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DBH at ASU

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erg923

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Darlin is "southern thing..." Dont be such a drama queen about it.
 

PurpleRain769

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I dont know everything about integrated care, no, but I don't think we need to sell as this grand and wondferful thing that requires a whole new degree. I am still a psychologist. And thats what my clinic wants. That what my clinic needs, first a foremost. Yes, to be maximally effective, I must tailor my practice to the setting, and must be well informed on medical conditions and their psycholgical sequela. But most of all, I just need to be a good psychologist and clinician. Assessment (whether quick and dirties or organ transplant psychological evaluations), diagnostics, AD/HD evals/screens, brief interventions, traige, consultation. Thats what they need. Fitting into the culture and model of primary care isn't all that hard. It takes some mentoring and getting used to, but a doctorate in "integrated care?" Paaaa-lease.

OMG, then do not get one... Kinda simple!

Oh wait... I just noticed you are VA psychologist. Nevermind. It all makes sense now! lmao.
 

erg923

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OMG, then do not get one... Kinda simple!

Oh wait... I just noticed you are VA psychologist. Nevermind. It all makes sense now! lmao.

Yes. Very simple indeed. And If I can save others from spending 50,000 on a made up degree with no market demand that I have ever heard of, then I will do that as well.
 

erg923

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A southern sexist thing... Maybe some sensitivity training is in order?

Nurses call me darlin here all the time. I love it. Makes me feel warm and fuzzy.
 

erg923

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Oh wait... I just noticed you are VA psychologist. Nevermind. It all makes sense now! lmao.

I assume this is a compliment, as the Department of Veterans Affairs has been pushing PACTs for over a decade now, whilst others healthcare systems followed our lead.
 

Therapist4Chnge

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I'd like to get this thread back on topic....

Below are my biggest issues with this "new" training option. Anyone who supports this degree, I'd appreciate a response to my points below.

This degree program is attempting to create a market where one does not currently exist. There are better options already out there, so trying to carve out a new area is not going to be very helpful to the public nor the students completing the additional training. There is no need to re-invent the wheel by creating a program with no track record that requires less training and is not recognized as equivalent in the eyes of the states (or licensure would be available for the specific type of program.)
 

Samarian

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Hi Everyone,

I'm currently having a problem. I'm in the first semester of the DBH program at ASU and I absolutely hate it. The lack of academic standards is shocking and certain professors are incredibly unprofessional. Is anyone else in this program? Am I the only one who feels this way? I am considering leaving the program. I was interested in integrated care, but it doesn't seem like this program is legit. Any feedback or help is appreciated.

Thanks
 

Samarian

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The DBH program at ASU may be confusing to some people, but the primary principal is sound. No one complains that licensed physical therapists, occupational therapists, dieticians and pharmacists with masters degrees go on to get doctorates in their respective fields. The DBH is a capstone program that stresses how to practice in an integrated health setting. It does not replace clinical degrees or represents itself as a continuation of them. The DBH offers a different skillset for doctoral clinical practice - a long standing need of well trained and licensed mental helth professions with masters degrees. The DBH is distinct professional training directed at the emerging model of behvioral healthcare aligned to primary medical care. In my opinion it is a perfect compliment and trainng program for msters level therapists who want to practice in a medical setting doing behavioral health work.
 
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WisNeuro

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    How does this add on to practicum placements in these settings? Placements that give hands on, supervised, experiences in these settings. Plenty of funded PCMHI internships and postdocs out there that already offer this.
     

    Samarian

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    Hi Everyone,

    I'm currently having a problem. I'm in the first semester of the DBH program at ASU and I absolutely hate it. The lack of academic standards is shocking and certain professors are incredibly unprofessional. Is anyone else in this program? Am I the only one who feels this way? I am considering leaving the program. I was interested in integrated care, but it doesn't seem like this program is legit. Any feedback or help is appreciated.

