Health Service Psychology Education Collaborative. Professional psychology in health care services: a blueprint for education and training

Enhancing Quality of Care Through Evidence-Based Practice: Training and Supervision Experiences

OBJECTIVE

Evidence-based practice (EBP) is the preferred approach to treatment in mental health settings because it involves the integration of the best available research, clinical expertise, and patient values to optimize patient outcomes. Training on empirically supported treatments (ESTs) in mental health settings is an important component of EBP, and supervision of therapists' implementation of ESTs is critical for therapists to develop and maintain a strong EBP skill set. This study aimed to evaluate training and supervision histories of therapists in outpatient and inpatient psychiatric care settings as an essential first step in improving patient outcomes.

METHODS

Electronic surveys were completed by 69 therapists, most of whom had a master's degree, within a psychiatry and behavioral sciences department at an academic institution. Participating therapists were recruited from several outpatient and inpatient mental health settings serving children, adolescents, and adults.

RESULTS

Although most therapists reported completing some form of EST-related coursework, a majority did not receive any supervision related to implementation of ESTs (51% for cognitive-behavioral therapy cases, 76% for dialectical behavior therapy cases, and 52% for other EST cases) during graduate and postgraduate training.

CONCLUSIONS

Although research from the past decade has supported the need for improvements in training on ESTs, and especially in supervision, problems related to limited exposure to training and supervision among therapists still exist. These findings have implications for how mental health centers can evaluate staff members' EST training and supervision experiences, training needs, and associated training targets to improve the quality of routine care.

Complementary medicine in psychology practice: an analysis of Australian psychology guidelines and a comparison with other psychology associations from English speaking countries

Background

Psychologists, and their clients, are engaging with complementary medicine (CM). Increasing evidence for CM approaches, such as improved nutrition and St John’s wort, has led to their inclusion in the Royal Australian New Zealand College of Psychiatrists clinical practice guidelines for mood disorders. This research aims to determine in what ways, and to what extent, Australian psychology regulatory bodies and associations consider CM relevant to psychology practice. Specifically, how these regulatory bodies and professional association’s ethical and practice guidelines engage with CM.

Methods

Documents from Australian regulatory bodies and professional associations, that relate to the governance or guidance of psychologists’ clinical practice, were systematically searched for key terms relating to CM.

Results

There were no direct references to CM in the 58 ethical and practice guidelines reviewed. There was also no reference to the relevance of CM to ethnocultural groups, such as Aboriginal and Torres Strait Islander traditional healing practices.

Conclusion

While other mental health care disciplines are working toward integrating CM, the discipline of psychology in Australia is not currently engaged in such developments. Given the exponential rise of CM use amongst those with mental health problems, psychology associations should consider developing resources and guidelines to assist psychologists in navigating CM in relation to clinical practice to help minimise risks, such as patient safety associated with concurrent CM use.

Systemic Challenges in Internship Training for Health-Service Psychology: A Call to Action From Trainee Stakeholders

The challenges observed in health service psychology (HSP) training during COVID-19 revealed systemic and philosophical issues that preexisted the pandemic, but became more visible during the global health crisis. In a position paper written by 23 trainees across different sites and training specializations, the authors use lessons learned from COVID-19 as a touchstone for a call to action in HSP training. Historically, trainee voices have been conspicuously absent from literature about clinical training. We describe longstanding dilemmas in HSP training that were exacerbated by the pandemic and will continue to require resolution after the pandemic has subsided. The authors make recommendations for systems-level changes that would advance equity and sustainability in HSP training. This article advances the conversation about HSP training by including the perspective of trainees as essential stakeholders.

