Expanding Internship Models: Half-time, Captive, Consortia, and Others Panel Presented at APA s Convention Washington, D.C.

Transcription

1 Expanding Internship Models: Half-time, Captive, Consortia, and Others Panel Presented at APA s Convention Washington, D.C., August, 2005 Much of this work was done under the auspices of the Clinical Training Task Force of the Education and Training Committee of NCSPP Task Force Members were Lorraine Mangione, Ph.D., Leon VandeCreek, Ph.D., Luli Emmons, Ph.D., Lavita Nadkarni, Ph.D., John McIlvried, Ph.D., and Doug Carpenter, Psy.D. Emil Rodolfa, Ph.D., joined us as a discussant for the panel.

2 Expanding Internship Models: Half-time, Captive, Consortia, and Others Lorraine Mangione, Ph.D. Antioch New England Graduate School Many changes in the training and service landscape have occurred since internships were first instituted, particularly the diversification of our nation and profession and along with it psychology s commitment to diversity, the large numbers of students, including women and ethnic/racial minorities, entering psychology, the development of professional psychology, issues of internship supply and demand, and the concept of competency evaluation. Given this context, how do we open things up, become more creative and innovative in our thinking about internships? How do we take into account present realities while holding onto our commitment to quality? This symposium offers ideas around types and structures of internships that could be translated to other settings, evaluation and quality of training, and enhancing the number and breadth of internships. The presentation draws from two inter-related sources, a qualitative study of alternative internships done by the Clinical Training Task Force of NCSPP, and from a conference convened this year by the California Psychology Internship Council called The Half-Time Internship: Coming Into the Mainstream. We are defining alternative internships as those that have developed out of the mainstream tradition of an internship structure, totally separate and autonomous from any doctoral program. However, alternative does not imply accreditation status.

3 Alternative Internship Models: Using Creativity to Benefit Students and Community Leon VandeCreek, Ph.D. Wright State University I will describe two examples of unique internships that could be duplicated by other doctoral programs. In each case, a doctoral program, rather than a community agency, operates the internship. The Non-Captive Model at Wright State University This internship is unique in that it is operated by a doctoral program (School of Professional Psychology at Wright State University). It follows a practitioner model of training. It is not a captive internship. Rather, its internship positions are open for national competition. The internship does not hold slots open for students from the doctoral program, although in most years one or more of the seven slots are filled by a local student. The program currently offers seven training slots, with a stipend of $18,000. All interns must work 50% of time (either 6 months full-time or 12 months half-time) in one of the doctoral program s two training centers and each intern must work in one of five other community sites. External sites are quite stable over time and include both inpatient and outpatient settings. External settings contribute half of the stipend and the doctoral program contributes the other half. The doctoral program coordinates and manages the didactic component and it hires the director of the internship program. The doctoral program also coordinates and funds the costs of APPIC membership and APA accreditation. However, variations in the proportion of costs that are borne by the doctoral program are certainly possible. The strengths of this model are that it is operated by a doctoral program that has sufficient resources to manage the didactic portions of the internship and it accepts students from around the country. Interns are able to participate in relevant activities of the doctoral program, such as serving as supervisors of practicum students and teaching assistants in doctoral courses. Challenges for this model of internship include needing sufficient resources to fund the management of the internship and the accreditation costs, although these costs could also be shared by all participating training sites. A sufficient number of training sites must also be available in the community and each must be willing and able to share in the costs to some degree. Advantages to the doctoral program include the availability of intern-level trainees who take on more substantial training, teaching, and service roles in the training clinics and courses.

4 Integrated Half-Time Internships This type of internship is also operated by the doctoral program. Widener University developed this type of internship when its doctoral program began and a small number of other doctoral programs have developed similar programs. In this model, the student participates in internship activities during the last two years of doctoral training, on a half-time basis. The student has previously completed practicum-level training. The doctoral program coordinates and manages the internship program. Only the doctoral program s students participate in this internship although students from other doctoral programs may be completing their internship at an agency at the same time. All of the doctoral program s student must participate in this integrated, half-time internship program. The two year-long placements for each student are coordinated by the doctoral program so that the internship experience is integrated across the two years and with doctoral coursework. Advantages of this model include that students do not apply for an external internship at the end of their doctoral work. Rather, they are accepted into the doctoral program and into the internship system at the same time. Students do not need to apply separately for internships, except internally within the doctoral program, and they do not move away from the community or the doctoral program for internship. A related advantage to this model is that the doctoral program oversees the placement and performance of each student from the beginning of doctoral work through the end of the internship. The doctoral program is in a unique position to craft the best clinical training for each student from beginning to end. A challenge is that this model requires that the local community be relatively rich with training resources in that students are placed in practicum sites and internship sites in the local community. It is likely that a small community could not support such a model of training. A related challenge is that in order for the internship to be APA accredited and APPIC listed, the doctoral program must demonstrate that internship-level work is distinctive and different from practicum-level work, especially when the placements are in the same agencies.

