Letter from the DCT of University of Kansas about Professional Schools

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edieb

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A friend just sent this to me. It seems people within the field are growing more and more frustrated about the for profit professional schools and the continuing downward slide of clinical psychology. Sad


Number 26 KU Clinical Psychology News Fall 2010
FROM THE DIRECTOR
Kansas windmills still churn to fill livestock tanks, but
increasingly the prairie breezes are cranking turbines to
reinvigorate our nation’s energy economy. The “winds”
of change are also whipping up a flurry of calls for new
ways of training PhD clinical psychologists to
reinvigorate our field. There always have been calls from
advocates for one interest or another to add this or that
element to training curricula. (But never to subtract
them!). Only the issues vary and a few are, in a word,
jejune (don’t you just love some words?). The more
interesting voices in the wind are those advocating a reshaped
landscape of professional psychology.
Partly in response to concerns about the rising number of
graduates of for-profit PsyD programs entering the
internship, postdoc and professional job markets, calls
have been raised for the APA to strengthen its
accreditation standards, for PsyD programs to limit their
enrollments and raise admission standards, for ceilings
to be placed on the number of students who can enter the
internship market from any given program in any given
year, for the internship to be made a post-doctoral rather
than a pre-doctoral requirement, and for state licensing
boards to eliminate a year of postdoctoral supervised
practice as a licensure requirement. The future outcome
of these initiatives is uncertain, if not doubtful, because
they require action by others in some instances and, in
others, they invite the certainty of legal opposition.
Yet other voices are advocating more revolutionary
change. Responding to the perceived failure of advances
in clinical science to be reflected in clinical practice,
including among PhD practitioners, a growing cadre is
taking matters into its own hands. The Association for
Psychological Science (APS), a science-oriented
alternative to the increasingly practice-oriented APA,
was an early manifestation.
Similarly, the 1990’s emergence of the Academy of
Psychological Clinical Science (APCS), currently a 50+
member association of high-profile clinical programs
advocating a rigorously scientific clinical psychology, is
serving as a counterpoint to more traditional clinical
training. Most recently, and perhaps most intriguingly,
we have seen the emergence of the Psychological
Clinical Science Accreditation System (PCSAS;
www.pcsas.org). The PCSAS clearly reflects a growing
disenchantment with APA accreditation among clinical
science oriented programs as well as, I suspect, a
disbelief that the APA is capable of mustering the
political will to tighten its accreditation reins even if it
wanted to. With only three programs currently listed as
accredited by it, it is doubtful that the PCSAS will
supplant the firmly entrenched APA accreditation
system anytime soon. Nevertheless, it may emerge over
time as a useful, supplementary credential for programs
wanting to clearly align themselves publically with the
clinical science movement.
Our program has long prided itself on providing
balanced training with the flexibility to prepare students
for both academic/research and clinical/applied careers.
Along with other “scientist-practitioner” programs cut
from the “Boulder Model,” our objective has been to
advance science and practice hand-in-hand. That remains
a laudable goal, and one I believe we will continue to
aspire to as our program adapts to the evolving world of
clinical psychology in the midst of what appears to be a
growing polarization within our profession. One thing is
certain: these are interesting times to be in the “training
business.” Please consider contributing to the cause!
Here’s hoping that this 26th edition of The Hawkline
finds you prospering and in good health. This is,
perhaps, a trite sentiment during the holiday season, but
for me it is an increasingly heartfelt one with rising
personal gravitas that is, perhaps, inversely proportional
to my slumping center of gravity! Peace be with you.
Ray Higgins

Members don't see this ad.
 
As a concerned APA member I am dismayed that there seems to be so little public discussion or articles related to changing accreditation standards to ensure professional freestanding for-profit clinical programs limit their enrollments and raise admission standards. It seems that generating more internships (which is probably the least controversial) is discussed quite often as a solution to the problem but I think it misses the point that many APA accredited programs have immense class sizes, are not seemingly very selective, are irresponsibly expensive, and have very poor match rates. How is this good for our profession or our patients?

I think this was mentioned previously somewhere but of the 391 psychology programs that compete for internships each year, only 15 programs...15! accounted for 32% of the unmatched applicants. Guess which type of programs?

http://www.apa.org/gradpsych/2010/09/unmatched.aspx

So what happens to these students? They end up taking unpaid or low pay, unaccredited internship positions which MAY be of lesser training quality. So rather than ameliorating any initial weaknesses in the free-standing professional school applicants, the programs exacerbate them with poor match rates that force many of them to take an alternative (and potentially substandard) training route. These programs also flood the market lowering our salaries.

What happens when this cycle is repeated for 20 years?
 
Members don't see this ad :)
As a concerned APA member I am dismayed that there seems to be so little public discussion or articles related to changing accreditation standards to ensure professional freestanding for-profit clinical programs limit their enrollments and raise admission standards. It seems that generating more internships (which is probably the least controversial) is discussed quite often as a solution to the problem but I think it misses the point that many APA accredited programs have immense class sizes, are not seemingly very selective, are irresponsibly expensive, and have very poor match rates. How is this good for our profession or our patients?