    Thanks
    The DBH program at ASU is very legit. It is relatively new and has an innovative concept of training post licensure therapists in the unique characteristics of integrated care. They have over 300 enrolled students at this time with over 700 graduates. The degree is not fully online, but requires a two semester internship (one year), dissertation (called a Culminating Project with reserch and defense) and has two tracks, clinical and managment. The program prepares licensed persons (in the clinical track) to practice in primary care settings. It was never intended as a licensure track program - and does not accept anyone who is not already licensed in a mental health field. The advantage of this degree is that it is from a very credible university and the training is specific to a type of clinical practice. Many people who have attempted to discredit this degree do so in attempting to compare it to other forms of clinical training - and in doing so demonstrate that they do not know much about the purpose and intent of the DBH training program at ASU or other institutions which are now developing DBH programs as a compliment to masters level clinical training programs. Additionally, DBH distractors and naysayers demonstrate little understanding of how integrated behavioral care is evolving (some may say taking over) in the changing landscape of behavioral health. Many masters level therapists want to complete doctoral level training but do not need or desire to repeat prior clinical experiences or learning. For those individuals this training is ideally suited. Lastly, many employers are now looking at the DBH as a clinicial managment capstone degree for key leadership positions within clinics, hospitals and other types of facilities. In 5-10 years this unique degree will be infiltrated throughout the mental health professions and will be unaquestionably respected - but as anything new or innovative, it too is subject to initial speculation on its utility and value (remember the talk aboaut the Psy.D?). However the DBH is already proving its value in the U.S. and abroad.
     
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    WisNeuro

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    Can you indicate how the DBH is proving its value objectively?

    Just to clarify, I'm one of those detractors, who happens to work in an integrated behavioral health care context every day.
     

    futureapppsy2

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    The DBH program at ASU is very legit. It is relatively new and has an innovative concept of training post licensure therapists in the unique characteristics of integrated care. They have over 300 enrolled students at this time with over 700 graduates. The degree is not fully online, but requires a two semester internship (one year), dissertation (called a Culminating Project with reserch and defense) and has two tracks, clinical and managment. The program prepares licensed persons (in the clinical track) to practice in primary care settings. It was never intended as a licensure track program - and does not accept anyone who is not already licensed in a mental health field. The advantage of this degree is that it is from a very credible university and the training is specific to a type of clinical practice. Many people who have attempted to discredit this degree do so in attempting to compare it to other forms of clinical training - and in doing so demonstrate that they do not know much about the purpose and intent of the DBH training program at ASU or other institutions which are now developing DBH programs as a compliment to masters level clinical training programs. Additionally, DBH distractors and naysayers demonstrate little understanding of how integrated behavioral care is evolving (some may say taking over) in the changing landscape of behavioral health. Many masters level therapists want to complete doctoral level training but do not need or desire to repeat prior clinical experiences or learning. For those individuals this training is ideally suited. Lastly, many employers are now looking at the DBH as a clinicial managment capstone degree for key leadership positions within clinics, hospitals and other types of facilities. In 5-10 years this unique degree will be infiltrated throughout the mental health professions and will be unaquestionably respected - but as anything new or innovative, it too is subject to initial speculation on its utility and value (remember the talk aboaut the Psy.D?). However the DBH is already proving its value in the U.S. and abroad.
    They have over 700 graduates with a doctorate in handful of years? Sounds legit. e_e
     
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    Therapist4Chnge

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    One topic was asked about, a response with little to nothing to do w the question was given, and a defenseless (and random) straw man was senselessly slayed. The worst part is that the audience is left dumber for having waded through the heaps on nonsense that were being passed off as fact (e.g. the degree "will be unquestionably respected")...uh huh.

    You sir/madam may have a bright future in politics, as no thing you have written remotely related to the actual reality out there in healthcare. God help those graduates. 700(?!) in a handful of years. Real programs that have existed 50+ yrs don't have that many graduates. How does ASU justify that sort of...output?
     
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    Samarian

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    Can you indicate how the DBH is proving its value objectively?

    Just to clarify, I'm one of those detractors, who happens to work in an integrated behavioral health care context every day.

    The DBH teaches "integrated clinical skills" , that is how to practice clinical mental health at the elbow of primary care medicine. Objectively, proximity matters and carries with it a skillset that is not currently offered in traditional clinical training programs. The healthcare industry is demanding more integration of services and the DBH simply formalizes that interest in a degree program. Primary care medicine and practitioners are using more masters level therapist every day (within their own office and clinical settings) and many of those therapists want additional training in how to practice alongside primary care providers. The DBH provides that specific training in a doctoral level educational framework. Seems to me that is very objective! I am not clear why anyone would object to a licensed mental health practitioner seeking additional specific training in an emerging element of clinical services - except, of course, if they perceived it as a threat.
     

    WisNeuro

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    I don't think you understood the question. You said that the degree is "proving its value." By what metric can you make the claim that it is worth the cost? What outcomes are you referring to? What specific data?

    It's not a threat to us, we're already trained in this field. We do, however, object to some students getting taken in by dubious claims and spending money needlessly. If you can show me data "proving" that this degree does something, I may be willing to reconsider.
     
