Three years ago when Erin Johnson, PhD, accepted an internship at Norton Sound Health Corporation in Nome, Alaska, she knew she'd be an hour-and-a-half plane ride away from any major city. What she didn't know was how amazing the experience would be, or that even after the internship ended she'd continue to call Nome home as a clinical and community psychologist.
Born and raised in Anchorage, Johnson was well versed in the mental and behavioral health issues that can arise in rural areas, including high rates of suicide, family violence and substance abuse. Still, moving from a city of more than 300,000 to one of fewer than 4,000 was an adjustment, she says.
"The region really is frontier — there are no roads to our bigger cities, and if the planes aren't flying, and you have a medical emergency, it takes a lot of coordination," Johnson says. "It was definitely an area that I wasn't used to but that I certainly wanted to serve — and after being here for a little while I know that it's where I'm supposed to be."
One of the organizations responsible for sending Johnson to Nome is the Western Interstate Commission for Higher Education (WICHE), a regional governmental entity launched in 1953 by the Western Regional Education Compact to facilitate resource sharing among higher education systems in the region.
Based in Boulder, Colorado, WICHE is overseen by three governor-appointed commissioners from each of its 16 member states and territories. WICHE's Mental Health Program, founded in 1955, is dedicated to assisting states in improving mental health care for the public, as well as to advancing the preparation of a qualified mental health workforce in the Western United States, says Tamara DeHay, PhD, associate director of the WICHE Mental Health Program.
"The shortage of accredited internship slots is a significant problem nationally, and is most acutely felt in the rural West where the imbalance is greatest," DeHay says.
To address this, WICHE has been working with state agencies and other organizations across the West and nationally to create more internships. These internship sites enable doctoral students in psychology to complete their training in rural and underserved areas, where the opportunity did not previously exist. The internships are also a career ladder in those areas that allow psychologist trainees like Johnson to stay and work when they are fully licensed.
WICHE's success in developing new psychology internships has attracted national attention. WICHE has partnered with the Association of Psychology Postdoctoral and Internship Centers (APPIC) to support APPIC-member programs in achieving APA accreditation. WICHE is working to help 35 to 40 programs submit self-studies for accreditation by December of 2015.
The goal is to set the base standard in the field for training around accreditation, says Jason Williams, PsyD, who chairs APPIC's Board of Directors.
"APPIC is very committed to the accreditation efforts across the nation, both with WICHE and with APA, and is really trying to not only help address the internship imbalance that's out there but to help more accredited programs come into the mix as well," he says.
WICHE has also recently been approved as a liaison to the Council of Chairs of Training Councils, whose mission is to provide a forum for communication among doctoral, internship and postdoctoral training associations in psychology.
Other strategic partnerships include WICHE's work with the Hogg Foundation for Mental Health, based at the University of Texas at Austin. In 2013, the foundation committed more than $3.2 million in grant funding to support the development and accreditation of internship programs in Texas. WICHE is providing consultative support to the majority of those grant-funded programs.
Innovations in rural mental health
WICHE's involvement in psychology internship development started in 2007 when Dennis Mohatt, vice president of the WICHE Mental Health Program, received a call from his brother Jerry Mohatt, who at the time was director of the Center for Alaska Native Health Research and professor of psychology at the University of Alaska Fairbanks.
Jerry pointed out that the newly created joint doctoral program at the University of Alaska–Fairbanks and the University of Alaska–Anchorage had to create an internship in the state, or run the risk that all their students would leave Alaska for the final stage of their training process, the doctoral internship, Mohatt remembers.
"That launched WICHE to start from scratch to look at how we would build a psychology internship in Alaska that would give people a broad training experience," he says.
The next year, WICHE worked with the state to build the Alaska Psychology Internship Consortium (AK-PIC), a group effort of five agencies — including Norton Sound Health Corp., where Johnson works — aimed at training Alaskan psychologists.