5 Alternative Internship Models: Using Creativity to Benefit Students and Community Lavita Nadkarni, Ph.D. University of Denver-Graduate School of Professional Psychology I II Three training relationship configurations o Integrated characterized by arrangements that require students to take coursework in their graduate program concurrent with internship training. o Allied - characterized by university faculty providing the didactic and administrative component. o Independent includes the more traditional form of internship. Exclusively affiliated consortium model at University of Denver-GSPP Rationale for development of consortium Student and program needs o For students, relocation disruptive due to family situation o For students, they had developed career opportunities during graduate school o From the program s view, an increase in students who only applied to local sites resulted in a reduction in internship matches Description of the consortium diversity of sites 6 sites, including HMO, university counseling center, community mental health center, forensic sites number of students 11 students, with one half-time position Stipend - $18,000 at each site, including benefits APA accreditation Shared governance of internship by sites and graduate program internship director is core faculty sites and university faculty co-lead weekly seminars administrative assistance is provided by program sites provide required weekly supervision Communication and coordination between sites contracts renewed on yearly basis day long orientation, conducted by site supervisors and faculty periodic site visits

6 end of year retreat with site supervisors and university faculty Advantages of the model for internship sites/doctoral program better meeting student needs in terms of diversity of training and desire to remain in area site benefits include collegiality, administrative benefits, APA accreditation, shared resources graduate program benefits include closer monitoring, greater faculty involvement, increasing diversity of student body Challenges for the model for internship sites/doctoral program site concerns about inbreeding, lack of diversity, having to accept problematic students, but concerns not realized student concerns about selection process, competition among students internship director challenges about coordination among different sites III APPIC affiliated consortium model at Argosy University/Honolulu Rationale for development of consortium provide an APPIC-affiliated training program for AU/H students who were not placed in APA-accredited internships or other APPIC sites Description of the consortium 10 sites, vary by year 14 students, all Argosy/Honolulu students minimum stipend of $6,000; varies by site APPIC membership Governance between doctoral program and sites Argosy provides weekly supervision and weekly training seminar Sites enter into a formal written agreement with Argosy Advantages of consortium model Provides internship training as there are limited number of APA sites in Hawaii students experience diverse cultural training opportunities Challenges of consortium model implementation of coordination between sites

7 lack of interaction between sites due to isolation of some sites; lack of cohort IV Receiving Grant to fund consortium model internship Heart of America Psychology Training Consortium Rationale for development bridge the gap between the increasing mental health needs and the severe shortage of mental health professionals in rural Missouri. Description of consortium collaborative partnership between Forest Institute of Professional Psychology, Royal Oaks Hospital and the Work Force Development Board of Western Missouri, Inc. mental health service centers throughout the state of Missouri focused on rural psychology and integrated health care training for 15 interns Governance between doctoral program and sites Board of Directors Training Committee with one supervisor from each site Internship Training Director from Forest Advantages of consortium model servicing rural communities providing diverse training opportunities for students increasing involvement of graduates to work in rural communities Challenges of consortium model seeking APA accreditation grant funding will expire, so need other sources of funding V.Independent model of internship Wright Institute s relationship with CAPIC Wright Institute was involved in the creation of CAPIC in 1991 as the school had developed a relationship between the internship community and the doctoral program. Wright Institute is seen as a hub for the community. The partnership with the sites included library privileges, free continuing education for the staff, and other resources.

