Is it REALLY okay to have no integrated reports when you apply to internship?

[Justanothergrad]

---

Members don't see this ad.

Direct assessment hours/integrated reports don't tell the whole story, though. In my program, we happened to have the director of our counseling clinic who supervised assessements leave and was replaced, but the new director put all assessments on hold for awhile while adjusting, so grad students weren't able to offer assessments via the clinic for a year. Then when assessments started up again, there weren't enough to go around for all students combined with a general decrease in demand for tests in our clinic for awhile. We got plenty of practice administering assessments via 3 assessment-based classes (which doesn't count as direct assessment but is an integral part of competency), but not much test administration to the general public through no fault of our own. Some of us in those cohorts had no integrated reports, but several practice administrations/reports of diferent tests and at least one test or one battery administered to a client. I hardly think that should be cause for holding students back. Even in counseling centers, sometimes a battery or two is required during internship year (it was required at mine) so those folks might still get more assessment experience on internship. But just because the assessment hours might be lacking doesn't mean that the practice administrations & course component were lacking....that is a key part of competency not reflected in the assessment hours.

While you're right that this doesn't mean someone hasn't had coursework, actual clinical cases and mock clinical cases from a course are not anywhere near same sorts of experiences nor do they carry the same type of training. Practice administrations are with less pathologized individuals and are less prone to complicated interpretation (understandably so since it is meant as an initial level of training rather than an more advanced level). Those courses are a key part of establishing competence, but I'm doubtful that people who take a single course in assessment are competent in assessment just like I doubt someone who takes an introduction to therapy skills is competent in providing therapy. People, by in large, do not feel highly competent in assessment even when they have numerous test reports and have had experience providing actual testing data (source: preliminary data from a 12 APA-doctoral program study on assessment interpretation that I just finished piloting. Data to be presented in about 4 weeks at an assessment conference). I'm skeptical that less experience would lead to better skills, although it may promote higher perceived competence given the easier cases and limited types of assessments conducted during mock tests.

Long story short, I can't imagine any psychology subfield (e.g., neuro, rehab, etc.) not seeing it as a redflag when they see an applicant with zero therapy hours despite the focus being largely on assessment (see Therapist4Chnge's post). I don't see a reason why another core competency (assessment) should be treated differently for areas focused in . I don't always fault the student for this, but it is a shortage in training (regardless of the reason).

 

[foreverbull]

While you're right that this doesn't mean someone hasn't had coursework, actual clinical cases and mock clinical cases from a course are not anywhere near same sorts of experiences nor do they carry the same type of training. Practice administrations are with less pathologized individuals and are less prone to complicated interpretation (understandably so since it is meant as an initial level of training rather than an more advanced level). Those courses are a key part of establishing competence, but I'm doubtful that people who take a single course in assessment are competent in assessment just like I doubt someone who takes an introduction to therapy skills is competent in providing therapy. People, by in large, do not feel highly competent in assessment even when they have numerous test reports and have had experience providing actual testing data (source: preliminary data from a 12 APA-doctoral program study on assessment interpretation that I just finished piloting. Data to be presented in about 4 weeks at an assessment conference). I'm skeptical that less experience would lead to better skills, although it may promote higher perceived competence given the easier cases and limited types of assessments conducted during mock tests.

Long story short, I can't imagine any psychology subfield (e.g., neuro, rehab, etc.) not seeing it as a redflag when they see an applicant with zero therapy hours despite the focus being largely on assessment (see Therapist4Chnge's post). I don't see a reason why another core competency (assessment) should be treated differently for areas focused in . I don't always fault the student for this, but it is a shortage in training (regardless of the reason).

For assessment-heavy internships, I don't disagree that this lack of real-world assessment experience could be an issue. However, internship is still supervised training, so I would hope training directors would understand that not all students have equal opportunity to assess folks at any given time and be willing to supervise folks to fill the gap in practical training somewhat, particularly in less assessment-heavy sites. If assessments are the primary form of direct hours, then I don't disagree that it'd be appropriate to fill it with folks with more experience.

 

[psych.meout]

Assessment is a core competence of health service psychology. Failure to provide a means for students to obtain practical training in psychological assessment is unacceptable. APA accreditation should be contingent on the availability of adequate training (e.g., didactics/coursework, supervision, direct contact) in psychological assessment.

