centers
The conference’s first full day began with a look at general trends in education and training. Elaine R. Rubin, PhD,
vice president for policy and programs at the Association of Academic Health Centers, launched the discussion by examining academic health centers. These centers are accredited, degree-granting institutions of higher learning
that include an allopathic or osteopathic medical school, at least one other health profession program, and an owned or affiliated hospital.
Many people do not understand the realities that academic health centers face, said Rubin. One common misperception is that academic health centers are ivory towers that lack connection to the community. Another
myth is that they have unlimited funds. People also believe that these centers are all top research I universities, that they focus only on medical care, and that their agendas dominate when they are involved in any joint project.
“The reality today is that academic health centers are doers, not just dreamers,” said Rubin. She cited several
examples of academic health centers meeting community needs: (a) the University of California at Davis has
launched a telehealth initiative that brings the center’s medical expertise to practitioners around the state via
video consultations; (b) the University of New Mexico is addressing disparities in health access by establishing
health extension offices in rural areas, using the model of agricultural extension offices; (c) 44% of the respondents to an Association of Academic Health Centers survey reported that they have at least one research park or business incubator that brings educational and job opportunities.
Academic health centers are not just home to elite scientists, said Rubin. These centers are often the largest employers in their city, state, or even region, with annual payrolls that can exceed $1 billion.
Academic health centers are also facing serious financial challenges. The cost of providing medical education and patient care is soaring, while income has plummeted. Public institutions have recently seen severe reductions in funding from the states. Private institutions have experienced huge losses to their endowments coupled with a drop-off in philanthropic donations. Patients are putting off elective procedures and even general care—a threat both to patients’ health and to centers’ finances. And the federal stimulus money that centers received was not enough to offset cutbacks in university and state funding.
Other challenges include the nation’s changing demographics, the technological revolution, health care reform, globalization, and changing societal demands and expectations.
Next, Martha M. Ellis, PhD, associate vice chancellor for community college partnerships at the University of Texas at Austin, explored the role of the nation’s 1,800 community colleges in preparing the health care workforce. “Community colleges were born out of the democratic ideal of an open door for postsecondary education,” she explained. Forty-eight percent of U.S. undergraduates are now enrolled in community colleges. For minorities, the percentage is 52 percent.
But community colleges were not established just for individual advancement, said Ellis. They were also set up
to advance the public good, both local and national. Sixtythree percent of current allied health professionals —
radiation technicians, sonogram technicians, and the like — received their training at community colleges.
Psychology has a big role to play in educating these students, said Ellis, explaining that psychology is part of the core curriculum at every community college. Psychology is required whether students are earning an associate’s degree or plan to transfer; it’s also the second most popular major for students who plan to transfer to universities.
But how can psychology faculty ensure that students who take just one class are psychologically literate? After all, Ellis pointed out, the definition of psychological literacy created at the National Conference on Undergraduate Education in Psychology (NCUEP) represents a big to-do list for a single introductory course. To achieve psychological literacy, students must attain basic knowledge of the subject matter and vocabulary, learn critical thinking skills, learn about ethics and diversity, and reflect on their own mental processes.
Consider just one element in that list, said Ellis. Is the basic knowledge that health care professionals need to know the same as that needed by psychology majors or welding majors or information technology majors? Most conference-goers agreed with the idea that health professionals need a special introductory psychology class of their own and that the applied aspects of psychology would be especially important in such a course.
But other participants argued that all students should be exposed to the entire depth and breadth of psychology.
Another suggested that allied health students have both specialized and general psychology courses. “There’s no
substitute for an introductory course where you’re learning the basic constructs,” that person said. Convenings like the ELC and the NCUEP can help the discipline decide such questions, said Ellis.
How psychology is taught in nonpsychology courses is another concern, she said, citing a case in which her university’s nursing curriculum included outmoded concepts in an abnormal psychology unit. Participants shared ideas for addressing such problems, including an institutionwide curricula review and increased use of team
teaching. “I wouldn’t teach a student to run an IV,” said one participant. “Why should a nursing school teach students about psychopathology?”
