When Benjamin Lord started his clinical psychology doctoral program at Virginia Commonwealth University in 2007, he had no idea that working in a medical setting as a psychologist was even a possibility. "I knew I wanted to be a psychologist," he says, "but I only knew one way of doing that: long-term psychotherapy."
Lord's work as a Graduate Psychology Education (GPE)-funded clinician in the university's primary-care clinic opened his eyes to new possibilities. The experience gave Lord a chance to learn brief interventions for mental health concerns as well as work shoulder-to-shoulder with other health-care professionals in addressing smoking, obesity and other behavioral health issues among the clinic's low-income patients.
Lord also got to learn nonclinical skills, such as supervising peers and providing seminars and educational materials to medical residents.
That experience working with underserved clients in a setting that integrates psychological and physical health care has paid off. "The proof is in the pudding: I got a job as a primary-care psychologist," says Lord. Even though he's still an intern at the VA Connecticut Healthcare System and hasn't yet defended his dissertation, he already has a job lined up at the James A. Haley Veterans' Hospital in Tampa, Florida.
Lord's career trajectory is just one of the many positive outcomes of the GPE program, says Bruce Rybarczyk, PhD, who launched the university's GPE program in 2010. "GPE has been a game-changer for our program and many others," he says. "My students' career trajectories — and patients' lives — have been changed dramatically."
The only federal initiative devoted to the education and training of psychologists, the GPE program has had a two-fold mission since Congress created it in 2002: supporting interprofessional training of psychology doctoral students, interns and postdocs in settings that integrate physical, mental and behavioral health care, and providing mental and behavioral health services to underserved populations.
Now the GPE program is poised to change even more lives: Federal appropriations for fiscal 2015 include a $1 million increase for the GPE program, bringing the total funding for the program to $7.9 million. The new grants will focus on addressing the needs of military personnel, veterans and their families. That increase comes on top of the $4 million increase for fiscal 2014, which allowed the program to expand from 16 to 40 grantees (see Who are the GPE awardees?).
"This is historic growth," says Karen Studwell, JD, associate executive director of APA's Education Government Relations Office. "This is a direct result of a longstanding commitment to grassroots advocacy by APA and its members."
APA's Education Directorate played a key role in working with congressional appropriators to create the GPE program, which is administered by the Health Resources and Services Administration (HRSA), says Studwell. The directorate and APA members continue to advocate for increased support for clinical, counseling and school psychology education and training, she adds.
A two-part mission
With the Affordable Care Act's emphasis on integrated care, the GPE program's innovative interprofessional training plays a key role in preparing psychologists for the workplace of the future, says Jim Diaz-Granados, PhD, executive director of the Education Directorate.
"It's critical that psychologists are trained to work on interprofessional health-care teams, which will ultimately improve health outcomes for patients being treated in primary-care settings," says Diaz-Granados, adding that the GPE program has served as a model for other HRSA training programs.
Learning how to provide that kind of care is the goal of the training Rybarczyk has put together for his graduate students, thanks to GPE funding. The GPE grant — plus matching dollars from the university — funds stipends for five "advanced leadership" students who provide mental and behavioral health services to patients in three safety-net primary-care programs: the university's medical center clinic for underserved patients, a federally qualified health center and a free clinic serving the homeless. Another 10 to 12 students from the university's clinical and counseling psychology programs rotate through these practicum sites each year, with more than 65 students receiving the training thus far.
"It's extremely hard for these patients to access mental-health care, and when they do, it tends to be a medical regimen without behavioral services," says Rybarczyk.
Virginia Commonwealth's GPE funding has supported more than 8,000 care sessions since 2010. And even though the interventions the students provide are brief, they work, says Rybarczyk. Patient tracking shows that they don't just get better during treatment, but also keep improving over the next year, says Rybarczyk, who will be submitting these and other findings to a peer-reviewed journal.
GPE grant support isn't just helping patients, adds Rybarczyk. It's also building a psychology workforce ready to practice in integrated settings. Six of the seven students now on internship are focusing on primary care as a career path. Three graduates are now doing primary-care postdocs, while another three have primary-care psychology jobs. "There's a big demand out there for psychologists who can be channeled into primary-care psychology," says Rybarczyk.
Another exemplary GPE grantee is the clinical psychology internship program jointly offered by the Medical University of South Carolina and the Charleston VA Medical Center. GPE funding will provide stipends to two interns per year for three years, but the program's impact goes far beyond those two trainees, says Daniel W. Smith, PhD, a professor of psychiatry and behavioral sciences who co-directs the internship program. Another six interns this year will get the GPE clinical training, while all 20 interns will receive the didactic component.
GPE funding allowed the program to create two new clinical rotations and upgrade a third. One of the new rotations takes place at the VA hospital, where interns learn to provide mental and behavioral services within primary-care settings. "The interns provide all kinds of things primary-care providers don't have time to address but that clearly have profound implications for patients' overall health," says Smith. The second new rotation is a sleep and anxiety treatment program at the university. The newly enhanced rotation takes place at the university's cancer center, where interns help patients and families cope with such issues as difficult medical regimens and end-of-life issues.
"Interns need the kinds of skills they can get working side-by-side with psychiatrists, primary-care physicians, oncologists and others if they're going to be well-prepared to join the workforce," says Smith.
An additional component of the GPE program is faculty development, says Studwell. "Some GPE-supported trainees have been inspired by GPE-supported training models to become the next generation of faculty," she says. "They not only conduct research on evidence-based practice, but also train future psychologists to deliver these services in integrated care settings."
Take Prerna Arora, PhD, whose internship at the Children's Hospital of Philadelphia was partially funded by the GPE program. Before that, she helped her grad school mentor at the University of Texas at Austin write a GPE grant application and then managed the program when that application was successful. Once she graduated, she helped write another GPE grant while a research and policy postdoctoral fellow at the University of Maryland School of Medicine and served as an evaluator for the resulting program.
All that GPE-related experience has influenced Arora's current research, which focuses on getting evidence-based practices into pediatric primary care, schools and other settings serving underserved children and adolescents. "The experience helped reshape the focus of my work," she says.
Today, Arora is an assistant professor of psychology at Pace University and a visiting assistant professor at the University of Maryland School of Medicine. She's also a frequent visitor to Capitol Hill, where she advocates for increased funding for the GPE program.
Says Arora, "I look forward to applying for a GPE grant in the future so I can help shape the training and career trajectory of students."
Rebecca A. Clay is a journalist in Washington, D.C.
Learn more about the GPE program.