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    Samarian

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    They have over 700 graduates with a doctorate in handful of years? Sounds legit. e_e
    Not sure if it is 700 or more- but they (ASU) graduates persons three times per year with about 35-50 each time (estimate). Halfare clinicl and half are management. They are taught by different faculty. So the clinical graduates probably number in the 20-30 per semester. I believe Boston University now has a DBH program, and Nicholas Cummings (who started the Psy.D degree program years ago, just started a new institute that will eventually grant DBH degrees in managment and clinical. It is logical that other universities will or could develp DBH training programs - as it makes ssense to do so from a need/interest and university income perspective.
     

    Chalupacabra

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    Additionally, DBH distractors and naysayers demonstrate little understanding of how integrated behavioral care is evolving (s0ome may say taking over) in the changing landscape of behavioral health.

    The detractors here are people actually working in the field. I'm going to take their word over someone who has drunk the DBH Kool-Aid and/or has a vested financial interest in supporting this institution.

    Many masters level therapists want to complete doctoral level training but do not need or desire to repeat prior clinical experiences or learning.

    You're really not going to win over anyone here with that argument - especially given its questionable logic. It seems to indicate a pretty questionable understanding of doctoral vs. master's level programs, among other problems. Sounds like yet another way to try and backdoor your way into a higher position without getting the proper training.

    DBH teaches "integrated clinical skills" , that is how to practice clinical mental health at the elbow of primary care medicine
    So basically what people learn through practica/internship/postdoc in doctoral programs already, but in a new, unproven and more expensive way.

    I am not clear why anyone would object to a licensed mental health practitioner seeking additional specific training in an emerging element of clinical services - except, of course, if they perceived it as a threat.

    People here take a vested interest in maintaining quality in the field and stopping the spread of disinformation and the promotion of programs with questionable utility. I see a lot of conjecture and anecdotes but not a lot data in your arguments. And again, 300 students in a program? That's making Alliant et. al. seem downright intimate.

    It is logical that other universities will or could develp DBH training programs - as it makes sense to do so from a need/interest and university income perspective.

    It would be logical if you could provide some sort of data (beyond the tuition dollars being raked in) supporting your argument. So far you've responded to criticisms of your pure conjecture with yet more conjecture.
     
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    Samarian

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    I don't think you understood the question. You said that the degree is "proving its value." By what metric can you make the claim that it is worth the cost? What outcomes are you referring to? What specific data?

    It's not a threat to us, we're already trained in this field. We do, however, object to some students getting taken in by dubious claims and spending money needlessly. If you can show me data "proving" that this degree does something, I may be willing to reconsider.

    Not sure who "we" are, but there are alot of "we's" out there trained in mental health who claim alignment to one degree or license of a specific type. The proof of the value coems in two forms, employment and self improvement. As for employment ASU could provide data on where their graduates are practicing or how their professional lives were altered or changed after receiving the degree. Our hospital hired two DBH's, one in clinical and one in managment for a behavioral health unit. As for self-improvment and professional development, that is more subjective but one needs to look no further than the "training" constantly peddled to mental health practitioenrs regarding new and emerging therapies to see the hunger and yearing (legitimate or not), that behvioral health professionals seem to seek out so intensly. One could ask, how does "professional development " or "continuing education" prove its value? Good title for a DBH managment dissertation! I just do not think that formalizing (in a degree program) a professional development or continuing educaiton experience is "spending money needlessly". Who are others to judge the needs of one prdofessional or professional group? Unless, of course, there is a perceived threat.
     

    Samarian

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    The detractors here are people actually working in the field. I'm going to take their word over someone who has drunk the DBH Kool-Aid and/or has a vested financial interest in supporting this institution.



    You're really not going to win over anyone here with that argument - especially given its questionable logic. It seems to indicate a pretty questionable understanding of doctoral vs. master's level programs, among other problems. Sounds like yet another way to try and backdoor your way into a higher position without getting the proper training.


    So basically what people learn through practica/internship/postdoc in doctoral programs already, but in a new, unproven and more expensive way.



    People here take a vested interest in maintaining quality in the field and stopping the spread of disinformation and the promotion of programs with questionable utility. I see a lot of conjecture and anecdotes but not a lot data in your arguments. And again, 300 students in a program? That's making Alliant et. al. seem downright intimate.



    It would be logical if you could provide some sort of data (beyond the tuition dollars being raked in) supporting your argument. So far you've responded to criticisms of your pure conjecture with yet more conjecture.