The focus then shifted to informatics. According to Edward H. Shortliffe, MD, PhD, president and chief executive officer of the American Medical Informatics Association, the field began as medical information science or medical computer science, then became medical informatics, and finally biomedical informatics. “Biomedical informatics is the scientific field that deals with the storage, retrieval, sharing, and optimal use of biomedical information for problem solving and decision making,” he said, adding that applications range from the cellular level to the population level. “Biomedical informatics is aimed at enhancing the quality of decisions made by patients, health professionals, and scientists.”
Electronic health records are a prime example of the power of biomedical informatics. The stimulus package provides incentives for health care providers to make unspecified “meaningful use” of electronic records by 2011 and penalties for those who do not by 2015. What would meaningful use entail? Electronic medical records could enhance clinicians’ decision making and facilitate the use of a team approach to health care.
But electronic medical records should also have an impact that goes beyond an individual patient’s care, said Shortliffe. By gathering information in one place, electronic records could also lead to standards for prevention and treatment, facilitate research and provide information to registries designed to improve public health.
There is one major barrier to widespread implementation of electronic health records, however: an inadequately trained workforce. Training initiatives are under way, and Shortliffe’s association is pushing for the creation of a new subspecialty in clinical informatics for physicians. What do such training programs cover? Computer science is obviously key, but cognitive science is equally important. “The entire field of computer/ human interaction depends hugely on psychology,” he said. Examples of overlapping interests include usability, decision making and safety.
Psychology’s input will be crucial as electronic health records are implemented. Shortliffe pointed to the surprising results of a case study published in 2001 in the Journal of the American Medical Informatics Association that examined the impact of the introduction of electronic records. While the technology expedited work, it also changed things for the worse. The introduction of electronic forms increased the amount of information recorded in some categories, decreased the amount in others, and removed the narrative aspect of records. “People tell stories in handwritten records,” he said. “Afterwards, it wasn’t a story anymore.”
And because of the way the screens were organized, there was also a change in clinicians’ reasoning. “With a paper record, they tended to reason from the patient’s data to multiple hypotheses,” said Shortliffe. “With electronic records, the data recorded were subservient to the hypothesis.” That shift from “forward-based” reasoning to a “backward-based” approach persisted even after the elimination of electronic records. “We need to be aware of the pitfalls and learn how best to design tools to minimize the chances of bad outcomes related to this,” said Shortliffe.
Training for what?
The discussion then turned to job opportunities and how programs are training students to fill them. Antonette M. Zeiss, PhD, deputy chief consultant in the Office of Mental Health Services at the Department of Veterans Affairs (VA), began the session with a look at opportunities at the VA. The VA already employs about 5 percent of the licensed psychologists in the United States and is seeking more.
At the most basic level, applicants need to be U.S. citizens, graduates of APA-accredited programs and internships, and licensed in any state within 2 years. “Every week I hear about people upset because they can’t apply for VA jobs because they didn’t do an accredited internship,” said Zeiss.
Applicants also need to be prepared to work in interdisciplinary teams, since psychology is integrated into the entire VA health care system. Although most VA psychologists have not been in the military themselves, they must be willing to learn about military culture and respect veterans. Research skills, training experience, multicultural competence, and a commitment to evidence-based care are also attractive.
Integration is also the norm at Walter Reed, said Erica Jarrett, PhD, chief of the primary care psychology service at Walter Reed Army Medical Center and a member of a Department of Defense task force that is developing a plan for integrating psychologists into primary care across the military. In addition to addressing traditional mental health concerns, psychologists and trainees also help treat patients with such problems as chronic pain, chronic illness, diabetes, weight problems, insomnia, and stress. “My patient load is the 20,000 patients internal medicine sees,” Jarrett explained.
