Gaining prescriptive knowledge

After many years of clinical practice, psychologist Pam Van Allen, PhD, knew she needed to expand her knowledge to best help her clients. Specifically, she wanted training in psychopharmacology.

"I found myself working in a multidisciplinary setting, and it didn't seem that I was able to serve the patients' best interests if I was fairly ignorant about the medications they were taking and the behavioral effects of those medications," says Van Allen, a staff psychologist for Kaiser Permanente in northern California.

She initially took undergraduate premed classes but jumped at the chance to get training specifically designed for psychologists--through one of 11 psychopharmacology training programs in the country. Like Van Allen, many psychologists go through a program because they feel that, "given the population they are serving, they need this education in order to function maximally," says Steve Tulkin, PhD, director of Alliant International University's clinical psychopharmacology program, through which Van Allen received her training. Van Allen is one of hundreds of psychologists who have obtained the type of postdoctoral psychopharmacology training that makes up the backbone of the prescription privileges (RxP) movement--which began roughly in 1995 and to date has grown to see RxP legislation introduced in 18 states and three laws granting psychologists prescribing authority, in Guam in 1998, and in New Mexico in 2002and in Louisiana in April.

And though a primary goal of the movement is to achieve prescription privileges for psychologists--especially in rural or underserved areas where there's a shortage of providers who can prescribe--many of these graduates don't expect to prescribe during their careers. Their main goal is to improve their knowledge to better serve their patients and be prepared to work in today's multidisciplinary health settings.

Better collaborators

Van Allen, for one, says she feels very comfortable in the realm of behavioral medicine in terms of understanding the positive results, potential negative reactions and side effects of medications on patients.

Indeed, she says, "Many primary-care physicians have told me that they don't know as much about psychiatric medications as I do and they find the collaboration useful."

Elizabeth Richeson, PhD, a private practitioner in Texas and psychopharmacology graduate, says she's had the same experience: "Doctors will often call me and ask for specific recommendations [regarding psychotropic medications]. And I find that the doctors are glad to tell me about the nonpsychotropic meds in detail which further enhances my knowledge base. I see our relationship as symbiotic." In fact, she adds, she has recently been approached by a cardiology practice for collaboration doing triage, evaluation and prescriptions for psychotropic medications.

Another graduate and practitioner in Illinois, Marlin Hoover, PhD, says since his training he's "much better able to identify target symptoms and give primary-care physicians feedback about how the medications they are managing affect their patients." He adds that his collaboration with primary-care doctors and psychiatrists has not only improved patient care, but has improved his relationship with these professionals and even their relationship with their patients.

Program characteristics

The training programs were created to do just that--improve patient care and collaboration with other health-care providers. Some programs are offered nationally, through entities such as the Prescribing Psychologist Register--a credentialing organization for psychopharmacology psychologists--but most are offered in conjunction with academic institutions, such as the University of Georgia, New Mexico State University and Fairleigh Dickinson University.

Most of these programs incorporate didactic elements of APA's model training curriculum--adopted by APA's Council of Representatives in 1996.

The model was based on guidelines developed by the U.S. Department of Defense (DOD) demonstration project, in which 10 military psychologists were trained to prescribe, as well as APA's Committee for the Advancement of Professional Practice's RxP task force, the Blue Ribbon panel of the Professional Education Task Force of the California Psychological Association and the California School of Professional Psychology (now Alliant International University), and a report by the American College of Neuropsychology.

The training is offered only to those who have completed their doctorate degrees. APA's curriculum also stipulates that the training should prepare psychologists to evaluate new advances in psychopharmacology research and prepare them for inevitable changes in the field of psychopharmacology during their careers.

In approximately 22 to 27 months, students learn about brain chemistry, the basics of psychotropic drugs and how these drugs affect the body and mind. The coursework is heavy on biophysical and neurophysiological science. APA recommends that students receive at least 300 hours of didactic education; most programs require even more.

In fact, says Lt. Col. James Meredith, PhD, director of the organizational health center at Kirtland Air Force Base in New Mexico and a DoD grad, the programs improved on the DoD project and the hours are much better focused.

He notes that "in DoD we had a lot of extra hours--645 to be exact--but we spent many hours listening to heart sounds or checking for breast lumps, for example"--things that he says he hasn't used in clinical practice. "I think these folks come out with better ability and knowledge to help with the kind of tasks you're faced with when prescribing," he adds.

Building advocates

Even without being able to prescribe yet, former students agree that they're much better at being an advocate for their patients after getting the training, says Robert McGrath, PhD, director of the psychopharmacology training program at Fairleigh Dickinson University.

And, in addition, many become tireless RxP advocates in their states. Keith Hulse, PhD, a hospital-based practitioner who has completed the didactic portion of Fairleigh Dickinson's program, says advocacy is almost expected of his 24 class members in Tennessee--they participate in the Fairleigh Dickinson program through distance-learning lectures and online case conferences. "Most go down to the state legislature for three days at a time each week," he says.

It helps, he adds, that the Tennessee Psychological Association (TPA) officially endorses the program. "Everyone is on the same page and working together," he says.

In fact, Hulse, who is president-elect of TPA now, was the RxP chair for TPA. When the TPA board voted to introduce RxP legislation, he says, they realized that a central component to passing the bill would be having a cadre of trained psychologists.

So the programs and the legislative efforts really go hand in hand. "It's not effective to go to the legislature to lobby for prescription privileges for psychologists and say 'No one is trained to do this yet,'" says Rochelle Jennings, JD, prescription privileges coordinator for APA's Practice Directorate.

For psychologists considering the training, Van Allen gives this advice: "Brush up on your hard science and your algebra. And don't expect to breeze through--the program has to be challenging, or we'll never reach the goal of prescribing."