Exactly. I'm not sure how or why any accredited program wouldn't make this a core component of the training. A second-year student in my program already has >25 integrated reports and significantly >100 assessment hours in her first year of practica, but she's not even an assessment-focused person.

 

[foreverbull]

Assessment is a core competence of health service psychology. Failure to provide a means for students to obtain practical training in psychological assessment is unacceptable. APA accreditation should be contingent on the availability of adequate training (e.g., didactics/coursework, supervision, direct contact) in psychological assessment.

Indeed, and I'm sure APA assesses sites to determine that there is adequate training, but a clinic director leaving is an unforeseen event that had cascading effects on training experiences....not sure what students were supposed to do about this.

 

[bcliff]

The term “assessment heavy” is a misnomer. Health service psychology at baseline is “assessment heavy,” some disciplines require specialized training in various aspects of psychological assessment (e.g., neuropsychology); however, to practice health service psychology ethically, all practitioners must obtain “heavy” training in psychological assessment (i.e., equivalent to training in intervention). It may not be a student’s fault that, due to bureaucracy, there is not an opportunity to obtain training in a core competence of this field, but that does not excuse the gap in training.

 

[Therapist4Chnge]

I view assessment as a critical component to competency, even for folks who primarily provide intervention services. You need to know what you are treating before you can treat it effectively. It is one of the areas that differentiate us from other professions that primarily provide therapy interventions. I’d argue it is what puts us in the best position to provide intervention.

As for report writing, it can be taught on internship, but it’s time intensive and requires a lot from the supervisor. I’m not involved in training anymore, though when I was I had significant reservations about anyone who didn’t have a decent # of integrated reports because I view them as integral to case conceptualization.

Again, it’s not the end of the world, but it would make me question the student’s ability to fully conceptualize a case because an intake without formal assessment will only take you so far.

For people who work in a hospital setting/primary care setting it is a HUGE component, whether it be for psych, pain, pre-surg, cog/neuro, etc. The assessments may not be a huge battery, but they are often the basis of treatment and provide value information to the referring physician/treatment teams.

 

[smalltownpsych]

When I was applying for internship, the shortage of slots was worse than it is now and if I hadn't obtained assessment experience, I doubt that I would have matched. I agree with the other posters that assessment is a vital core competency and to not provide the opportunity to obtain supervised experience during practicums is an epic fail on the part of the program. My program required a minimum of 3 or 5 integrated reports and one was half of our clinical competency exam.

 

[Justanothergrad]

For assessment-heavy internships, I don't disagree that this lack of real-world assessment experience could be an issue. However, internship is still supervised training, so I would hope training directors would understand that not all students have equal opportunity to assess folks at any given time and be willing to supervise folks to fill the gap in practical training somewhat, particularly in less assessment-heavy sites. If assessments are the primary form of direct hours, then I don't disagree that it'd be appropriate to fill it with folks with more experience.

I agree and hope that training directors at internship sites see their sites as providing opportunities to fill in the gaps and to stretch assessment knowledge, but that can't mean initiate assessment training when experience is lacking. Internship is a capstone and not an early level of training. I understand that there are times where issues arise which interfere with getting assessment hours, but those should not be the standard. Relatedly, it frustrates me when I see internship programs that don't include assessment, or include only minimal amounts. It's a major part of our professional identity. It needs to be there just as much as it needs to be in the program level practica. Like I said, therapy skills/knowledge are a vital part of training in assessment-heavy professional identities and I see no reason that assessment skills/knowledge shouldn't also be a vital part of therapy-emphasized professional identities.

 

[Chad Allen]

I am having a similar problem. Most of the sites on the BAPIC practicum listing in SF do not have opportunities for integrated reports. They seem to be generally reserved for interns. Currently my externship/practicum is at the SFVA Medical Center and cognitive/neuropsych testing opportunities are mainly only given to Interns. I have requested multiple times that I receive opportunities for integrated reports to no avail, which is weird since one of my supervisors is a professor at my school where I took the top score on the Assessment Prelims and did exceptionally well in all of my assessment courses. I have lots of assessment experience for specific problems like insomnia, depression, anxiety and PTSD, however no integrated reports. Furthermore, the assessments I do give are mainly Beck inventories, and PCL-5 for PTSD. I have messaged my school and they are going to let me know if any opportunities come up in the spring at their assessment clinic. I won't be holding my breath.