The primary care psychology postdoctoral residency rotation Jarrett directs emphasizes general psychology, health psychology, effective interdisciplinary collaboration, and exposure to other disciplines. Residents even learn how to read lab results. That skill can make a real difference, Jarrett added. “We had a patient sent to us for depression because he was sleeping 20 hours a day,” she said. “The resident looked at his lab results, and he turned out to be anemic.”
Federally qualified community health centers are another good option for both training and jobs, said Parinda Khatri, PhD, director of integrated care at Cherokee Health Systems. Integration with primary care is vital in this setting, too, with behaviorists located right in the primary care area. Patients sign one consent form for all care, and no one individual leads a patient’s care.
Trainees work closely with physicians, nutritionists, physical therapists, dentists, and other practitioners — a big shift from the way Khatri herself was trained. “We have a multidisciplinary training team, because we recognize that in today’s health care system, it’s going to be hard to operate in a silo.” The environment is very fast paced, so learning how to provide quick assessments, brief interventions and immediate feedback are important.
Psychology training can even take place within medical schools, said Stephanie Felgoise, PhD, vice chair of the psychology department and director of the PsyD program in clinical psychology at the Philadelphia College of Osteopathic Medicine.
Interdisciplinary collaboration is the norm in this setting as well. A student with a dissertation on hypertension might have a committee chaired by a primary care physician, for example. That collaboration helps future doctors as well as psychology students, said Felgoise. By working side by side, medical students and clinicians learn how psychologists can help them better serve patients.
Patrice G. Saab, PhD, an associate professor of psychology at the University of Miami, described how she prepares students for research careers. Intensive mentorship is fundamental to the program’s success, said Saab, explaining that carefully matched students and mentors begin collaborating from the moment students arrive on campus. The program also encourages comentorship and course work in other departments as ways of providing more specialized training. A student working with Saab on cardiovascular health research might also have a statistician as a mentor, for example. Medical school faculty encourage psychology students to work in their labs. “Students benefit, but collaborators do, too,” said Saab. “They get highly motivated students with rigorous methodological and quantitative training that facilitates their research.” To make their students even more competitive in the job market, the program recently added an optional fifth year devoted to creating a research portfolio.
The next day began with a description of a project bringing multiple professions together to pursue joint goals. The Interprofessional Professionalism Collaborative grew out of the notion that the doctoral-level health professions were each struggling independently with how to define, teach, and measure professionalism and could perhaps do a better job together, explained Catherine Grus, PhD, associate executive director for professional education and training in APA’s Education Directorate.
The collaborative’s goals are to describe behaviors that reflect what professionals would demonstrate when interacting with each other and then to create behavioral assessments, teaching tools, and other resources common to all health professions. The group hopes that interprofessional professionalism will enhance outcomes for patients, promote a culture that values individual competence, and improve practice and academic environments.
After 2 years of conversation, said Grus, the group came up with a definition of interprofessional professionalism: The consistent demonstration of core values evidenced by professionals working together, aspiring to and wisely applying principles of altruism, excellence, caring, ethics, respect, communication, and accountability to achieve optimal health and wellness in individuals and communities.
The collaborative itself is a model of interprofessional professionalism, said Ted Y. Mashima, DVM, DACZM, DACVPM, associate executive director for academic and research affairs at the Association of American Veterinary Medical Colleges.
Loretta Nunez, MA, AuD, CCC-A/SLP, director of academic affairs at the American Speech-Language-Hearing Association, described the collaborative’s three specific goals:
Identify and describe observable behaviors associated with interprofessional professionalism. With input from the field, the collaborative has now developed a list of 43 behaviors, such as ethical decision making, compassion, and integrity.
Develop a toolkit on interprofessional professionalism that will include resources for assessing students and practitioners.
Disseminate the group’s work. The first step toward achieving that goal was to develop a “wiki” page that the group has used to solicit input. A website is under development, and the group is giving presentations and drafting an article to inform others of their efforts.