8 The Half-Time Internship: Coming Into the Mainstream Luli Emmons, Ph.D. California Psychology Internship Council This talk raised some of the questions about the need for new internship models and suggested some answers. Many of these ideas came out of the first national conference on half-time internships, The Half-Time Internship: Coming Into the Mainstream, hosted by CAPIC in April As a regional membership association of doctoral programs and California internships, CAPIC provides quality assurance and information services to students, doctoral and internship programs. CAPIC-member internships meet the state licensing requirements for internship, but most are neither APA-accredited nor members of APPIC. Last year 75%, or 539 internship positions, of member programs were half-time. The half-time internship is not a new model of training in psychology. Over the last two decades, however, it has become less common than the full-time internship model. Last year less than 2% (48) of APPIC internships were half-time, down from nearly 5% ten years ago. Yet APA guidelines and principles do not discourage the development of half-time internships. The guidelines and principles endorse experimentation and flexibility within the same quality assurance safeguard as full-time internships. Despite the general trend, the half-time internship has worked well as a successful training structure in some regions of the U.S. and for specific client and student populations. In California, the half-time internship is a well-established training model. California s success with and dependence on half-time internships suggests an important potential and need for psychology training in the rest of the country and has raised some questions and concerns. Within CAPIC we have been concerned that mainstream psychology is not benefiting from many of the advantages half-time internships have to offer. Another concern is the perception of a two-tiered training structure. Are the students choosing to be trained in these settings being marginalized by this perception? At the recent CAPIC conference, The Half-Time Internship: Coming Into the Mainstream, representatives of 23 national organizations joined doctoral and internship programs to address these concerns, and to further develop models of half-time internship training, as well as to identify obstacles to their acceptance and inclusion in mainstream psychology, and to propose solutions and to ultimately propose solution and action steps for stakeholders in psychology education. Conference delegates addressed a number of fundamental questions including: Why do we need or want this type of internship in psychology? We need to increase the range of options for trainees. Diverse trainees need diverse training activities, and for those with family and work obligations, especially, the half-time internship is crucial. For those impacted by the supply and demand crisis in predoctoral internship

9 training, the recognition and development of this model is one important solution. Conference delegates identified benefits of these internships across the board, to trainees, doctoral programs, training sites, the profession, and the community. For example, extending training over a longer time allows the opportunity for the trainee to get more exposure to different supervisors, diverse and underserved populations, service delivery models and systems, and the choice to stay in the local community for their internship. Half-time internships often accept students from local doctoral programs. Close proximity to the doctoral program is beneficial to the training site as well. Internship quality can be monitored and assured best when there is open communication among academic programs, student/interns, internship staff, and perhaps external, third-party reviewers, such as CAPIC. Often based in community settings, these internships provide needed mental health services for underserved populations often seen by agencies that cannot afford to support full-time paid internship programs. How do we regard and evaluate the half-time internships that already exist, most of which are not accredited? We have found there are a lot of misunderstandings and a lack of knowledge about the different half-time models. For example, many programs not know how to include half-time internships with full-time internships at the same site, or how to make sure half-time internships meet APA accreditation criteria. Negative perceptions of half-time internships present an obstacle to the development of more. Because half-time internships often encounter difficulty in meeting some policies of APA accreditation, APPIC, and/or state licensing boards, these internships may not be as highly perceived or sought after as accredited ones. There is a serious problem with lack of funding for many half-time internships. Community sites often lack the resources to provide stipends. The lack of stipends is a major reason for not seeking APA-accreditation. How do we overcome these obstacles and how can we develop more half-time internships? Much can be done on a national and regional level to encourage the creation of half-time internships for the predoctoral training pool and to support the organization, quality assurance, and accreditation of half-time internships. A first step is to develop common terminology for describing the variety and range of these programs. Education is needed, particularly planning and implementation tools for training directors. We need to carefully review APA, APPIC and licensing board policies to determine if they do, in fact, present obstacles to the creation of halftime internships and determine if changes can be made. For example, the APA Committee on Accreditation could consider dual accreditation for a program with an integrated internship. In response to the conference, APPIC is proposing modifications of requirements for the number of interns and hours of individual supervision at half-time sites. Finally, we can develop more regional organizations like CAPIC, or like the Arizona Training Consortium, to complement the work of national organizations like

10 APPIC and ACCTA. The advantages of local organizations are many. Knowledge of local resources, politics, people and culture is conducive if not critical to effective collaboration and development of regional and community training sites. We can consider exporting these models to other regions where the demand for half-time internships is high and the benefits to the community would be great. These are just a few of the benefits, obstacles, and solutions related to the halftime internship model. Many of us know from personal experience how much these internships help psychologists contribute to the common good. We know that they attract diverse students to the psychology profession, people inspired to provide socially responsive services, and help us address widespread problems with psychology training. I hope you ll agree that this is an issue worth working on.