Healthcare Quality Improvement Competency: A Clinical and Training Imperative for Geropsychology

Quality improvement (QI) work is increasingly necessary to ensure healthcare is delivered safely, efficiently, and equitably. As geropsychologists play an increasingly vital role in healthcare service delivery for older adults, it is imperative that they develop professional competence in QI, yet there is little formal QI training aimed at geropsychologists or to graduate students pursuing geropsychology. This article aims to elucidate the importance of QI education and training in geropsychology. In line with the Pikes Peak model for training in professional geropsychology, we outline QI knowledge and skills competencies for geropsychology training and suggest a rubric for integrating QI education into academic and clinical training from graduate school to professional practice. We provide recommended readings that geropsychology educators can read to become familiar with QI or use as part of a syllabus. Finally, we offer some recommendations for how current and future geropsychologists can be leaders in quality improvement work.

Patterns of Psychologists' Interprofessional Collaboration Across Clinical Practice Settings

Healthcare increasingly emphasizes collaborative treatment by multidisciplinary teams. This is the first research focusing on psychologists' participation in team-based care, the mix of professionals with whom psychologists collaborate, and how these collaborations vary across practice settings. Data are from 1607 respondents participating in the American Psychological Association Center for Workforce Studies' 2015 on-line Survey of Psychology Health Service Providers. Practice settings differed markedly in systemic organizational support for interprofessional collaboration and in psychologists' participation in collaborative activities. Psychologists in individual private practice reported least support for and least occurrence of interprofessional collaboration. Psychologists' collaboration with non-behavioral health professionals, such as non-psychiatrist physicians and nurses, was more frequent in general hospitals and VA medical centers. Across settings, greater contact with another health profession was generally associated with psychologists being more confident about working with that profession. However, for work with psychiatrists, that association was attenuated. A collaborative practice model is presented for psychotherapy patients also treated by physicians or other professionals who manage a patient's psychotropic medication.

Psychologist homicide victims: The National Violent Death Reporting System and other sources

OBJECTIVE

Homicide of healthcare workers has been reported but little is known about psychologists as victims of homicide. This study aimed to investigate what is known about homicide of psychologists.

METHODS

The Centers for Disease Control and Prevention's National Center for Injury Prevention and Control's National Violent Death Reporting System (NVDRS) provides insights into violent deaths, including homicide. This study interrogated the NVDRS and conducted Internet searches about psychologist decedents of homicide.

RESULTS

Between 2003 and 2018 the NVDRS identified 12 psychologist homicides. Internet searches revealed 15 psychologist homicides. Only three (11.1%) were known to have been killed by current or former patients. Another was by a colleague's patient. Another assailant was suspected to be a patient. We summarize patterns and circumstances of deaths, address issues related to violence in healthcare, and review selected resources addressing violence prevention.

CONCLUSION

Psychologists, like other health professionals, may be victims of homicide. Such deaths have diverse contributing factors and are rarely perpetrated by patients. As concern about health professional safety mounts and the NVDRS becomes better established, it will hopefully become a more sensitive, precise, comprehensive and useful mechanism for tracking trends in violent deaths of psychologists and other health professionals and ultimately inform preventative strategies.

Interprofessional Education: Collaboration and Learning in Action

Interprofessional education (IPE) is necessary to ensure that future health care professionals are prepared to provide holistic, patient-centered prevention programs, assessments, diagnoses, treatment plans, and chronic illness management in a collaborative manner. Accrediting bodies such as the Commission on Osteopathic College Accreditation and the American Psychological Association newly require programs to implement instruction and evaluate IPE core competency development in each year of their programs. The IPE core team at the Philadelphia College of Osteopathic Medicine has designed, implemented, and tested an IPE core course over the past 2 years that includes students in osteopathic medicine, clinical psychology, mental health counseling, and physician assistant programs. Throughout this process, the IPE core team has identified strengths, weaknesses, opportunities, and challenges. Cultural considerations, institutional resources, pedagogy for large interdisciplinary groups at different stages of training, and technology and assessment tools for student and course evaluation are all critical considerations.

Integrated Behavioral Health Curriculum in Counseling Psychology Training Programs

Effective training in integrated behavioral health requires systematic, interprofessional education that is anchored in competencies. We describe core learning objectives, competencies, and strategies for assessing counseling psychology trainees in integrated health care settings. Two programs that have transformed their training to emphasize interprofessional and primary care competencies of psychological practice are presented, along with their training goals and didactic and experiential curricular activities. We describe the assessment of student learning, accompanied by program adjustments implemented to improve student outcomes. We conclude with a call for counseling psychologists to ensure student competency development as members of the interprofessional health care workforce.