Jody Gandy, PT, DPT, PhD, director of academic and clinical education affairs at the American Physical Therapy Association, then explored the challenges of interprofessional education and practice:
Lack of institutional commitment. “If interprofessional education doesn’t have support from higher up, it fails,” said Gandy. The president or provost must back efforts and provide logistical support, she said. The culture needs to change, too. Tenure assessments focus on individual achievement, for instance, not on how well people function in teams. Creating a culture that rewards interprofessional professionalism may mean changing accreditation standards, Gandy added. Reimbursement and documentation systems represent additional impediments.
Hierarchical model. “We live in a world that’s a hierarchical medical model,” said Gandy, explaining that other professions are unjustly “allied” to medicine. “That language pervades practice, research, and more.” Teamwork also complicates accountability and liability issues, she added.
Siloed care. Even when institutions provide interprofessional education, what happens in the classroom does not necessarily translate into practice. “We talk about interprofessionalism in the classroom, but we have siloed care,” said Gandy.
Curriculum issues. “Everyone has a curriculum obesity problem — they can’t put any more in,” said Gandy. Another challenge is how — and at what stage — to blend interprofessional and professional content. Subjects such as ethics and evidence-based practice are good examples of courses that can be taught across disciplines, she said.
Barriers to interprofessional education
Participants then broke into small groups to discuss barriers to interprofessional education and related issues. Turf issues hinder interprofessional education and practice, agreed participants at one table. Instead of working as a patient-centered team, said a participant, practitioners try to protect their own turf. One solution would be to focus on trainees’ interprofessional identity before their individual professional ones. But, said one participant, that idea is heretical. “You get accused of killing your profession,” she said. Reimbursement practices also hamper interprofessionalism. One solution would be to have reimbursements go to a central pool that supports the entire team. Professional incentives also need to change to reward interdisciplinary work. “The people who do it pay a price,” said one participant, adding that the faculty members who participate in interdisciplinary teaching tend to be at the bottom of the hierarchy.
Participants then discussed how psychology fits within interprofessional teams. Psychologists are natural partners to audiologists and speech pathologists, said Nunez, explaining that psychologists can help parents cope with a diagnosis of hearing loss in their children, help cochlear implant teams identify appropriate candidates, and help individuals cope with hearing loss in old age. Psychologists and veterinarians are also perfect partners, collaborating on such issues as bereavement, animal hoarding, and the link between human and animal abuse.
How do other professionals perceive psychology’s role in health care, education, and research?
One participant described working with physicians to provide care for people with diabetes. The team was initially skeptical, but the psychological intervention not only helped achieve better treatment compliance — it also had an impact on biological indicators. Focusing on wellness is another way to overcome such reluctance, said another participant, urging colleagues to help other professions understand that psychologists do much more than treat mental disorders. Data on the cost effectiveness of psychological interventions would also be persuasive, said another participant. Others noted the importance of training students to work in primary care teams and in interdisciplinary groups to inoculate them against the hierarchical model.
Ways APA could promote interprofessional education, practice and research
Suggestions included gathering evidence about the effectiveness of interprofessional work, working to establish interprofessional reimbursement codes, launching a public information campaign, educating undergraduates about the importance of interprofessionalism and changing accreditation standards.
Promising practices in education and training
Conference participants spent their first afternoon together discussing a specific topic and developing questions to ask of the larger group the next day. The interactive session, chaired by Louise Douce, focused on five areas:
1. Teaching Psychology
This group’s first question asked what percentage of the material covered in an introductory psychology course is retained by nonmajors after a year. Less than 12%, most of the group guessed. “That’s a trick question,” said Douce, explaining that no data exist to answer the question. One participant noted that undergraduates are unlikely to remember much of any course once it is over;
another pointed out that undergraduates are often forced to take psychology. One implication, said Douce, is that psychology professors need to work extra hard to engage students. Undergraduates’ entertainment expectation is higher than it was 20 years ago,” she pointed out. “We have a generation with total information overload.” Another participant wondered if there should be two different Psychology 101 courses—one for psychology majors and one for those in other disciplines.
