As the Greek philosopher Heraclitus once said, the only constant is change. This quote is particularly apt for the field of health service psychology at this time. There are four major areas of change that are important for graduate students to be informed about, as they will affect our training, careers and how we may practice in the future.
1. Health-care reform is here.
The Affordable Care Act (ACA) was designed to increase access to health care for more than 30 million Americans. With the implementation of coverage through state health insurance exchanges, there are several factors for providers to keep in mind. Insurance exchanges are expected to increase access to mental health services and emphasize patient-centered care. However, these exchanges will also likely bring an increased focus on provider accountability and the ability to demonstrate effectiveness and positive patient outcomes. Providers may be increasingly asked to integrate outcome assessment into their practice and submit data on patient satisfaction, symptom reduction, and other effectiveness metrics. Increases in access to care may also impact reimbursement levels for psychological services. Trainees should begin researching how ACA is being implemented in their states and follow any changes closely.
2. Psychology in integrated and primary care.
Integrated health care merges disciplines into coordinated multidisciplinary teams to treat patients comprehensively and holistically. Since private practice may become an increasingly unsustainable career choice, emerging psychologists will need to rethink their employment opportunities and find creative solutions. Fortunately, the move toward integrated health care holds a lot of potential for psychologists. These models of care offer alternative, or supplementary, career opportunities that may help to maintain the sustainability of clinical practice. Flexibility will be important, such as being able to provide brief assessments and consultations (e.g., the "15-minute" session). Trainees interested in pursuing this career path should seek out training in integrated or primary care during their practicum, internship or postdoc experiences.
3. Accreditation: The new minimal standard.
In August, APA adopted a policy that health service psychologists must be trained in accredited graduate programs and internships, and that this should be required for licensure for independent practice. Accreditation is the best mechanism for self-regulating our profession, because it ensures that graduate students have the highest quality training experience and protects the consumers of psychological services. While these changes will not be implemented immediately, this new standard will have a broad impact on our field. APA, APAGS and the training community continue to work to ameliorate the internship crisis, so that all students can obtain an accredited internship. Trainees in non-accredited programs should talk with their program directors about this policy and advocate for the program to move toward timely accreditation.
4. Evaluating competency: Beyond content knowledge.
A multi-year effort is underway to revise the APA Commission on Accreditation's Guidelines and Principles, the standards for program, internship and postdoc accreditation in professional psychology. One recommended change is to move the field toward a competency-based assessment model, which means that programs will need to evaluate trainees across several domains of proficiency and be able to demonstrate this proficiency to accrediting bodies. APA's Health Service Psychology Education Collaborative has identified six domains of competency for clinical psychology: science, professionalism, relational (interpersonal skills, communication), applications, education, and systems (leadership development, advocacy). Trainees should follow the standards closely since they will determine how doctoral training needs to evolve in the next several years.
While many of these changes will have a positive impact on doctoral training and the field of clinical psychology, there are likely to be growing pains and struggles. As emerging psychologists, we know that change can be hard. For more information about these issues, reach out to APAGS and your state psychological associations. The best way to prepare for these changes is to stay knowledgeable about them, and make informed decisions about your training programs and career trajectories. I hope this article helps to begin this process.
Email Jennifer Dora, APAGS chair.
Letters to the Editor
- Write Us