Applying Task Force Recommendations on Integrating Science and Practice in Health Service Psychology Education

The proper role of research skills and training to conduct research in professional psychology education has been controversial throughout the history of the field. An extensive effort was undertaken recently to address that issue and identify ways the field might move forward in a more unified manner. In 2015, the American Psychological Association (APA) Board of Educational Affairs convened a task force to address one of the recommendations made by the Health Service Psychology Education Collaborative in 2013. That recommendation stated that the education and training of health service psychologists (HSPs) include an integrative approach to science and practice that incorporates scientific-mindedness, training in research skills, and goes well beyond merely "consuming" research findings. The task force subsequently developed recommendations related to the centrality of science competencies for HSPs and how these competencies extend beyond training in evidence-based practice. This article discusses the findings of the task force and the implications of its recommendations for education and training in HSP. The challenges and opportunities associated with implementing these recommendations in HSP graduate programs are examined.

Comparing Agency Leader and Therapist Perspectives on Evidence-Based Practices: Associations with Individual and Organizational Factors in a Mental Health System-Driven Implementation Effort

Agency leaders and therapists are essential stakeholders in implementation of evidence-based practices (EBPs) within publicly-funded mental health services. Little is known about how these stakeholders differ in their perceptions of specific EBPs and which individual and organizational factors differentially influence these perceptions. Within the context of a system-driven implementation of multiple EBPs, survey data from 160 leaders and 720 therapists were examined to assess differences in perceptions of six EBPs. Findings indicated that leaders and therapists have unique perspectives and preferences regarding EBPs that are shaped by distinct sociodemographic and professional characteristics and aspects of organizational functioning.

Education and Training in Clinical Neuropsychology: Recent Developments and Documents From the Clinical Neuropsychology Synarchy

The Clinical Neuropsychology Synarchy (CNS) interfaces with the American Psychological Association and affiliated organizations to address issues and advances in specialty training. The past several years have seen the development and dissemination of several initiatives pertinent to specialty training. Among these initiatives was the creation of a taxonomy for education and training in clinical neuropsychology. In additional there has been a movement towards competency-based education that has become codified in the APA’s new Standards for Accreditation. Calls for competency-based education have also influenced the expectations of the APA’s Committee on Recognition of Specialties and Proficiencies in Professional Psychology. As the convener of national clinical neuropsychology organizations the CNS has overseen the development of relevant documents for our specialty. This paper presents three documents critical to training in our field that were developed through the CNS and approved by its member organizations. The first is the Taxonomy for Education and Training in Clinical Neuropsychology. The second is Entry Level Competencies for Clinical Neuropsychology and the third is a distillation of the entry-level competency document for the purpose of identifying competencies to be addressed at the post-doctoral residency level.

Interprofessional Education: Opportunities and Challenges for Psychology

This manuscript is an outgrowth of an invited panel presentation at the national Association for Psychologists in Academic Health Centers Conference in 2017 on Interprofessional Education (IPE). IPE is a structured and transformative educational strategy designed to provide active learning experiences where trainees from diverse healthcare professions gain shared content knowledge plus collaboration skills as they learn about, from, and with each other. Collaboration skills include understanding professional role distinctions and overlap, effective team-based communication, shared values/ethics and respect for each other's expertise, and teamwork dynamics. It is increasingly important to expand training beyond the intraprofessional activities in which psychology trainees engage to prepare them to participate in interprofessional collaborative care. As healthcare systems move to team-based collaborative practice and value-based reimbursement models, the profession of psychology needs leaders at every academic health center to facilitate the design and/or implementation of IPE activities. The panel of psychologists presented roles that psychologists play in IPE institutional program design and implementation, graduate training programs, and the perspectives of an early career psychologist and psychology trainee. Opportunities and challenges are highlighted, culminating in a call to action. Psychologists must embrace their identity as health professionals and engage their learners in IPE so that the emerging cognitive schemata of healthcare that is developed includes the profession of psychology. Otherwise, healthcare teams and health professionals will not understand the value, roles, or potential contributions of psychologists in enhancing patient care outcomes, ultimately jeopardizing psychologists' referrals, involvement in healthcare delivery, and career opportunities.