This group also sought feedback on various priorities for doctoral training, including teaching students how to advocate for their role in health care and requiring them to gain experience in
interdisciplinary health care settings. Requiring students to be able to translate research into action in local, national, or global interdisciplinary settings was the most popular response. “We heard this morning about how we are perceived by other professionals: They don’t understand what we have to offer, but then love it once they find out,” Douce said.
The group asked how confident conference-goers were in their competence to teach health psychology materials. The responses were equally divided between extremely confident and not at all confident. Of special concern was how to present material useful to students in other disciplines. “That’s a possible deliverable from this conference,” said Douce, suggesting a series of modules
about teaching psychology to optometry, dentistry, veterinary, and other students.
2. Doctoral Programs
This group asked whether increasing attention to health disparities and diversity issues in local, national, and global contexts is necessary for preparing the health care workforce. Participants strongly agreed that it was.
Students often do not want to question their own cultural assumptions, because it is uncomfortable, said one participant. Another agreed, noting the disconnect between what psychologists say they want and what they actually do. “When I talk to doctoral students or new professionals, especially those from minority backgrounds, they say we’re not doing this,” the participant said. “We need
to talk about social justice, systemic injustice, and ways we create a system that’s oppressive.” Students themselves can enter psychology with a social justice perspective and then become part of a system that contributes to those disparities, added Douce.
Addressing diversity issues is not just uncomfortable but also inconvenient, said another participant. “Often in psychology departments, we collect data because it’s convenient; we gather samples from the people who are available to us,” he said. “If we’re going to do the kinds of things we’re talking about and do them well, we have to be willing to be uncomfortable and inconvenienced. We have to make an extra effort beyond what we’re used to.” Another challenge is that programs are now training students who will not be practicing in the United States, which has implications for teaching. The question’s focus on local, national, and global contexts was deliberate, said one group member. “Sometimes you only have to go six blocks away to begin to expose students to cultural diversity issues and disparities,” she said.
3. Internship Programs
This group asked whether internships are adequately preparing future psychologists for the health workforce. Participants were not sure. “It’s hard to characterize 450 internships in one classification,” Douce agreed. One barrier is the predoctoral nature of psychology internships, said one participant. “It takes away interns’ chance to be referred to as doctors and work on a par with residents,” the participant said. “They’re on a rung below and get bunched in to the allied health category.” The group also asked what internships need to focus on to adequately prepare tomorrow’s health care workforce. Participants agreed that internships should focus on clinical competencies, research, teaching, interdisciplinary collaboration, and management. Some argued that it would be more realistic to focus on clinical competencies and interdisciplinary collaboration alone. A graduate student admitted it was scary to listen to the expectations the group had. Douce pointed out that students do not have to learn everything they will need in their future careers by the time they graduate.
4. Postdoctoral Programs
The next group asked what priorities postdoctoral training should have in preparing the health workforce. Most participants agreed that the biggest priority should be defining and developing trainees’ professional identities as psychologists in health care settings. Other popular responses were training postdocs in interdisciplinary and team functioning and consultation skills and in effectiveness research, program evaluation, and quality improvement.
One participant wondered if there should be a paradigm shift in how psychology conceptualizes the role of postdoctoral training. “We felt it wasn’t to accumulate clinical hours for licensure,” said one group member, calling instead for a focus on developing the specialized skills needed to work in a health care setting.
The group also asked about the greatest challenges for postdoctoral training for the health care workforce. Most participants agreed that the greatest challenge was institutional support and funding for training. “It’s not just money; it’s political will,” argued one participant.
“Money is the end result of a profession organizing itself around an initiative and making it happen.” Another participant pointed to postdocs’ debt burden as a hurdle and called for higher wages for postdoctoral trainees in addition to more training slots. Another problem is the trend for faculty not to bother with getting licensed. “We need faculty who are reinforced and supported for going on and getting licensure as well,” said one participant.