    I am working in the field and I am only reportingwhat I see occuring. I am NOT trying to win anyone over. I am simply reporting what I see based on my experience in a hospital. I am an adminsitrator with an MBA. I also have a pilots license (but I cannot prove that being an MBA pilot has value in the marketplace- but it sure does to me!). I'm taking soem graduate classess in psychology to learn more about the field and assist me with understnding the needs of our patients - in teh chance we may open a free standing behavioral health unit. I do know that I currently make considerably more money than the behavioral health practitioners that work at our hospital. My employer likes that I can fly to meetings, and occassionally take others with me - but the 'value" of that defies quantification. You ask for "proof" but reject the most subtantial proofs of all - the success of the DBH program (now at no less than two universities). Regardless, new pathways to practicing behavioral health are well underway and that means that new and emerging professionals are now being included in the mix and they are practicing in new arenas like the hospital where I work. I understand that such change can be very threatening to the status quo- but the momentum cannot be stopped by objections grounded in professional jealously and fear. I do not know what kind of data you want, or feel you need, but DBH's are getting jobs and the DBH graduates like their training and value it - as are thier employers. The question begs, do you want to be the status quo or something innovative. I know who I will hire.
     
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    Samarian

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    So...in other words, there is no data on the value, despite having over 700 graduates?

    Individual professionals go to school or degree programs for varied interests and purposes. I have no idea on how to place a metric on such interests - or a reason to do so. If an individual wants training in a certain field or specialty- and finds value or employment advanced due to it - I am not sure what else needs to be "proved". Intrinsic value at the individual level is difficult to measure.
     

    WisNeuro

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    You can play off the "people are just feeling threatened" card all you want to deflect posting any real information. The reality is, many of us on here are already professionals. Many in good six figure jobs with great benefits. We're not threatened, no one is coming for our jobs anytime soon. We are concerned about students out there who do not know any better and fall for marketing schemes. It's happened before and it will keep happening. So far, I have seen zero objective data that this degree serves any real purpose other than providing income for the university. You keep making wild claims, but have nothing to back it up with from a data standpoint. For a healthcare model that stresses empirically supported treatments and measurable outcomes, I find this deeply troubling.
     
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    Fan_of_Meehl

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    The DBH teaches "integrated clinical skills" , that is how to practice clinical mental health at the elbow of primary care medicine. Objectively, proximity matters and carries with it a skillset that is not currently offered in traditional clinical training programs. The healthcare industry is demanding more integration of services and the DBH simply formalizes that interest in a degree program. Primary care medicine and practitioners are using more masters level therapist every day (within their own office and clinical settings) and many of those therapists want additional training in how to practice alongside primary care providers. The DBH provides that specific training in a doctoral level educational framework. Seems to me that is very objective! I am not clear why anyone would object to a licensed mental health practitioner seeking additional specific training in an emerging element of clinical services - except, of course, if they perceived it as a threat.

    'except, of course, if they perceived it as a threat.'

    I'll look forward to meeting a 'DBH' 'at the elbow of primary care medicine'--or anywhere else, for that matter--and enjoying the opportunity to compete with them and their 'skillset that is not currently offered in traditional clinical training programs.'

    I'm you're huckleberry...that's just my game.

    This is the most sophisticated trolling I've seen in a long time.
     
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    Samarian

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    You can play off the "people are just feeling threatened" card all you want to deflect posting any real information. The reality is, many of us on here are already professionals. Many in good six figure jobs with great benefits. We're not threatened, no one is coming for our jobs anytime soon. We are concerned about students out there who do not know any better and fall for marketing schemes. It's happened before and it will keep happening. So far, I have seen zero objective data that this degree serves any real purpose other than providing income for the university. You keep making wild claims, but have nothing to back it up with from a data standpoint. For a healthcare model that stresses empirically supported treatments and measurable outcomes, I find this deeply troubling.
    I suggest you ask the graduates if they feel duped by the program. The ones I know do not. If you are so secure, and graduates you ask are pleased with what they got for thier money - why are you so interested? Maybe those jobs you say you have are not as secure (to you) as your propose?
     

    Samarian

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    'except, of course, if they perceived it as a threat.'

    I'll look forward to meeting a 'DBH' 'at the elbow of primary care medicine'--or anywhere else, for that matter--and enjoying the opportunity to compete with them and their 'skillset that is not currently offered in traditional clinical training programs.'

    I'm you're huckleberry...that's just my game.

    This is the most sophisticated trolling I've seen in a long time.
    The fact you see this as "competition" proves that the concept of threat is in play. It's not a competition, unless you perceive it as such.
     