11 Quality and Inequality: The Changing Landscape of Internship Training John McIlvried, Ph.D. University of Indianapolis This paper discussed quality assurance for internship training, and reported on findings about quality assurance at a sample of academic institutions that utilize alternative internship sites. Alternative internships are defined as those that have grown up outside of the main tradition of internships as separate, independently operated programs (i.e., primarily non-apa/appic internships). The notion of quality assurance is inextricably embedded in one s paradigm and set of valuative assumptions. With respect to quality assurance, one s paradigm and model dictate what content will be examined, what sources of data are viewed as legitimate, what methods are acceptable for collecting data, and what timeframe is utilized in evaluating outcomes. Thus, it should be recognized that quality assurance procedures for evaluating internships are not neutral. In the more traditional approach to internship training, graduate programs send their students off to complete the internship, and rely on APA or APPIC to ensure that some minimal level of acceptable training will occur because of the quality assurance mechanisms that APA and APPIC represent. Internship programs that are not APA approved or APPIC members become suspect as to their quality, and are typically not recommended or accepted by the students graduate department or school. Despite the implied inequality between internships, these alternative internships are becoming more frequently used and warrant closer examination. Our study found that academic institutions that utilize alternative internships had a variety of policies and procedures in place to ensure that these internship sites met certain minimum criteria for quality training (e.g., processes in place for supervision, communication, evaluation, problem resolution, etc.). Quality assurance mechanisms used by academic institutions included routine meetings with site supervisors and students, site visits, direct involvement in aspects of internship training by faculty from the academic institution, regular review of contracts with the site regarding an agreement to meet specific criteria, interns written evaluations of the site, supervisors written evaluation of interns, etc. A common theme across the various academic institutions was that utilization of alternative internships was accompanied by a greater degree of regular contact and involvement with the training site to monitor and/or augment the quality of training provided. A number of conclusions and recommendations emerged from this study: 1. Quality assurance is not a unidimensional enterprise, to be accomplished in only one way for all internships. There are multiple pathways and methodologies to

12 assure quality training, and which ones are best depend on a number of factors and valuative assumptions. Since no single picture of an internship is representative of all programs, consequently no single approach to quality assurance will necessarily be valid for all sites. We must therefore approach quality assurance in a flexible yet rigorous fashion. 2. Quality internship training must become more sensitive to contextual factors including the emotional, financial, and interpersonal costs borne by students who are faced with relocation, loss of income, and disruption of family/social responsibilities in order to complete many internships. Additionally, quality internship training should provide greater opportunities for interns to become better trained to deal with diverse and underserved client populations. 3. Quality internship training emphasizes the importance of a lattice of collaborative relationships between educational programs, internship training sites, and various institutions and agencies (hospitals, CMHC s, counseling centers, etc.). This requires greater communication and involvement between academic programs and internship training sites. 4. Quality internship training ensures that outcomes and competencies are assessed, and that multiple feedback loops are built in so that data are analyzed and utilized to modify training. We need to do a better job at specifying and measuring outcomes and competencies. Educational programs need to demonstrate a greater continuity of training where they take greater responsibility for working with internship programs to measure performance and use this information to improve their graduate training. We also need to allow greater latitude for sites to demonstrate alternative ways that they ensure quality training has occurred, lest we fall back into the checklist mentality of measuring quality and accreditation. 5. Quality internship training is planful, and specifies processes and administrative structures necessary to successfully conduct the program. All internship programs (regardless of whether they are APA, APPIC, CAPIC, or none of these) should have policies and procedures in place for evaluation of interns, handling problems and remediation, guidelines for supervision, communication and feedback mechanisms, etc.)