 

[WisNeuro]

I am having a similar problem. Most of the sites on the BAPIC practicum listing in SF do not have opportunities for integrated reports. They seem to be generally reserved for interns. Currently my externship/practicum is at the SFVA Medical Center and cognitive/neuropsych testing opportunities are mainly only given to Interns. I have requested multiple times that I receive opportunities for integrated reports to no avail, which is weird since one of my supervisors is a professor at my school where I took the top score on the Assessment Prelims and did exceptionally well in all of my assessment courses. I have lots of assessment experience for specific problems like insomnia, depression, anxiety and PTSD, however no integrated reports. Furthermore, the assessments I do give are mainly Beck inventories, and PCL-5 for PTSD. I have messaged my school and they are going to let me know if any opportunities come up in the spring at their assessment clinic. I won't be holding my breath.

It's going to be an uphill battle at some sites. I'm sure that some sites will be able to look past it, but many will see 0 integrated reports as a major red flag.

 

[erg923]

Furthermore, the assessments I do give are mainly Beck inventories, and PCL-5 for PTSD.

These are symptom inventories...not testing

 

[Justanothergrad]

These are symptom inventories...not testing

It frustrates me to no end with how frequently these are referred to as assessments in the same category as extensively validated, multi-scale instruments with normative groups.

 

[WisNeuro]

It frustrates me to no end with how frequently these are referred to as assessments in the same category as extensively validated, multi-scale instruments with normative groups.

The thing is, that it's very obvious on APPIC applications, so I auto adjust their numbers when I review anyway.

 

[roryportman]

.....Taken from APPIC, "The definition of an integrated psychological testing report is a report that includes a review of history, results of an interview and at least two psychological tests from one or more of the following categories: personality measures, intellectual tests, cognitive tests, and neuropsychological tests." Most people think the tests have to be from two different categories when they don't.

A bit tangential to topic, but I always get confused reg the difference between intellectual vs cognitive vs neuropsych.. can someone pls clarify?

 

[Justanothergrad]

The thing is, that it's very obvious on APPIC applications, so I auto adjust their numbers when I review anyway.

Yeh, that's the part of it that is easy to correct.

The larger issue that frustrates me is that when folks enter practice a few years in the future and conceptualize doing 'assessments', they are extending this early erroneous practice by relying solely on face-valid instruments without any sort of embedded (or external) PVT/SVT for an 'assessment' that is narrowly focused and questionably valid. That isn't all on the as there are tons of barriers to testing, but those barriers don't tend to be part of the conceptualization and interpretation of symptom reports either.

 

[WisNeuro]

A bit tangential to topic, but I always get confused reg the difference between intellectual vs cognitive vs neuropsych.. can someone pls clarify?

Intellectual is things like the WAIS, WISC, TONI, etc. Where the primary purpose is to get a measure of IQ, like if you were doing an LD assessment and needed IQ/achievement testing. Neuropsych measures would be like the WMS, Trails, BDAE, D-KEFS, etc, where the primary function is to assess for possible neurological dysfunction. In a nutshell anyway.

 

[roryportman]

Intellectual is things like the WAIS, WISC, TONI, etc. Where the primary purpose is to get a measure of IQ, like if you were doing an LD assessment and needed IQ/achievement testing. Neuropsych measures would be like the WMS, Trails, BDAE, D-KEFS, etc, where the primary function is to assess for possible neurological dysfunction. In a nutshell anyway.

Thank you! And how does "cognitive" fit in?

These are symptom inventories...not testing

Is something only considered real "testing" if it fits "extensively validated, multi-scale instruments with normative groups" (as @Justanothergrad mentioned)?

Sorry to hijack the thread! This is all great to know as I'm currently in my first practicum, wondering how to understand and track everything. Until I started reading this, I too was under the impression that integrated reports must generally be cognitive + personality.

 

[WisNeuro]

I don't really see a distinction between cognitive testing and neuropsychological testing, it's more of an academic argument. And yeah, if you're not using validated instruments, it's not real testing to me. I also generally look past projectives, but others won't.

 

[erg923]

Thank you! And how does "cognitive" fit in?



Is something only considered real "testing" if it fits "extensively validated, multi-scale instruments with normative groups" (as @Justanothergrad mentioned)?

Sorry to hijack the thread! This is all great to know as I'm currently in my first practicum, wondering how to understand and track everything. Until I starting reading this, I too was under the impression that integrated reports must generally be cognitive + personality.

There is absolutely no skill involved in giving, or even interpreting, a BDI, BAI, etc.