5. Professional Development
This group asked how many states require continuing education (CE) for license renewal. The answer is 43. The other health care professions have universal CE mandates, noted one participant, wondering whether psychology was at a disadvantage for not following suit. Another participant pointed out that the state-by-state system in psychology has led to an inconsistent definition of what counts as CE. And, the person added, CE and professional development are two very different ideas. Another participant remarked that psychologists in states that do not require CE for license renewal make professional development choices that are different from those made by psychologists in states that do have requirements.
What is most important is life-long learning, said Douce. “One of my colleagues in physics was taught that everything she thought was true could be changed twice in her professional lifetime,” she said. “We don’t teach that. We teach that human behavior is constant—and do ourselves a disservice by doing that.”
The participants strongly agreed that programs should include tests of knowledge of the material they have learned—attendance alone is not enough. One participant argued that tests do not just
document learning; research shows that assessing one’s understanding actually increases one’s learning. Another participant pointed out that the quality of CE programs varies greatly; another suggested that the next step could be to see if psychologists actually apply what they have learned to their practices. Illinois took a step in that direction by asking CE participants to describe how they would use what they had learned to improve their teaching. Although that requirement was later dropped, the participant said that the request to apply learning to one’s own situation was a good model.
A highlight of every ELC is the Education Advocacy Awards Luncheon. The BEA presented two Education Advocacy Distinguished Service Awards.
The award for an APA member-at-large recognized Charles Brewer, PhD, of Furman University. “As many of you know, Dr. Brewer has been a long-standing supporter of psychology education and training,” said Louise Douce. “What you might not know is that he’s also a stalwart supporter of education advocacy in every possible way.” The award recognized Brewer’s personal and professional commitment to advancing psychology education and training and raising awareness of the need for grassroots efforts.
The Education Advocacy Grassroots Network award recognized APA President James H. Bray, PhD, of Baylor College of Medicine. “In addition to serving as president, Dr. Bray serves as a leader for our Federal Education Advocacy Coordinator Network,” said Douce. “He has never hesitated to respond to requests for help.” The award recognized his persistent efforts to secure champions for psychology and gain support for education and training on Capitol Hill.
The Friends of Psychology Distinguished Service Award recognizes the critical role of congressional staff members. “These are the unsung heroes,” said Douce. This year’s award recognized the efforts of Abigail Pinkele, a legislative assistant to Rep. Gene Green (D-TX). The award acknowledged her efforts to secure an explicit authorization for the Graduate Psychology Education (GPE) program and her understanding of the significant role that mental and behavioral health care plays in improving overall health care.
HRSA Interdisciplinary Advisory Committee and GPE grants
Ronald H. Rozensky, PhD, professor and associate dean for international programs at the University of Florida’s College of Public Health and Health Professions, began this session with a look at the U.S. Health Resources and Services Administration (HRSA). “HRSA’s goal is to make sure there’s an adequate workforce out there to meet the country’s health care needs,” said Rozensky, explaining that HRSA’s Bureau of Health Professions is home to the GPE program.
Rozensky is chair of the bureau’s Advisory Committee on Interdisciplinary Community-Based Linkages, which provides advice to Congress. The committee’s focus next year will be on preparing an interprofessional workforce to address health behaviors.
Rozensky and leaders from the other advisory committees recently sent a letter of recommendations to Congress. The focus was interprofessional team care as the key to health care reform. One suggestion was to open the Graduate Medical Education program to other professions to eliminate barriers to interprofessional training. “It’s extraordinary that we have a psychologist on the committee, let alone the chair of the committee,” said Nina Levitt, EdD, associate executive director for government relations in APA’s Education Directorate. “And to have the four advisory committees come together on any one issue and write a joint letter has never happened in history.”