The multidisciplinary pediatric psycho-oncology workforce: A national report on supervision for staff and training opportunities

OBJECTIVE

This paper presents data on licensure/certification status, supervision of multidisciplinary pediatric psychosocial staff, and training opportunities in pediatric cancer programs in the United States, data that are critical to provide care aligned with the Standards of Psychosocial Care in Pediatric Cancer (Psychosocial Standards).

METHODS

An online survey of psychosocial care consistent with the Psychosocial Standards was completed from a national sample of pediatric cancer programs (144/200). Licensure/certification status, availability and format of supervision for multidisciplinary staff (social workers, psychologists, psychiatrists, child life specialists/recreational therapists), and types and number of psychosocial trainees were reported.

RESULTS

Nearly all pediatric psychosocial providers were licensed/certified. Peer consultation was the most frequently endorsed form of staff supervision although a sizeable group of centers reported no systematic ongoing supervision. Trainees in social work and child life were most common although the size of trainee cohorts is generally small. Psychosocial trainees are more prevalent in sites with pediatric hematology/oncology medical fellowship programs and in larger programs.

CONCLUSIONS

A properly trained and supported psychosocial workforce is essential to providing evidence-based care consistent with the Psychosocial Standards. Psychosocial providers are appropriately licensed. However, supervision opportunities are variable and may be inadequate for the intensity of the work. It is important to address the limited opportunities for trainees in pediatric cancer programs, which may influence the pipeline for ongoing and future work in this area.

Leadership Perspectives on Integrating Psychologists into Specialty Care Clinics: An Evolving Paradigm

Integration of health psychologists into specialty care is a shift in the tertiary care construct that addresses all aspects of a patient's presentation, including psychiatric/social history, psychological well-being, and behavioral contributions to the disease process, assuring both optimal health outcomes and cost-effectiveness in a financially challenging healthcare environment. In this paper, we discuss leadership perspectives (physician and psychologists) on the factors involved in integrating a health psychologist into a busy tertiary care environment. Ultimately, we hope that this information provides a primer on how to frame a proposal for an integrated health psychologist emphasizing the elements important to senior medical leadership and administration. First, we briefly discuss the current payer framework, providing support for integration emphasizing costs and other metrics. Second, we introduce organizational structure models and strategies for integration. Lastly, we will discuss the unique skillset psychologists possess, and additional skills necessary, to be effective in the changing landscape of healthcare. We think this information is important both for leaders attempting to integrate a health psychologist into specialty care and for the early career health psychologist embarking on his/her first senior staff position.

Quality Improvement in Health Care: The Role of Psychologists and Psychology

Quality Improvement (QI) is a health care interprofessional team activity wherein psychology as a field and individual psychologists in health care settings can and should adopt a more robust presence. The current article makes the argument for why psychology's participation in QI is good for health care, is good for our profession, and is the right thing to do for the patients and families we serve. It reviews the varied ways individual psychologists and our profession can integrate quality processes and improve health care through: (1) our approach to our daily work; (2) our roles on health care teams and involvement in organizational initiatives; (3) opportunities for teaching and scholarship; and (4) system redesign and advocacy within our health care organizations and health care environment.

Core competencies in clinical neuropsychology training across the world

OBJECTIVE

This work aimed to review main competency requirements from training models in countries with well-established specialties in clinical neuropsychology and to extract core competencies that likely will apply to clinical neuropsychologists regardless of regional and cultural context.

METHOD

We reviewed standards for post-graduate training in clinical neuropsychology from countries in Europe, Australia, and North America based on existing literature, presentations at international conferences, and from description of the training models from national psychological or neuropsychological associations.