    WisNeuro

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    I would, but I have yet to meet one of these graduates in person. As I have stated before, I am interested because I advise current students at the undergraduate and graduate level and do not like seeing them fall victim to fraud. But I do appreciate the argumentative fallacies.
     
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    Fan_of_Meehl

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    The fact you see this as "competition" proves that the concept of threat is in play. It's not a competition, unless you perceive it as such.

    You're right...It's not a competition. Nor is it a threat.
     
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    erg923

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    The fact you see this as "competition" proves that the concept of threat is in play. It's not a competition, unless you perceive it as such.

    But actually it is thought, right? They are in competition for jobs within a employment market. This degree lacks both the scientist and the (broad) practitioner part of the practice of psychology. The fact that I have never met a DBH, OR EVEN HEARD THE CONCEPT MENTIONED, in all my interactions in the this sub-field is not a coincidence. Your program and degree have problems, my friend.
     
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    Therapist4Chnge

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    Reasons why I'm concerned:
    1. Saddling students w debt is bad for them and also tax payers.

    2. They don't know what they don't know.

    3. I don't want my patients to be treated by someone who can't rationally reason through a junk degree. It is up there w. U of Pho, Walden, and "2 box tops and $20" scam programs

    4. As my prior mentor used to say: "Show me the data!" As s scientist I cannot support things that aren't based on science.
     
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    Fan_of_Meehl

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    Between the burgeoning numbers of
    2. They don't know what they don't know.

    This is an especially acute problem in the field of clinical psychology where members of the lay public (or poorly trained mental health care or medical care workers) completely fail to appreciate the distinction between the process that a professionally trained and experienced doctoral-level practitioner follows in, say, determining a diagnosis of posttraumatic stress disorder versus the process that a lay person (or poorly trained practitioner) would follow in 'diagnosing' PTSD.

    I can't tell you how many 'diagnoses' of PTSD I've seen entered into the problem list in the VA medical record from physician's assistants, nurses, or primary care physicians in association with a brief 20 min encounter where the focus was clearly on assessing the medical presenting issue and the 'diagnosis' of PTSD was clearly an afterthought.

    On the treatment side, if you get your information about PTSD treatment from USA Today or Yahoo News, the first-line treatment that you'll be likely to recommend involves blueberries, yoga and a service dog.
     

    Therapist4Chnge

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    I just saw the above PTSD example this afternoon in my office. Poor documentation + clear secondary gain + lawyer = not the most accurate information. The diagnosis was wrong, interventions were wrong (1.5yr of therapy and...nothing!), and the provider will continue to jack things up in the future. This is why #2 is so problematic.
     
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    Fan_of_Meehl

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    It appears that with the advent of distance learning technologies (as well as the increased availability of information across the board due to the ubiquity of the Internet--which is a good thing) the older established structures regarding higher education and conferral of an advanced degree are destabilizing and, ultimately, liquefying. You want a doctoral (terminal) degree in X that historically has indicated that you are among the most experienced and knowledgeable members of society in the subject matter X? Well, you can be in the minority these days and follow the traditional educational path of applying to competitive brick-and-mortar degree programs housed in established universities OR--for a hefty price--you can join the hordes of 'scholars-in-the-basement-and-in-the-making' who can earn 'the same' degree/status (at least to people outside the field) from the comfort of their own homes if you'll just 'CLICK HERE' and enter your credit card information (for a limited time only, offer expires 10/1/15 so ACT NOW!!!). The more suckers they sucker in, the more capital they have to expand their operations. At least the licensing/credentialing boards serve as an ultimate check...sorta. Then you have the issue of hordes of hopelessly indebted disillusioned folks who can't get licensed/credentialed to earn the money to pay back the massive student loans they incurred resulting in both personal and societal costs.

    THIS is why we feel compelled to respond to this issue on this message board, not--I assure you--from any insecurities about these folks representing a threat to our professional standing or ability to earn a good income or have a stable job.