 

[psych.meout]

There is absolutely no skill involved in giving, or even interpreting, a BDI, BAI, etc.

If I can just hand a patient forms and leave the room for them to complete the inventories, there's no skill in it and I'm not learning and developing my clinical acumen. I really just don't understand what some of these programs are doing that this kind of thing is what passes for assessment.

I saw someone asking on Reddit about what the difference is between APPIC vs. APA accredited internships, and when someone else inquired why their program doesn't provide them with this information as part of their mentoring and training, they said that their program doesn't talk about any of this stuff until their fourth year in the program. How are you supposed to supplement any deficiencies in your training (e.g., lack of integrated reports, as in this thread) if you're already in your fourth year?

This is very much what we're talking about here when we say that these unfunded programs with huge cohorts don't provide sufficient training and mentorship.

 

[Spydra]

If I can just hand a patient forms and leave the room for them to complete the inventories, there's no skill in it and I'm not learning and developing my clinical acumen. I really just don't understand what some of these programs are doing that this kind of thing is what passes for assessment.

I saw someone asking on Reddit about what the difference is between APPIC vs. APA accredited internships, and when someone else inquired why their program doesn't provide them with this information as part of their mentoring and training, they said that their program doesn't talk about any of this stuff until their fourth year in the program. How are you supposed to supplement any deficiencies in your training (e.g., lack of integrated reports, as in this thread) if you're already in your fourth year?

This is very much what we're talking about here when we say that these unfunded programs with huge cohorts don't provide sufficient training and mentorship.

I and a number of my friends are in funded programs with small cohorts and we're being taught in this same horrible manner so it isn't just the unfunded programs with huge cohorts that are guilty of this. In my program we are routinely told that self report measures such as the BDI are considered personality assessments and if we include something like that with something like the WAIS or WMS then it creates an integrated report. We students figured out on our own this is not true and are following the APPIC definition, but it is really frustrating when our professors keep touting wrong information and insist that we just don't understand.

Internship is not discussed until the semester before you're scheduled to apply, which has forced several students to scramble last minute to find an additional practicum because of how short they are on hours and/or integrated reports. Our professors routinely dismiss questions prior to that point with comments about how we can worry about all of that later. We know this isn't true, so we're all figuring it out on our own.

 

[AcronymAllergy]

It seems to be becoming more and more commonplace for practicing psychologists to do little or no assessment in their day-to-day work, for a variety of reasons. Various graduate programs (of all qualities, outside of neuropsych) also seem to be providing fewer and fewer opportunities for testing (in part probably due to the previous point). Because of this, an absence of integrated reports may not stand out quite as much now, or 5 years from now, as it did 5-10 years ago. That doesn't abate my disappointment much, but it is what it is.

 

[Justanothergrad]

I and a number of my friends are in funded programs with small cohorts and we're being taught in this same horrible manner so it isn't just the unfunded programs with huge cohorts that are guilty of this. In my program we are routinely told that self report measures such as the BDI are considered personality assessments and if we include something like that with something like the WAIS or WMS then it creates an integrated report. We students figured out on our own this is not true and are following the APPIC definition, but it is really frustrating when our professors keep touting wrong information and insist that we just don't understand.

Internship is not discussed until the semester before you're scheduled to apply, which has forced several students to scramble last minute to find an additional practicum because of how short they are on hours and/or integrated reports. Our professors routinely dismiss questions prior to that point with comments about how we can worry about all of that later. We know this isn't true, so we're all figuring it out on our own.

The larger issue is that psychology has understudied and underutilized assessment as a core component of competency. As a result, most trainees are not ready to perform the tasks associated with this core aspect of our identity (a component that is our only unique skill and that represents our history more than any other). You're right that this is not entirely a student issue with respect to assessment training and these problems occur across programs and program types. Part of the problem falls on the field's trends in general. For instance, I've been coordinating with numerous professional agencies the last few months about the need for a national assessment training, practice, and perceptions surveys (e.g., a state of the union) and there isn't a lot of interest. Many don't even respond to my inquiry. Some of it falls on us who focus on developing assessment instruments with better and better utility (e.g., good sensitivity/specificity and behavioral prediction). That said, there are also student issuses - folks don't think it will be useful and so they don't make it a training priority in coursework and practice (there are also plenty of folks, likely as a result in my opinion, who exaggerate numbers on APPIC).

