THE CONTRIBUTION OF PSYCHOLOGY TRAINING FOR VETERANS AND THE NATION Stacy D. Pommer, LMSW Veterans Health Administration Office of Academic Affiliations May 2015
OBJECTIVES: I WOULD LIKE YOU TO BE ABLE TO Describe Associated Health Education (AHE) training in VA and OAA s mission Use non competitive/direct hire authority to meet staffing needs Identify the national impact of VA psychology training and education trends Describe mental health expansion initiatives in VA 1
OAA Overview 2
OFFICE OF ACADEMIC AFFILIATIONS MISSION To Educate for VA and for the Nation Statutory Mission of VA VA Policy Memo #2 69th anniversary Incredibly important recruitment tool Direct appointment authority Creating the clinical workforce for VA and the country Many will leave and then return to VA employment in the future Our major succession planning activity 3
AHE PORTFOLIO Associated Health includes all clinical health professions with the exception of Medicine, Dentistry, and Nursing Other OAA sections: Graduate Medical/Dental Education, Nursing Education, and Advanced Fellowships Over 40 Associated Health professions train in VA 118,000 rotate through VA annually 31,000 AH trainees ~85% without compensation (WOC) 15 funded disciplines AY 14 = 4,395 stipends AY 15 = 4,513 stipends AY 16 = 4,681 stipends Audiology Clinical Pastoral Education Blind Rehabilitation Dietetics Chiropractic Care Occupational Therapy Optometry Pharmacy Physical Therapy Physician Assistants Podiatry Prosthetics/ Orthotics Psychology Social Work Speech Pathology 3
OFFICE OF ACADEMIC AFFILIATIONS (OAA): ASSOCIATED HEALTH EDUCATION (AHE) TEAM WASHINGTON DC Kenneth R. Jones, PhD Director Debbie L. Hettler, OD, MPH, FAAO Clinical Director Stacy Pommer, LMSW Health Systems Specialist HOUSTON David M. Latini, PhD Health Systems Specialist MENLO PARK Samuel S. King, MS, MDiv Statistician 5
VISION: INTERPROFESSIONAL TRAINING Training that goes beyond a simple multidisciplinary team Members of multiple professions and trainees share responsibilities Shared curriculum, didactics, projects, and collaborative assessment and care Trainees learn about the unique contributions of their discipline, the disciplines of fellow trainees, and how to communicate effectively to provide team based care Goals: Understand and appreciate own and other s professional perspective and how to work together in a complementary way 6
Succession Planning and Practices 7
VHA WORKFORCE STRATEGIC PLAN Developed annually by the Healthcare Talent Management (HTM) Office within Workforce Management & Consulting http://vaww.succession.va.gov/workforce _planning/default.aspx 8
2015 TOP FIVE OCCUPATIONS WITH LARGEST STAFFING SHORTAGES 1. Medical Officer (0602) 2. Nurse (0610) 3/4. (tied) Physician Assistant (0603) 3/4. (tied) Physical Therapist (0633) 5. Psychologist (0180) 9
PSYCHOLOGY QUALIFICATION STANDARDS Psychology trainees must meet eligibility for VA employment at the time of appointment/hire and can be recruited/selected while still in training Offers can be contingent on being fully qualified at time of hire Current Psychology Qualification Standards Require: Degree from an APA accredited doctoral program Completion of an APA accredited internship or a newly funded VA internship program seeking APA accreditation Revised Qualification Standards are in the national concurrence process When published, applicants with doctoral degrees from Canadian Psychological Association (CPA) accredited programs will be eligible for VA employment 10
NON COMPETITIVE HIRING FLEXIBILITIES: THE EASY WAY TO APPOINT NEW STAFF DO NOT: Use USAJOBS posting: Internal/external USAJOBS announcements are not required (USAJOBS announcement can be prudent in some situations) Use Certificates of Eligibles: Certificates of Eligibles are not required If vacant position is not posted at USAJOBS Use Veteran Preference: Veteran preference does not apply to the Inspector General s Top 5 Shortage Occupations for any particular FY (FY15 HRML 05 15 01 includes Physician, Nurse, PA, PT, and Psychologist) regardless of if the recruitment is for a VACAA position or not 11
NON COMPETITIVE HIRING FLEXIBILITIES: THE EASY WAY TO APPOINT NEW STAFF DO: Post positions at your facility: Local Bargaining Unit (BU) agreements rarely specify USAJOBS announcements as a requirement with language similar to post at the facility Release internal ads to BU so that posting period ends shortly before the Resource Management Committee (or equivalent) approval takes place Use this language: Language in internal announcement may be similar to No selections or personnel actions will take place until this position is approved to fill by the Resource Management Committee or equivalent 12