    I am also personally sick to death of the 'administrator/bureaucrat/non-provider/efficiency-expert/full-of-#%$#/socialized-psychopath' type that has infested and overrun healthcare systems (especially in government organizations). The type of program we have been discussing appears to be a breeding ground for those types who generally have nothing better to do than create meaningless 'bean-counting' and busywork policies/procedures that do nothing but get in the way of a competent practitioner trying to provide quality evidence-based care to their clients/patients. This is one of the major reasons why the VA, for example, can't keep primary care providers (I've talked to plenty of them prior to them leaving). They kinda resent the gibbering hordes of uninformed, uneducated, lazy, busybody control-freak types who constantly are looking over their shoulders and shoving telescopes up their asses 24/7 analyzing and pestering them about their 'productivity' (according to the RVU's) while the friggin secretary (adminstrative assistant, excuse me) is busy filing her nails, facebooking her boyfriend, on break, or otherwise screwing off and can't be fired because she has union protection.
     

    erg923

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    I am also personally sick to death of the 'administrator/bureaucrat/non-provider/efficiency-expert/full-of-#%$#/socialized-psychopath' type that has infested and overrun healthcare systems (especially in government organizations). The type of program we have been discussing appears to be a breeding ground for those types who generally have nothing better to do than create meaningless 'bean-counting' and busywork policies/procedures that do nothing but get in the way of a competent practitioner trying to provide quality evidence-based care to their clients/patients. This is one of the major reasons why the VA, for example, can't keep primary care providers (I've talked to plenty of them prior to them leaving). They kinda resent the gibbering hordes of uninformed, uneducated, lazy, busybody control-freak types who constantly are looking over their shoulders and shoving telescopes up their asses 24/7 analyzing and pestering them about their 'productivity' (according to the RVU's) while the friggin secretary (adminstrative assistant, excuse me) is busy filing her nails, facebooking her boyfriend, on break, or otherwise screwing off and can't be fired because she has union protection.

    Interestingly, the VA seems to have its own "in house" org/IO team-VHA National Center for Organizational Development. http://www.va.gov/ncod/

    Never seen em...

    And I'm curious how or why there name is never mentioned when we talk about changing the culture in the wake of this past years scandal. After all, the whole scandal is basically a systems and culture issue. Where are they? Where were they? Did they really not have any clue that this kinda of thing was brewing? Isn't that their job?
     
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    Fan_of_Meehl

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    From their web page:

    "We integrate research, training, and consultation to build healthy VA organizations"

    Yeah, right.

    I recently Googled 'Mental Health Treatment Coordinator, VA' to try to see if there had been any professional discussions among provider regarding this new role that VA has given us...

    What I came across were the .pdf files with the full texts of responses from providers from the Mental Health Provider Surveys (from 2012 and 2013). It's now 2015. It was extremely disheartening to see articulate comment after articulate comment from multiple mental health providers in VA on these wonderful surveys saying the same things over and over (with perfect reliability) in 2012, 2013, (I assume 2014 too). The growth of the needless paperwork/checklists, focus on kissing ass upwards in the organization over valuing quality care for patients, etc. Now, as far as I know, no action has been taken (or even pretended to be taken) in response to these same criticisms and complaints year after year. 2015 will be no different.

    "We integrate research, training, and consultation to build healthy VA organizations"

    I'm sure they'll get right on that. :)
     

    Samarian

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    From their web page:

    "We integrate research, training, and consultation to build healthy VA organizations"

    Yeah, right.

    I recently Googled 'Mental Health Treatment Coordinator, VA' to try to see if there had been any professional discussions among provider regarding this new role that VA has given us...

    What I came across were the .pdf files with the full texts of responses from providers from the Mental Health Provider Surveys (from 2012 and 2013). It's now 2015. It was extremely disheartening to see articulate comment after articulate comment from multiple mental health providers in VA on these wonderful surveys saying the same things over and over (with perfect reliability) in 2012, 2013, (I assume 2014 too). The growth of the needless paperwork/checklists, focus on kissing ass upwards in the organization over valuing quality care for patients, etc. Now, as far as I know, no action has been taken (or even pretended to be taken) in response to these same criticisms and complaints year after year. 2015 will be no different.

    "We integrate research, training, and consultation to build healthy VA organizations"

    I'm sure they'll get right on that. :)

    It is amazing that anyone could, or would, find a rationale to defend the VA on its service record. Worse yet, hold out the VA as a model of effectiveness and health practice standards. The VA is a tragic and sad place for patients and employees. It may even be an outdated care model that needs to be replaced. The new healthcare laws and expansion of care for veterans outside the VA is on the verge of getting much bigger. The deflection of veterans to civilian (non federal employee) healthcare providers may speed that process along. The idea of effeciency has clearly evaded the VA and is only exceeded by its neglect and delay in the teatment of veterans. Some say it is corrupt - yet there are those in this forum that defend it. Incredible.