RESULTS

Despite differences, the reviewed models share similar core competencies considered necessary for a specialty in clinical neuropsychology: (1) In-depth knowledge of general psychology including clinical psychology (post-graduate level), ethical, and legal standards. (2) Expert knowledge about clinically relevant brain-behavioral relationships. (3) Comprehensive knowledge about, and skills in, related clinical disciplines. (4) In-depth knowledge about and skills in neuropsychological assessment, including decision-making and diagnostic competency according to current classification of diseases. (5) Competencies in the area of diversity and culture in relation to clinical neuropsychology. (6) Communication competency of neuropsychological findings and test results to relevant and diverse audiences. (7) Knowledge about and skills in psychological and neuropsychological intervention, including treatment and rehabilitation.

CONCLUSIONS

All the models have undergone years of development in accordance with requirements of national health care systems in different parts of the world. Despite differences, the common core competency requirements across different regions of the world suggest generalizability of these competencies. We hope this summary can be useful as countries with less established neuropsychology training programs develop their models.

Society of Counseling Psychology Leadership Academy: Cultivating Leadership Competence and Community

The Society of Counseling Psychology Leadership Academy is a year-long program designed to engage and develop student and early career psychologist leaders in counseling psychology. As a division of the American Psychological Association, the Society of Counseling Psychology is part of a nonprofit professional organization that seeks to recruit and retain members as well as to develop talent to meet future organizational leadership needs. This article describes the history of the Leadership Academy, its conceptual foundations, curriculum and program components, and associated implementation processes. We discuss how we utilized results of a formative program evaluation to improve the program over time. Outcomes associated with three cohorts of the Leadership Academy suggest that the program was largely effective in achieving its functional goals. Conclusions and recommendation for leadership development and research are discussed.

Expanding the geriatric mental health workforce through utilization of non-licensed providers

OBJECTIVES

We evaluate policy and practice strategies for bolstering the geriatric mental healthcare workforce and describe costs and considerations of implementing one approach.

METHOD

Narrative overview of the literature and policy retrieved from searches of databases, hand searches, and authoritative texts. We identified three proposed strategies to increase the geriatric mental healthcare workforce: (1) production of more geriatric mental health providers; (2) team-based care; and (3) non-licensed providers. We evaluate each in terms of challenges and potential and provide estimates of costs, policy, and practice considerations for training, employing, and supervising non-licensed mental health providers.

RESULTS

Use of non-licensed providers is key to reforms needed to allow a more older adults to access necessary mental healthcare. Licensed and non-licensed providers have achieved similar improvements for generalized anxiety disorder among patients, although non-licensed providers did so at a lower cost.

CONCLUSION

Supervised non-licensed providers can extend the reach of licensed providers for specific mental health conditions, resulting in lower costs and increased number of patients treated. Although several barriers to implementation exist, policy and infrastructure changes that may support this type of care delivery model are emerging from reforms in financing and associated delivery initiatives created by the Affordable Care Act.

The Evolution of Psychology as a Basic Bio-behavioral Science in Healthcare Education

For over a century, researchers and educators have called for the integration of psychological science into medical school curricula, but such efforts have been impeded by barriers within medicine and psychology. In addressing these barriers, Psychology has re-examined its relationship to Medicine, incorporated psychological practices into health care, and redefined its parameters as a science. In response to interdisciplinary research into the mechanisms of bio-behavioral interaction, Psychology evolved from an ancillary social science to a bio-behavioral science that is fundamental to medicine and health care. However, in recent medical school curriculum innovations, psychological science is being reduced to a set of "clinical skills," and once again viewed as an ancillary social science. These developments warrant concern and consideration of new approaches to integrating psychological science in medical education.

Psychologists in Academic Health Centers and Medical Centers: Being Visible, Relevant and Integral

Psychologists play key roles in academic health centers. This article is an outgrowth of a presentation at the 2015 Conference of the Association of Psychologists in Academic Health Centers addressing various strategies by which psychologists can effectively adapt to and develop successful careers in medical schools, academic health centers, and teaching hospitals. The authors encourage early career and mid-career psychologists in academic health centers to be active, engaged members of their institutions and to participate in multiple aspects of the research, educational, and clinical missions.

