Webcast 06 – Developing the Workforce: Successes, Challenges, and Outcomes of Training Doctoral-Level Psychology Students in Integrated Primary Care

Summary

Primary care often serves as the front line for both mental health and health behavior change issues, resulting in an increase in of integration of behavioral health into primary care. Despite the successes of integrated primary care (IPC) and increased training opportunities at the internship and post-doctoral level in IPC, there continues to be a deficit of skilled behavioral health consultants. Further, limited opportunities exist to engage in IPC as a doctoral level practicum student, which is an opportune time to increase excitement and skills in this area of clinical psychology. The current project examined the training and utilization of doctoral-level clinical psychology practicum students in the involvement of IPC in two ambulatory primary care residency-based health centers (Internal Medicine (IM) and Family Medicine (FM)) with established IPC services. Specifically, we examined the model of training, particularly related to training in an underserved, urban, patient population, and trends in IPC consults for practicum students compared to expected competencies. The practicum consists of doctoral level psychology students (N=4; 2 per year) engaged in IPC services for at least 8 of 16 hours per week. The training model focuses on a developmental, experiential approach, and utilizes well-supported guidelines for competency in IPC (McDaniel et al., 2014). In addition to traditional supervision, training often mimics that of the medical learning setting, including an emphasis on shadowing, direct observation, modeling, “on-the-fly”supervision, and didactic training, focused on moving practicum students at their developmental rate from observer to independent learner. Due to the setting of the training experience, particular emphasis is placed on social determinants of health in all aspects of training. Throughout the training year considerable movement toward competency in IPC are often seen in practicum student’s abilities including: detecting patient needs appropriate for the IPC setting, engagement of brief interventions, understanding of medical language and culture, and communication with medical providers. Challenges identified in this setting included: variability in skill level; ability to influence factors less likely to change (e.g., personality); theoretical resistance to brief intervention; and time constraints on faculty schedules. Data will be presented examining changing trends in IPC visits by practicum students throughout their training year and will compare performance to postdoctoral fellows. Observations suggest that practicum students see a wider variety of patients as the year progresses, become more efficient, and have increased professionalism. This suggests that training practicum students in IPC is achievable and worthwhile, and may serve to improve the workforce imbalance in the future.