13 Discussion of Unique Internship Models Papers Emil Rodolfa, Ph.D. University of California, Davis, Counseling and Psychological Services These were very interesting papers and hopefully will encourage our profession to consider creative and innovative models of training. I want to make three major points: First, there is a problem a bottleneck in the sequence of training. These thoughtful papers on internship models led me to take a look at the numbers: a. In , APPIC reported that there were 588 sites with 2606 full time and 44 half-time internships; (76%) programs were accredited with (84%) slots. b. In , APPIC reported that there were 589 sites with 2581 full time and 26 half-time internships; (76%) of the programs were accredited and (84%) of the slots were accredited. A decrease of about one percent overall and a 3% decrease in accredited programs. c. During the 2001 APPIC Match, there were 2,947 applicants and 2,763 positions, an imbalance of 184 more applicants than slots. During the most current match, there were 3,117 applicants and 2,757 an imbalance of 360 more applicants than sites. 12% of the applicants seeking an internship placement did not achieve their goal. Some small percent are not really ready to go out, but that number is not 12%. Clearly there is a problem in the supply and demand for internship. But what are we going to do about it? This is a bigger problem than just a problem of numbers. I also think it is important to say that our profession should not be driven by the number of internship slots. The number of internship slots is not related to the question of how many psychologists our nation needs. APA s efforts to conduct a workforce analysis should be acknowledged. I want to applaud the presenters for the steps they are taking to deal with this issue: 1. They have organized a national conference to examine half-time internships. 2. They have organized a number of creative internship programs into an association. 3. They have supported the enhancement of mental health in local and regional areas through the development of half-time internships. 4. They have helped build an association that is beginning to increasingly focus on half-time internships. 5. They are examining how to assess quality in training. 6. They highlighted the relationship between the internship and the academic program when describing the captive internship. This is clearly a relationship that needs to be enhanced. Second, there is a lack of clarity about the sequence of training. What is the sequence of training to develop a professional psychologist? When is a student ready for internship? What are the competencies needed? How many practicum hours are needed and is more better?

14 Foundational (the building blocks) and Functional (what psychologists do) competencies are needed. The more specific we are about the competencies, the more differences are expressed. At a general level, there are many similarities in the views of the competencies needed to be a psychologist (Rodolfa, et al, 2005). How do we teach these competencies? How do we measure the competencies at academic, internship and licensure levels of experience? Practicum hours: Is more better? Academic Training Directors have differed from Internship and Postdoctoral Training Directors in their view of hours. Academic Training Directors thought students needed fewer hours (Ko & Rodolfa, 2005). There are no standards for practicum training. The increasing -- perhaps excessive -- hours are driven by student anxiety to get an internship. What are the Models of internship training? It appears that at the internship level there is a great deal of consistency that transcends training models. Perhaps the commonality of goals at the internship level should be emphasized during accreditation review rather than a declaration of a model. Although it may not be useful to return to a checklist mentality of the previous process of accreditation, it may be useful to have a middle-ground between what was and what currently are the guidelines and principles of accreditation. One of many possible alternative approaches to this issue could involve the use of the existing and emerging models of training to conceptualize and to implement training. But instead of evaluating and accrediting programs according to the extent that training goals and objectives correspond to how the training is implemented, our research suggests it may be more productive to evaluate programs according to the competencies they help trainees develop. That is, programs would be free to use training models singly or in combination to suit their unique needs and resources so long as the resulting framework produced competent trainees (Rodolfa et al, 2005). What are the minimal standards for an internship program? APPIC is proposing some variations of their standards/criteria. Is it a reduction or a variation? I don t believe it is a reduction, but it does acknowledge the changing structures in internship training. John made a comment about how you get to California. Some ways are better, easier, safer, faster, cheaper. A part of the answer has to do with the resources you have, the mode of transportation available. Luli discussed the benefits of internship training to the students (interns), the community and the academic programs. There are also many benefits to the sites. APA Commission, Postdoctoral training? (When is enough-- enough?) The end game of the training sequence is being examined. Should there be postdoctoral training? Internship is becoming more important as the discussions about postdoctoral training grow in intensity and frequency. My final point is about funding resources. We need to do a better job of seeking grant funding for training. I applaud APA for their efforts re GPE. In an article in Professional Psychology: Research and Practice, Olvey and her colleagues (2003?) highlighted the discrepancy in high standards for licensure and the low pay for psychologists when compared to other professions. Low pay begins at internship and efforts need to be made to enhance funding resources at the federal and other levels. We need to do a better job to seek funds for training. We need to teach psychologists to be better advocates for the profession. Thanks for allowing me to comment on these interesting papers.

15