The consortium accepted its first round of applicants in 2009, and with help from WICHE staff, received seven years of APA accreditation in 2012. Because of the geographical distances involved in training, the program's eight interns participate via a secure videoconferencing platform in weekly supervision and didactic seminars with their cohort members at the other Alaska consortium sites.
"It boggles the mind of many in the lower 48 that we've made this work, because there's about 1,400 miles between two of the internship sites," Mohatt says. "But when you build a capacity for cohort connection and develop a comprehensive, integrated training experience, it works."
Today, three-quarters of the 37 interns who have gone through the program stay on and take full-time jobs at one of the consortium's sites. "The program has already had a role in noticeably improving Alaska's vacancy rate for psychologists," DeHay says.
In addition, since AK-PIC's development, WICHE has developed similar internship programs in Colorado, Hawaii, Oregon and Nevada. The Hawaii Psychology Internship Consortium achieved APA accreditation on contingency status in October, after applying for accreditation during their first training year. Colorado, Oregon and Nevada plan to submit their self-studies in December 2015.
A unique aspect of WICHE's work is helping psychology internship programs identify ways to keep their funding stream sustainable, says Catherine Grus, PhD, deputy executive director of the APA Education Directorate.
In Alaska, for example, psychology internship funding is now part of the base budget for the Alaska Department of Health and Human Services, Division of Behavioral Health, thanks to advocacy by WICHE and others. WICHE has also been able to facilitate support of state funding for psychology internships in Hawaii, Oregon and Nevada.
"It really makes sense for states to invest in psychology internships as a workforce development," DeHay says. "Funding a training program is more cost-effective than funding itinerant providers, which is a common workforce strategy in rural areas. Letting someone grow into a role from a training program is also more likely to lead to retention of those providers."
Given the scarcity of funding these days, Grus says this model is one that everyone in the field needs to think about.
"It's just a really stellar example of creativity, and of serving the development of training positions but also serving the communities where those positions are located," Grus says.
A national movement
In an effort to address the ongoing internship shortage nationwide, last year APPIC partnered with WICHE to conduct a survey of APPIC member programs — both accredited and non-accredited — to identify the barriers to APA accreditation. With that information, WICHE developed a screening tool that APPIC may use to help determine how ready an internship program might be for seeking APA accreditation, says Sarah Ross, PhD, a senior program and research associate for WICHE.
Now WICHE and APPIC are working together to recruit 35 to 40 APPIC programs that are not accredited and want to be, says Allison Ponce, PhD, chair of the APPIC Accreditation Readiness Project.
"Our focus is … helping programs that are already established internships move toward accreditation," Ponce says.
WICHE is constructing virtual learning communities of about six programs each that will meet monthly over nine months and support one another, with WICHE's leadership, in preparing for submitting their self-study.
WICHE will provide each learning community with monthly instructional webinars on all aspects of the accreditation process, group problem-solving sessions related to program accreditation questions, tailored consultation to individual programs, and real-time editing and feedback on self-study documents, Ross says. Each learning community will also be given a platform for document sharing and peer review, as well as a tracker that monitors progress toward completion of self-study domains and associated tables.
Ponce says APPIC would like to see at least 25 programs submit their self-studies by December of 2015.
In a similar vein, WICHE also partnered with APA last year to provide webinars on the required documentation and data collection processes involved in psychology doctoral internship development and accreditation. The webinars were developed to augment APA's Internship Stimulus Program, which launched in 2012 and has awarded $3 million over three years to help training programs with quality internships earn APA accreditation.
DeHay hopes these efforts and new approaches to internship development will have a positive impact on the field.
"We've seen how successful it can be and there is clearly such a need for it," she says. "I hope other organizations like ours that have the capacity to provide this type of support will see this model as something they can also implement."
Amy Novotney is a journalist in Chicago.
For more information on WICHE's mental health program and efforts to develop internship programs, visit WICHEopens in new window.