I think this was mentioned previously somewhere but of the 391 psychology programs that compete for internships each year, only 15 programs...15! accounted for 32% of the unmatched applicants. Guess which type of programs?

http://www.apa.org/gradpsych/2010/09/unmatched.aspx

So what happens to these students? They end up taking unpaid or low pay, unaccredited internship positions which MAY be of lesser training quality. So rather than ameliorating any initial weaknesses in the free-standing professional school applicants, the programs exacerbate them with poor match rates that force many of them to take an alternative (and potentially substandard) training route. These programs also flood the market lowering our salaries.

What happens when this cycle is repeated for 20 years?


I think many of us agree with this point. However, it seems that although we all AGREE with your point, we don't know how to initiate the process of change. Do you have any ideas?
 
"Who gets to determine the policies of the APA? Historically, it has been those members who are willing to be active, involved, and vocal."

This is the statement that appears in the January 2011 Monitor on Psychology in an article where the current APA president (Dr. Melba Vasquez) outlines her agenda for 2011.

APA members wrote letters to the senate to push for mental health parity and had good success with the process. I think the same kind of influence can be made internally. So, for starters, if you share these concerns send her a letter or (copy forward the letter by the U of K professor) and let her know them. Too easy.

[email protected]
 
So rather than ameliorating any initial weaknesses in the free-standing professional school applicants, the programs exacerbate them with poor match rates that force many of them to take an alternative (and potentially substandard) training route. These programs also flood the market lowering our salaries.

Regarding the last point, I'm still not understanding how a professional school grad with clearly substandard training and non-APPIC internship (and no post-doc, more than likely) is going to lower the salaries of psychologist grads who've clearly received superior training.

As far as I can see, the latter (if they can get licensed) only competes with mediocre LCSWs and other masters-level therapists for the McTherapist jobs out there, while the former can take VA jobs, medical school positions, research positions, etc. There is a self-sorting mechanism involved when a student goes through a substandard program, and I just can't see how they can compete en masse with all psychologists out there and "lower... salaries" for all of us.

While I don't completely buy the argument that a poorly-prepared psychologist from a substandard program somehow drags down the profession as a whole, I do understand it and think it has some obvious, face-valid merit. However, what I don't understand is how students who can't even match for internship and come from diploma mills are any threat to a student from a solid program who matches to a quality internship. The idea that that kind of graduate drags down salaries for all of us assumes that all licensed psychologists compete on a level playing field. I just can't see how that could be the case.
 
I would completely agree that for academic/research these graduates probably don't assert much impact. For clinical practice though, it seems they are and this can include VA practice.

www.petris.org/Docs/psychologist_supply_managed_care.pdf

This article researches the various economic factors that can impact a psychologist income. The results provide evidence that individual practitioner income is adversely affected by greater supply in the psychology workforce.

As noted in the abstract, a 10% increase in the supply of psychologists in a psychologists' market of practice resulted in a $1,749 reduction in income compared with a $1,330 income reduction due to a 10% increase in managed care participation.

Another article of interest can be found on google probably by searching

Richard M. McFall DOCTORAL TRAINING IN CLINICAL PSYCHOLOGY

He provides a short history of the supply and demand problem faced by psychology including "...recognizing that there no longer was a shortage of clinical psychologists, the government stopped providing training grant support for the doctoral training of clinical practitioners. By the 1990s, the Veterans Administration considered making a 50% cut in the number of doctoral-level psychology and support staff positions, possibly replacing them with outside consultants, most likely social workers (Sleek 1994)."
 
I would completely agree that for academic/research these graduates probably don't assert much impact. For clinical practice though, it seems they are and this can include VA practice.

www.petris.org/Docs/psychologist_supply_managed_care.pdf

This article researches the various economic factors that can impact a psychologist income. The results provide evidence that individual practitioner income is adversely affected by greater supply in the psychology workforce.

As noted in the abstract, a 10% increase in the supply of psychologists in a psychologists' market of practice resulted in a $1,749 reduction in income compared with a $1,330 income reduction due to a 10% increase in managed care participation.

Another article of interest can be found on google probably by searching

Richard M. McFall DOCTORAL TRAINING IN CLINICAL PSYCHOLOGY

He provides a short history of the supply and demand problem faced by psychology including "...recognizing that there no longer was a shortage of clinical psychologists, the government stopped providing training grant support for the doctoral training of clinical practitioners. By the 1990s, the Veterans Administration considered making a 50% cut in the number of doctoral-level psychology and support staff positions, possibly replacing them with outside consultants, most likely social workers (Sleek 1994)."

The Petris article is a good one, and both seem to go a long way to making your point - although the Petris article doesn't seem to address VA positions directly, and your quote (didn't read the whole article - couldn't get it) seems to just support the idea that more competitive psychologists can remain competitive in terms of earnings (while mediocre ones will fall further and further behind). Presumably in a VA where a 50% cut in clinical psych. positions has happened competitive psychologists are the ones that will keep getting jobs, and the mediocre ones won't. Perhaps I'm just engaging in massive denial here.