 

[temppsych123]

One comment/question - it was my understanding when I applied to internship that for an integrated report to count, you didn't necessarily have to be the person who administered the tests, but you did have to be the person who scored them, integrated the data into the report, reviewed the history and prior notes, etc. If this is the case (and I could be wrong), that might make it easier to find opportunities to write integrated reports in settings where, for whatever reason, the testing itself is given to people with more training - you can observe their testing and then write up the report, without having to administer the testing yourself. Again, don't take my word on this though, but perhaps worth investigating.

 

[Justanothergrad]

One comment/question - it was my understanding when I applied to internship that for an integrated report to count, you didn't necessarily have to be the person who administered the tests, but you did have to be the person who scored them, integrated the data into the report, reviewed the history and prior notes, etc. If this is the case (and I could be wrong), that might make it easier to find opportunities to write integrated reports in settings where, for whatever reason, the testing itself is given to people with more training - you can observe their testing and then write up the report, without having to administer the testing yourself. Again, don't take my word on this though, but perhaps worth investigating.

This is correct as I understand it. Although hopefully folks will have the chance to administer as well (you learn from it) if the site is able to provide testing services that can be utilized to shape the report.

 

[Sanman]

OP, I agree with those that say it is about damage control and selling yourself at this point. If you can get some reports, please do so. If you cannot, you are limiting yourself to those internship sites that do very little assessment. I'm not sure what your area of interest is.

As an aside, this lack of standardization is one thing that really drives me nuts about graduate training in psychology en masse. A medical school with no hands-on training in surgery would lose accreditation in a second and it would never be deemed acceptable. I don't care if their focus is family medicine. We are doing a disservice to students and the field when they get out. This and the need to make money is how you end up with crappy reports.

 

[icomeheresometimes]

At every practicum site I've been at I've tried to get an integrated report but circumstances have not allowed it to happen. Faculty in my program have been very dismissive of my concerns about not having any 4 years into the program. I have done a lot of clinical writing (well above average, the problem is the reports are all based on one instrument each) but nothing that meets the criteria for an integrated report. Getting reports is hard in my program but most people manage to get at least one site, one year that helps them get some. I have had some bad luck with practicum assignments and the opportunity has just not been available.

I'm in a research heavy program and I don't feel like faculty are looking out for me in terms of getting good clinical training. Am I really going to be okay when I apply if I don't have any?

I couldn't tell you what programs are looking for overall, but I applied for internship this year from a research-focused PhD program. Doing integrated reports is a core component of our training, and they would never let us apply for internship without 4-5 minimum. For child/family, they say at least eight. In our case, I'm based at a university that has a department clinic that does assessments for students and the community, so everyone does assessments through this clinic for a few years of their training. (There are also other practicum placements that have assessment opportunities, but they aren't necessary for everyone given that we get it through our program clinic for sure.) It does seem concerning to me that your program isn't finding a way to provide that exposure for you - I'm sorry that it's been such an ordeal. I honestly wouldn't know how to best advise you, though.

 

[LadyHalcyon]

So after reading this thread it seems my assessment training might be an anomaly. It should be mentioned I attended a 5 year program (not including internship). We had three therapy practicum and one assessment prac. The first year we just took classes. The year i was in my assessment prac (2nd year) I was required to complete 14 total integrated batteries; 6 months at a child site and 6 months at an adult site. During the 3 remaining therapy practica I was required to complete 3 integrated assessment per year. I had an intense second therapy practicum though, which required me to complete 8 (way more than the required 3). As a result, I applied to internship with 28 integrated reports and these reports were freaking no joke, like 15 to 20 pages easily. Interestingly, I've observed classes below me not being required to do as many reports as out cohort. They reduced the assessment practicum requirement from 14 reports to 10 reports. Additionally, they no longer required half the reports from a child site and half from an adult site. The rational for this decision was related to the ability of our DCT to procure assessment focused practica. I wonder if the lack of availability of assessment experiences in graduate programs is not reflective of an overall reduction in assessment within our profession. Now, in my post-doc, I bill insurance for assessments. The pay leaves much to be desired. I'm worried about how managed care will impact our profession in general, but especially in the area of psychological assement. For me, assessment is the cornerstone of not only our profession, but also of good conceptualization skills.

Sent from my SM-G950U using SDN mobile

 

[PsyDr]

Of course psychologists are able to turn a “NO” answer into two pages of responses.