NON COMPETITIVE HIRING FLEXIBILITIES: THE EASY WAY TO APPOINT NEW STAFF DO: Include Trainees who are nearing completion of degree/training program: Trainees may be selected before receiving degree if on track for completing the program and otherwise meet qualification standards Use of appropriate language in Tentative Job Offers (TJO) will protect VA if candidates fail to become fully qualified at time of appointment If announced on USAJOBS, ensure language reflects that current trainees may apply and assessment questionnaires (done by HR) are not screening out trainees 13
LANGUAGE IN USAJOBS ANNOUNCMENTS When using USAJOBS announcements include language about the exception for applicants who completed a newly funded VA internship: Education: Have a doctoral degree in psychology from a graduate program in psychology accredited by the American Psychological Association (APA) and have successfully completed a professional psychology internship training program that has been accredited by APA. Exception: (1) New VHA psychology internship programs that are in the process of applying for APA accreditation are acceptable in fulfillment of the internship requirement, provide that such programs were sanctioned by the VHA Central Office Program Director for Psychology and the VHA Central Office of Academic Affiliations at the time that the individual was an intern and (2) VHA facilities who offered full one year pre doctoral internship to PL 96 151 (pre 1979_ are considered to be acceptable in fulfillment of the internship requirement). 14
Impact of VA Training 15
VA PSYCHOLOGY TRAINING: NATIONAL IMPACT VA has been training psychologists since 1946 APA s doctoral program accreditation efforts resulted from VA s 1945 request Nationally, >50% of psychologists have had some VA training (estimated from # who had VA training and number who passed EPPP in 2012) ~70% of current VA Psychologists have had VA training (All Employee Survey 2014) 16
VA PSYCHOLOGY TRAINING: ACADEMIC YEAR 2015 16 120 Internship programs 643 positions 49 states + DC & Puerto Rico 70 Postdoctoral sites 438 positions* 32 states + DC & Puerto Rico Total: 1,081 positions *Excludes Advanced Fellowships, MIRECCs, & HSR&D 17
APPIC INTERNSHIP MATCH DATA: ACADEMIC YEAR 2015 16 4,005 applicants participating in match 3,569 internship positions matched Phase I/II 2,716 matched to accredited position (64%) 3,701 internship positions offered 643 VA Internship Positions (17%) 436 students did not match (11%) 18
INTERNSHIP AND FELLOWSHIP POSITION TRENDS: THE PAST DECADE Internship and Fellowship Position Trends 700 600 643 500 400 300 200 100 363 77 438 Internship Fellowship 0 AY06 AY07 AY08 AY09 AY10 AY11 AY12 AY13 AY14 AY15 AY16 Academic Year 19
NATIONAL PSYCHOLOGY INTERNSHIP AFFILIATION AGREEMENT http://vaww.oaa.med.va.gov/dbahealth/ahpsyaffiliat ionlist1.aspx In OAA, the only national affiliation agreement is for psychology internships (all other agreements are local) This one agreement with an accredited doctoral program applies to all Agreement covers only psychology internship affiliations (not externship/practicum) Psychology Training Director must verify the affiliate s program type (clinical, counseling, combined) and degree (Ph.D., Psy.D.) for incoming interns OAA is working to establish agreements with all APA accredited doctoral programs (not school psychology) 20
LEARNERS PERCEPTIONS SURVEY Clinical Faculty/Preceptors: Quality of faculty, teaching ability, and clinical skills Learning Environment: Preparation for future training, quality of care, time for learning, and preparation for clinical practice Working Environment: Workspace, peer group morale, faculty/preceptor morale, CPRS, ancillary/support staff, and laboratory services Physical Environment: Facility maintenance/upkeep, facility cleanliness/housekeeping, call rooms, availability of food on call, and availability of needed equipment Personal Experience: Continuity of relationship with patients 21
LEARNERS PERCEPTIONS SURVEY LPS 2015 Psychology Trainee Satisfaction % Very and Somewhat Satisfied July 11, 2014 April 2, 2015 LPS Domain Psychology % (n=178) National % (n=7051) Clinical/Faculty Preceptors 92 92 Learning Environment 92 91 Working Environment 78 86 Physical Environment 77 88 Personal Experience 94 92 22
REFLECTING ON PERSONAL EXPERIENCES Whitney Havins, Ph.D.: Neuropsychology Fellow Baltimore VA My internship year was my first exposure to the VA system. I was impressed by VA s clear commitment to training in psychology and to evidence based practices. I sought a postdoctoral neuropsychology fellowship with the goal to continue my training experience in a truly integrated healthcare system with an emphasis on patient centered care. I have been honored to work with our nation s Veterans and plan to pursue a career in VA, where I can actively participate in the education and training of future VA psychologists. 23