Not sure how the training grant issue effects things.

I agree that if you're an undistinguished psychologist from an undistinguished program with poor training, you're not only competing with hordes of other LCSWs and the like for therapy dollars, you're also competing with other psychologists. Which is why I didn't do what a lot of my colleagues did and get into the private practice world right after school - seemed economically foolish.
 
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"Who gets to determine the policies of the APA? Historically, it has been those members who are willing to be active, involved, and vocal."

This is the statement that appears in the January 2011 Monitor on Psychology in an article where the current APA president (Dr. Melba Vasquez) outlines her agenda for 2011.

APA members wrote letters to the senate to push for mental health parity and had good success with the process. I think the same kind of influence can be made internally. So, for starters, if you share these concerns send her a letter or (copy forward the letter by the U of K professor) and let her know them. Too easy.

[email protected]

I just wanted to bump this thread given the amount of discussions that come up here at SDN regarding the uncertainty of the field, diminishing training standards, and frustration over the APA's lack of action. I actually had a similar discussion last night with my cohort (fun Sat night chatter :laugh:). I walked away from it feeling a bit disappointed in myself for my own lack of action. So I plan to send a letter to Dr. Vasquez at the address above (thanks codetype4/9) to inquire about any changes in accreditation standards. Other interns will too. If any others want to join... let's make a little noise.
 
I just wanted to bump this thread given the amount of discussions that come up here at SDN regarding the uncertainty of the field, diminishing training standards, and frustration over the APA's lack of action. I actually had a similar discussion last night with my cohort (fun Sat night chatter :laugh:). I walked away from it feeling a bit disappointed in myself for my own lack of action. So I plan to send a letter to Dr. Vasquez at the address above (thanks codetype4/9) to inquire about any changes in accreditation standards. Other interns will too. If any others want to join... let's make a little noise.

I would highly encourage you to write them O Gurl. I wrote a letter to the APA about a month ago on this topic and found them receptive:

Dear Dr. X,

I want to thank you for your email concerning standards for
accreditation of professional psychology education and training
programs, and to let you know that we are putting your correspondence on
the agenda of the Commission on Accreditation. I do believe that some
of the concerns you raise are shared by others, although we do not have
good data on the career course of psychology graduates. I also know
that both the Council of Chairs of Training Councils and the APA Board
of Educational Affairs are most interested in issues facing professional
education and training, so I will share your email with them as well if
that is OK with you.

Thank you for taking the time to write.

Cynthia

Cynthia D. Belar, PhD, ABPP | Executive Director
Education Directorate
 
I am not sure, but I think Dr. Higgins' letter was sent en masse, so there would be no reasonable expectation of privacy.

I, too, am not on board with making internship post-doctoral. The only issue I am planning to mention is accreditation standards for for-profit programs. I think that is something that could yield vast improvements in the current state and trajectory of psychology.
 
below

Nice letter (most recent).

Do we have permission to post Dr. Higgins' letter here? Was this a private email?

As to the sentiment, of course, I agree.

Things I disagree with:

- Eliminating supervised hours. We seek to distance ourselves from masters level providers, while at the same time presenting ourselves as the gold standard for various aspects of mental health treatment and assessment. This doesn't help.

- Making internship post-doctoral would require vast re-writes of licensure rules across the states. Dangerous without ensuring all of that is in place simultaneously.
 
the top line says "KU Clinical Psychology News" and you think it was a private e-mail?

Nice letter (most recent).

Do we have permission to post Dr. Higgins' letter here? Was this a private email?

As to the sentiment, of course, I agree.

Things I disagree with:

- Eliminating supervised hours. We seek to distance ourselves from masters level providers, while at the same time presenting ourselves as the gold standard for various aspects of mental health treatment and assessment. This doesn't help.

- Making internship post-doctoral would require vast re-writes of licensure rules across the states. Dangerous without ensuring all of that is in place simultaneously.
 
- Eliminating supervised hours. We seek to distance ourselves from masters level providers, while at the same time presenting ourselves as the gold standard for various aspects of mental health treatment and assessment. This doesn't help.

Pay is the biggest issue with the supervised hours, at least from my perspective. I'm not sure if there is a realistic way to change how insurance classifies psychology interns and post-docs, but that is really the only change that would help us without cutting out requirements. Mid-level encroachment is already an issue in a multitude of areas, and as JS noted, cutting hours just invites them to chip away further at our training.

- Making internship post-doctoral would require vast re-writes of licensure rules across the states. Dangerous without ensuring all of that is in place simultaneously.

It is nearly impossible to get legislation passed to reduce training requirements as no public official wants to be associated with something that decreases training.
 
Logistics aside, there's some weight to making internship post-PhD so far as history goes (internship used to be the first clinical experience, now intern applicants have more clinical experience at the time of application than early interns did during their entire training, etc.). But as a solution to the internship crisis, it's ridiculous.
 
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