Psychology Student Experience of a Brief, Interprofessional Team Training

Healthcare providers, including psychologists who work as health service providers and with older adults, must be able to work effectively with professionals from other disciplines. Interprofessional education (IPE) engages students from two or more professions to learn collaboratively. To date, only a few studies have examined psychology student involvement in IPE. This article describes the experience of clinical psychology (Psy.D.) doctoral students ( N = 59) who attended a brief, interprofessional (IP) team training. Results of paired-samples t-tests suggest that there was an increase in self-reported positive attitudes about healthcare teams and skills related to working in IP teams from pretest to posttest. Hence, the training may facilitate the development of attitudes necessary for interprofessional competency and provide an opportunity to practice skills central to IP collaboration and team work which are essential for psychologists working in today’s healthcare environment. This experience may serve as a model for psychology programs seeking to expose students to brief, IP, team-based learning.

Interprofessionalism and the Practice of Health Psychology in Hospital and Community: Walking the Bridge Between Here and There

Interprofessionalism is a cornerstone for health care reform and is an important dimension for success for the practice of professional psychology in integrated care settings, whether in academic health centers, ambulatory clinics, or in independent practice. This article examines salient skills that have allowed the author to practice in both primary and tertiary health care settings, as well as in academic health centers and independent community practice. The scientist practitioner model of professional psychology has served to guide the author as a "roadmap" for successful collaborative, integrated care in the changing health care environment. The author emphasizes that marketing of health services in professional psychology is crucial for achieving the goals of interprofessionalism, and to secure a role for professional psychology in health care reform. Future challenges to psychology in health care are discussed with implications for training and practice.

Psychologists' Contributions to Patient-Centered Medical Homes

Mounting evidence supports the value of integrated healthcare and the need for interprofessional practice within patient-centered medical homes (PCMH). Incorporating behavioral health services is key to fully implementing the PCMH concept. Unfortunately, psychologists have not been front and center in this integrative and interprofessional care movement nor have they typically received adequate training or experience to work effectively in these integrated care programs. This article builds the case for the value of PCMHs, particularly those that incorporate behavioral health services. Attention is paid to the diverse roles psychologists play in these settings, including as direct service providers, consultants, teachers/supervisors, scholars/program evaluators, and leaders. There is a discussion of the competencies psychologists must possess to play these roles effectively. Future directions are discussed, with a focus on ways psychologists can bolster the PCMH model by engaging in interprofessional partnerships related to education and training, practice, research, and leadership.

Commentary: The Wright Ross Salk Award: Worker Bees and Benefits to the Hive: Service Contributions to the Profession and Society of Pediatric Psychology

This article reflects on service contributions upon receiving the 2016 Society of Pediatric Psychology Wright Ross Salk Distinguished Service Award. As the title implies, worker bees make service contributions for the overall benefit of the hive and colony. So too, the scientific discipline, clinical profession, and the Society of Pediatric Psychology need the service contributions of multiple individuals to survive and thrive. Many people have made professional contributions to benefit the field and its organizational home; many more worker bees will volunteer in the future to fill important service roles and sustain the hive. The article discusses lessons learned about service.

Training for Research and Teaching in Geropsychology: Preparing the Next Generation of Scholars and Educators

For geropsychology to flourish in the years ahead, we need scientists to advance knowledge and teachers to draw new professionals into the field. In this project the authors surveyed 100 geropsychologists who completed a doctoral degree in clinical or counseling psychology about their experience with training for research and teaching. The majority were currently conducting some degree of research (38%) and some form of teaching (45%). The majority of ratings for components of research training were in the "very good to excellent" range, whereas elements of teacher training were rated in the "poor to good" range, though there was variability among persons and components. Qualitative comments revealed enthusiasm for research and teaching roles and a need to enhance our training of geropsychologists as educators. The authors provide several suggestions that could enhance research and teacher training for current and future students of professional geropsychology.