The conversation then turned to promising practices within the GPE program itself. Gilbert Newman, PhD, director of clinical training at the Wright Institute, described a GPE-funded program in Berkeley, CA. The program trains students in a model Newman calls “key problem triage,” a 14-question screen that helps them identify the most significant contributor to a patient’s main medical problem or most treatable high-impact problem. Each of those 14 areas has additional assessment measures designed to help students gain an even deeper understanding of the problem. “We focus on a single problem utilizing the briefest available intervention,” said Newman, explaining that students then move straight to an empirically supported treatment protocol. The program is also developing an online “Wikipedia-like program” that will put information about hundreds of mental health topics at trainees’ fingertips, said Newman.
GPE is also improving access to care and training in rural areas. Tami De Coteau, PhD, of the Indian Health Service, described a program that trains students while providing services to members of North Dakota’s Standing Rock Sioux tribe. De Coteau developed the training model with a GPE grant in South Dakota in 2003.
The reservation has high levels of substance abuse and violence and a suicide rate that is three times the national average, said De Coteau. The internship program aims to improve Native Americans’ access to mental health services while training a culturally sensitive workforce prepared to work in remote or reservation communities.
The result is a training model with some unique elements, said De Coteau. Each intern participates in a community development project, such as helping to establish a women’s “talking circle” that functions as a support group. The program also uses horses — an important part of Sioux culture — to help teach interns about their own nonverbal behavior.
Paul M. Robins, PhD, program director of pediatric psychology, described the internship program he co-directs at the Children’s Hospital of Philadelphia. The program has two goals: to prepare interns in psychology and other health professions to address the needs of low-income children with health problems and to improve access to care for those children. The program has developed rotations in such specialized areas as adolescent HIV, primary care, attention-deficit hyperactivity disorder, behavioral health in schools, developmental delays in children in the child welfare system, and aggressive behavior in young girls. Each year, the program provides services to about 300 children who would otherwise have gone unserved.
At Eastern Virginia Medical School, psychology interns and medical residents train side by side. The goal is to prepare students for work in settings that integrate psychological and physical care, said Barbara Ann Cubit, PhD, an associate professor of psychiatry and behavioral sciences and family and community medicine. The program has interns and residents provide joint care, make treatment decisions as part of a team, and take classes taught by both psychology and family medicine faculty. Psychology interns receive supervision from mentors in family and community medicine as well as psychologists.
On the conference’s final day, participants headed to Capitol Hill to visit their congressional representatives. Their goal? To increase funding for the GPE program.
GPE is the federal grant initiative administered by HRSA for psychology doctoral, postdoctoral, and internship programs, the Education Directorate’s Nina Levitt told participants in a briefing before their visits. The focus is on interdisciplinary training and work with underserved populations.
The program began in 2002 with a $2 million appropriation, then grew to $4.5 million the next year, with a set-aside for geropsychology training. In 2006, as a result of across-the-board budget cuts, Congress dropped the program’s funding back to $2 million, which eliminated the geropsychology set-aside.
GPE has one champion in the House: Rep. Gene Green (D-TX), who introduced legislation providing an explicit authorization for the GPE program in the 111th Congress. Rep. Green was honored at a special reception during the conference. There is some support in the Senate but no champion, said Levitt.
The president’s 2010 budget mentioned GPE for the first time — “a significant boost to our efforts,” according to Levitt. Despite the presence of a champion in the House, the House bill did not request an increase in funding. The Senate bill requested a $2 million funding increase. Levitt urged participants to ask the House to agree to the Senate’s $4 million funding proposal.
Graduate Psychology Education (GPE) funding increase
Funding for the GPE program for 2010 has been increased from $2 million to $2,945,000, allowing not only for another competition in 2010 but also for an increase in the number of grants awarded. This is the first increase in GPE funding in 5 years and the only increase in programs in that budget line. The increase was reported in the fiscal 2010 Omnibus Appropriations Bill conference report (House Rep. 111-366).
Since 2002 there have been 70 grants in 30 states for approximately $24 million. News of the 2010 grant process will be shared immediately when it becomes available. Information will also be available at the HRSA website.