    Recently the VA has been taken to task with the introduction of the Veterans Choice Program which allows civilian hospitals to treat veterans in rural areas. No VA "chief" or bean counter there! The Veterans Choice Program is an emerging model of care and has the potential to show the effectiveness of community based care provided by non-federal "employees" of the "VA system". As for that DBH degree, I would not count it out. My wife is a physician (MD), and she works well with DO's). The medical training for training for either is not fully similar, yet they offer complimentary approaches to the provision of healthcare. My wife feels it is odd that such a debate about "which training program is better" seems silly when the distribution of either degree, license or training standard is not fully integrated into primary care medicine anyway. On the side, she thinks the DBH is very promising and can provide new ideas and innovation. I suggest we quit quarreling over which one is "bigger" and start to discuss similarities and clinical quality improvements. Debating training standards is important and useful at the policy level, but medical training is NOT standard throughout the world, just ask any foreign trained medical practitioner attempting to be licensed in the US. Even states differ considerably as do various medical specialty boards. The DBH is not going away - nor should it - and the masters level clincians are no longer going to play a secondary role in status, leadership or salary - in the emerging new practice models of mental helath care in the United States. The DBH offers a pathway for systemic change that is long needed and the DBH students seem to be discovering that there are important professional trainings that can enhance their employability just like all other medical professions - - and that they are cost effective and beneficial personally and professionally. So the VA, and its employees, can protect its APA programs, internships and guilded processes on the basis of some self inflated "standard" as the drain of patients slowly makes it way to the door. The bus outside can take them to the great and qualified non-federal employee providers (some with the feared DBH degree) at the clinics and hospitals down the street - and the VA can fund it. Is this a great country or what?
     
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    erg923

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    The DBH offers a pathway for systemic change that is long needed and the DBH students seem to be discovering that there are important professional trainings that can enhance their employability just like all other medical professions - - and that they are cost effective and beneficial personally and professionally.

    This is make believe.
     
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    WisNeuro

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    It is amazing that anyone could, or would find a rationale, to defend the VA on its service record.

    Go look at the clinical outcomes data that exists and say that genuinely without trying to sell something. The VA is very far from a perfect system, but it outperforms the private sector on most clinical outcomes data collected.
     
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    AcronymAllergy

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    Go look at the clinical outcomes data that exists and say that genuinely without trying to sell something. The VA is very far from a perfect system, but it outperforms the private sector on most clinical outcomes data collected.

    Agreed. Much of the press that the VA gets is negative, for a variety of reasons (not least of which is simply because it's a government agency). The VA doesn't do everything great, but for as large a system as it is, it does quite a bit right (e.g., pioneering EMR). This is entirely anecdotal, but most of the Veterans with which I've worked who've made use of the Choice program in my area have come back to the VA because they were unhappy with the care received in the community.

    As for MD/DO vs. clinical and counseling psychology doctorate/DBH, that's not a valid comparison; the former comparison involves equivalent and practice-oriented degrees, while the same cannot be said for the latter comparison.
     
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    PsyDr

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    Dr. X, under what license do you practice?
    What is a psychologist?
    What is a psychiatrist?
    What are you licensed as?
    And what education does that entail?
    And you abide by the state laws for that profession and the ACA ethics code, correct?
    So that's all the state is concerned with, in regards to your work?
    But you did this extra doctorate, right?
    When we qualified you under your education, you said you were a Doctor of Behavioral Health. But that's not a degree that you are licensed to practice under, correct?
    Can you read this highlighted passage from the dictionary, under the word "mislead"?
    Do you think working under one license and emphasizing a degree that the state says has nothing to do with your work is misleading?
    Can you read this portion of the ACA ethics statement about misleading credentials?
    Can you read this portion of the Drake v Portundo decision?
     
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    erg923

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    It is amazing that anyone could, or would, find a rationale to defend the VA on its service record. Worse yet, hold out the VA as a model of effectiveness and health practice standards. The VA is a tragic and sad place for patients and employees. It may even be an outdated care model that needs to be replaced. The new healthcare laws and expansion of care for veterans outside the VA is on the verge of getting much bigger. The deflection of veterans to civilian (non federal employee) healthcare providers may speed that process along. The idea of effeciency has clearly evaded the VA and is only exceeded by its neglect and delay in the teatment of veterans. Some say it is corrupt - yet there are those in this forum that defend it. Incredible.

    There are many VA psychologists on here (myself included), and of course we take pride in our mission and our organization, whilst also critique/bemoaning its many flaws. If you wanna bitch and moan, be my guest. But the people that actually make it better wont be you. It will be us (me).