Educating the Psychology Workforce in the Age of the Affordable Care Act: A Graduate Course Modeled after the Priorities of the Patient-Centered Outcomes Research Institute (PCORI)

The Affordable Care Act (ACA) represents a paradigm shift in the U.S. healthcare system, which has implications for psychology programs producing the next generation of trainees. In particular, the ACA has established the Patient-Centered Outcomes Research Institute (PCORI), which has been tasked with developing national priorities and funding research aimed at improving healthcare quality by helping patients and providers to make informed healthcare decisions. PCORI's national priorities span five broad domains: person-centered outcomes research, health disparities research, healthcare systems research, communication and dissemination research, and methodologic research. As these national priorities overlap with the knowledge and skills often emphasized in psychology training programs, initiatives by training programs to bolster strengths in these domains could place trainees at the forefront of this emerging research paradigm. As a part of a new Masters program in behavioral health, our program developed a health psychology course modeled around PCORI's five national priorities, and an initial evaluation in a small sample supported student learning in the five PCORI domains. In summary, the current report has implications for familiarizing readers with PCORI's national priorities for U.S. healthcare, stimulating debate surrounding psychology's response to the largest healthcare paradigm shift in recent U.S. history, and providing a working model for programs seeking to implement PCORI-related changes to their curricula.

Healthcare Reform and Preparing the Future Clinical Child and Adolescent Psychology Workforce

The healthcare environment is undergoing important changes for both patients and providers, in part due to the Patient Protection and Affordable Care Act (ACA). Ultimately the healthcare delivery system will function very differently by the end of this decade. These changes will have important implications for the education, training, scientific inquiry, and practice of clinical child and adolescent psychologists. In this article we provide a brief description of the fundamental features of the ACA, with a specific focus on critical components of the act that have important, specific implications for clinical child and adolescents psychologists. We then provide recommendations to help position our field to thrive in the evolving healthcare environment to help facilitate further awareness and promote discussion of both challenges and opportunities that face our field in this evolving health care environment.

Professional psychology competency initiatives: implications for training, regulation, and practice

Psychology in the United States has struggled with defining and specifying competencies for the practice of psychology since the Boulder Conference of 1949 outlined the first training model for graduate programs in psychology. Competency was largely defined by types of experiences and “seat time” until 1986, when the first major competency model in professional psychology in the United States was proposed. By 2000, discussions about the competencies had begun in earnest, and since that time, psychology’s focus on competencies has intensified, resulting in a shift away from a model of training that involved tracking the number of hours spent learning specific knowledge or skills to a “culture of competence” that emphasizes outcome, that is, the acquisition of the essential knowledge and skills. In order to develop this culture, competence must first be defined and described. A number of efforts to do so have been completed, initially resulting in a confusing array of different models or perspectives. Over time, however, the models have become more refined and similar in their structure and framework. This article provides an overview of these efforts and discusses the next steps in the implementation of a competency model that is comprehensive enough to be useful, but simple enough to be used. The implications of the competency development process for training, practice, and regulation are discussed.

Twenty years of the Journal of Clinical Psychology in Medical Settings: we hope you will enjoy the show

The 20th anniversary of the Journal of Clinical Psychology in Medical Settings is celebrated by highlighting the scientist-practitioner philosophy on which it was founded. The goal of the Journal-to provide an outlet for evidence-based approaches to healthcare that underscore the important scientific and clinical contributions of psychology in medical settings-is discussed. The contemporary relevance of this approach is related to the current implementation of the Patient Protection and Affordable Care and its focus on accountability and the development of an interprofessional healthcare workforce; both of which have been foci of the Journal throughout its history and will continue to be so into the future. Several recommendations of future topic areas for the Journal to highlight regarding scientific, practice, policy, and education and training in professional health service psychology are offered. Successfully addressing these topics will support the growth of the field of psychology in the ever evolving healthcare system of the future and continue ensure that the Journal is a key source of professional information in health service psychology.