REFLECTING ON PERSONAL EXPERIENCES Brian Tate Guelzow, Ph.D.: Suicide Prevention Psychologist, San Francisco VAMC Throughout my training as an intern and a fellow, I felt so fortunate to have the support of supervisors who were so clearly, deeply committed to my professional development and personal growth. The opportunity to work alongside them as a colleague has been a real dream come true. 24
REFLECTING ON PERSONAL EXPERIENCES Chebon Porter, Ph.D. Neuropsychologist and Director of Clinical Training Birmingham VA Though I was fortunate to have options for internship training, I chose the VA because of the quality and breadth of training experiences. I returned to the VA after fellowship because of the impact that Veterans and my VA mentors had on me. Simply put, it seemed to be the most honorable career path I could choose. In 15 years of service to veterans there is no doubt and I am humbled by the opportunity to serve veterans spanning 75 years of military service. 25
Mental Health Education Expansion 26
MENTAL HEALTH EDUCATION EXPANSION INITIATIVE Five year interprofessional MH Expansion began in Fall 2012 Phase I (AY14): General Outpatient Mental Health Clinics OR Patient Aligned Care Teams 52 facilities requested 237 positions 203 positions awarded at 43 facilities 87 Outpatient Mental Health 116 PACTs with Mental Health Integration Phase II (AY15): Core Mental Health Programs OR Advanced Training Opportunities targeting underserved populations 52 facilities requested 159 positions 127 positions awarded at 45 facilities 117 Core Mental Health Programs 20 Advanced Training Opportunities 27
MENTAL HEALTH EDUCATION EXPANSION INITIATIVE Phase III (AY16): Mental Health Clinical Program OR Medical Care Clinic/Team Aligned with recommendations from VHA s Taskforce on Mental Health Innovations 74 facilities requested 277 positions 230 positions awarded at 67 facilities Mental health clinical programs at 37 facilities Medical care clinics/teams at 31 facilities Combination mental health clinical programs and medical care clinics/teams at 29 facilities New programs established at 21 facilities Expansion of existing training programs at 54 facilities 28
MENTAL HEALTH EDUCATION EXPANSION INITIATIVE POSITIONS AWARDED 160 140 120 100 80 60 40 20 0 Positions Awarded by Discipline Phase I (AY14) Phase II (AY15) Phase III (AY16) Clinical Pastoral Education Nursing Pharmacy Psychiatry Psychology Social Work 29
MENTAL HEALTH EDUCATION EXPANSION INITIATIVE: FUTURE OPPORTUNITIES Phase IV (AY17): A: LPMHC and MFT Internships B: Psychology Currently drafting RFP Expansion of psychology internships New facilities (to include 50 th state) Additional positions for existing internships Expansion of neuropsychology fellowships Training Trends Only for 2 year neuropsychology fellowships Existing fellowships must have or be seeking specialty accreditation New facilities planning to seek specialty accreditation 30
MENTAL HEALTH EDUCATION EXPANSION INITIATIVE: FUTURE OPPORTUNITIES Phase V (AY18): To be determined May include option to expand other disciplines including LPMHC and MFT pilot training programs 31
Tips and Recommendations 32
RECOMMENDATIONS Have a strong working relationship with your Designated Educational Officer (DEO) Collaborate with the VA Psychology Training Council (VAPTC) Know your training program How many fellows, what areas, funding source(s) How many interns, funding source(s) Mentor others in the training role Receive training and serve as an APA site visitor Follow the money with regard to making annual accreditation and site visit fee payments 33
RECOMMENDATIONS Read and follow the re publication of VHA Handbook 1400.04: Supervision of Associated Health Trainees. Is your Trainee Handbook and Grievance Policy consistent with this? If you cannot remediate a trainee, what does your Trainee Handbook say will happen? Have trainees complete the Learners Perception Survey Do not have trainees participate in New Employee Orientation TMS course, Mandatory Training for Trainees, is the only vetted mandatory course. 34
RECOMMENDATIONS Be aware of bureaucratic pitfalls: Counting trainees in facility FTEE Allocations process Other challenges Utilize OAA website resources https://vaww.portal.va.gov/sites/oaa/lists/associated%20health% 20Links/AllItems.aspx Add link of available resources to your favorites Frequently Asked Questions Allocation Reports Military History Pocket Cards 35
SUMMARY: YOU SHOULD BE ABLE TO: Describe Associated Health Education (AHE) training in VA and OAA s mission Use non competitive hire authority to meet staffing needs Identify the national impact of VA psychology training and education trends Describe mental health expansion initiatives in VA 36
THANK YOU, QUESTIONS, AND CONTACT INFO General AHE Questions: Assoc.Health@va.gov Internship Affiliation Questions: Psychology.Affiliation@va.gov Fellowship Questions: Psychology.Fellowship@va.gov 37