    Most of the actual flaws in the system are poorly understood by armchair quarterbacks and are not vetted by the media. Malicious corruptions is hardly the issue that most of us see. Its actually incredibly good intentions that are complicated by a bureaucracy that, for some reason, seems to have become more bloated since attempts to austere it in during the Clinton Admin. I also think its inherently very difficulty for one organization (Department of Veterans Affairs) to be both a health care provider/system and a welfare and disability service. Obviously, these trains collide frequently because they have opposite messages with opposite goals, right?

    The new healthcare laws and expansion of care for veterans outside the VA is on the verge of getting much bigger.

    I think its important to make the point that, no. No its not. There is no data to indicate this. And given that the VA choice act typically posses more pragmatic problems with both access and care continuity than it fixes, people are not leaving in droves. New empanelment for PCC services in the VA continues to go up, not down. Now, 100 years from now, will we have the same VA system? I kind of doubt it. But, most seem unaware that we have compensated for outsourced care for years-under some different guidelines/criteria. It has never gained much traction.
     
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    WisNeuro

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    There are lots of VA psychologist on here, and of course we take pride in our mission and our organization, whilst also critique/bemoaning its many flaws. If you wanna bitch and moan, be my guest. But the people that actually maker it better wont me you. It will be us.

    I think this is besides the actual problem. The media likes to attack the VA because it's a symbol of the government. It's an easy target. For example, look at the "wait-time controversy." You never see the media reports comparing VA specialty services wait times to those averaged in the private sector, where the wait times are sometimes 2-10 times longer than in the VA. The issue isn't that the VA is broken, the issue is that US healthcare is broken. Most objective data would actually point to the VA being one of the least broken parts of that system.
     
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    erg923

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    WisNeuro

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    I wasn't attacking your point, rather trying to engage sam in his flawed, presupposed, argument. He's basing his point on a flawed premise that is not supported by objective data, but rather by a flawed, political narrative. Although, we've clearly seen that at this point, some people are not concerned with objective data.
     

    Fan_of_Meehl

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    If you want to get empirical and examine the effectiveness of the 'Choice' program in satisfying veteran's healthcare needs then I invite you to survey (ask) a few veterans about what their experience has been with it.

    One of the biggest issues with the VA and its public image is that the negatives are always published and covered in detail in the media but the positives go largely unappreciated. The folks we provide good mental health treatment to (for example, a recent veteran with PTSD who just completed cognitive processing therapy with me and who was able to see how his symptom scores were reduced to about 20-30% of their original severity since starting treatment, his expanded social network (that he attributes to the therapy) going from zero friends/buddies to about 4-5 buddies that he socializes regularly with, and the improvement in the trajectory that his marital relationship (things are going much better now)...these never make it to the media because the folks who are truly suffering from PTSD just want to get help, get better, and be left alone to live their lives (they're not the ones, generally, who are going to be front and center in the media).

    I apologize for the negative tone of my rant in a prior post...I actually love the central mission of my job (applying psychological science (with a good dose of human fallibility and sincere desire to connect with others who are suffering) to address psychological problems). I am grateful for the VA for providing me an opportunity to do this on a regular basis and job security so I can focus on my central mission as a provider. Of course I (and other providers) get frustrated at times when we reflect on how much better a job we could do (and how the job could be even better) if, basically, the administrators/bureaucrats would just get out of the way and let us do what we do. Alternatively, if they are truly interested in my work ethic with respect to my caseload, then they can interview me on the spot at any time and I will gladly share my case formulation, diagnostics, rationale for current interventions, etc. But they aren't interested in that, they want to count magic beans. :)
     
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    smalltownpsych

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    Here at the Institute for Everyone can be a Doctor, we are using 21st century technology to change the way we are preparing the newest healthcare providers for the evolving marketplace. So don't send us your checks or money orders to pay your tuition, we will get the cash directly from Sallie Mae. We will take care of all of the messy paperwork and hassles and we will absolutely guarantee that you can still practice under your existing license as an LPC, LCSW, or MFT so long as you maintain an active license to practice in your state, and you will now be able to call yourself a doctor, too.

    I wonder how much money I could make doing this.
     
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    Samarian

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    Here at the Institute for Everyone can be a Doctor, we are using 21st century technology to change the way we are preparing the newest healthcare providers for the evolving marketplace. So don't send us your checks or money orders to pay your tuition, we will get the cash directly from Sallie Mae. We will take care of all of the messy paperwork and hassles and we will absolutely guarantee that you can still practice under your existing license as an LPC, LCSW, or MFT so long as you maintain an active license to practice in your state, and you will now be able to call yourself a doctor, too.

    I wonder how much money I could make doing this.

    Not very much. Your heart is not in it.
     
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