In This Issue

APA presidential candidate questions

Candidates discuss the role of psychologists in health care, RxP and training

Candidates were asked to respond to a list of questions posed by the division. What follows are the unedited responses received from the candidates.

Todd Finnerty, PsyD

Thank you for the opportunity, here are my responses to your questions.

1. What advocacy efforts would you propose to maintain positions for psychologists in public (i.e., county, state and federal) agencies? What do you see as the possible expansion of the roles psychologists provide in public settings (e.g., being head of treatment teams, prescription privileges with limited formulary, writing orders for behavioral treatments, etc.)?

Psychologists are leaders. However, sometimes the way regulations are written we are inadvertently left out of leadership opportunities. In addition, we are sometimes subjected to requirements and expectations which are based on the training of physicians — not what is relevant for psychologists. For example, because of "physician-centric" language psychologists in some hospital settings and other locations are expected to obtain board certification to be viewed as equal to their physician-peers. This is not consistent with the way psychologists are trained. Despite this, as psychologists our organizations sometimes accept these "physician-centric" language-requirements instead of educating regulators and organizations about psychologists. We do not all need to be board certified to be viewed as equal to a physician. We do not all need to have had an APA-accredited internship to be competent. I propose that we advocate against "physician-centric" language being applied unquestioningly to psychologists without any relevant evidence-base for such requirements. For example, there is no compelling evidence that a psychologist who obtained a non-APA accredited internship is less competent than a psychologist who had an APA-accredited internship. These "physician-centric" approaches are lacking in empirical support and should not be used for employment selection.

2. What is your vision for psychology's roles in the national health care service system?

We won't just act within the health care system — we'll act on the health care system. Health care reform was practically made with psychology in mind; now we need to educate policymakers and the leaders of organizations about that fact. Emphasizing psychology can make a dramatic impact on our health care system and help to achieve the triple aim of a better health care experience, improved health and lower costs. All three of my presidential initiatives are relevant to expanding our role in the national health care system.

3. What is your stance on RxP? Specifically, do you have plans for addressing this issue? If so, could you describe them? If not, please describe why you do not find this an issue of importance for the field.

I'm "radically indifferent" to RxP. I say this coming from the perspective of having conducted an RxP-related dissertation and having had extensive graduate-level training in psychopharmacology. However, I do not believe that pursuing prescriptive authority should be a national priority for all psychologists. I do believe that demonstration projects with underserved populations such as in prisons and on Native American Territories are reasonable and worth trying. For example, here in Ohio we're working on getting a demonstration project in our prisons approved — a location where it is difficult and expensive to get psychiatrists to work. I also am not against innovative approaches that may be tried in settings like the VA. I am against expending substantial resources to get those projects in to place.

I am against RxP as a current, national priority for all psychologists. The average psychologist has proven to be indifferent to obtaining prescription privileges for themselves. Psychologists are smart people and could learn to prescribe if they wanted to — but surveys show a large percent just don't want to. While I have no objection to groups of RxP psychologists advocating for the ability to prescribe medications; in a time of tumultuous changes in health care including threatened reimbursements for the services we already provide — I simply cannot justify expending substantial national resources on pursuing prescription privileges when we must defend the ground we do have. Our national advocacy resources are thin and we must strike where it matters. We must promote the importance of psychotherapy and assessment, but more importantly we must innovate. Prescribing psychotropic medication is not innovative. Many nondoctoral professionals such as nurses and physician assistants have already beaten us to the territory. In addition, it is counter to the current trend of having treatment go through primary care. It is unrealistic to expect that psychologists will be the providers responsible for maintaining the typical antidepressant prescription. In addition, while medication may be the most common mental health treatment, it is not necessarily the best. It is also not necessarily the future of mental health treatment. However, a 50-minute psychotherapy session is also not the only way psychologists can deliver services or the only way we can collaborate with a primary care provider. We need to develop the interventions of the future and medications are not likely to be "it." I've proposed the Psychology Innovation Challenge to help stimulate innovation in psychology and develop the interventions of the future.

4. What are the skills and areas of knowledge that you think will increase the capacities of psychologists who identify science as their primary work focus? What are the skills and areas of knowledge for psychologists who identify their primary work as practice? What are the skills and areas of knowledge for psychologists who identify their primary work as education?

Bringing diverse areas of knowledge, skills and attitudes together will serve us all — regardless of what our current occupation is. We should be cautious about attempting to "homogenize" the field in to one single type of potato, particularly when it comes to the standards we set for accrediting our programs. A single potato is subject to famine. However, no matter where they work, psychologists should be able to embrace fresh, innovative perspectives. Dogmatically adhering to tradition will not serve us in the future nor will simply looking over the fence and trying to copy what physicians are doing. We must lead. We must innovate.

5. What is your position on the role that public sector psychology plays in training? How would you support this role and what would you do to enhance training opportunities within the public sector for the next generation of psychologists?

Organizations like the Dept. of Veterans Affairs are critical to the training of psychologists and have had many positive effects on the field. One current positive trend from the VA is the implementation of Evidence-Based Practice system-wide. The VA and other organizations are critical in regard to internships. The VA provides quality training and also receives benefits from having so many of our trainees. I believe, however, that the VA and other organizations are currently paying too much tax-payer money for internship accreditation and suffering undue burdens in relation to maintaining APA-accreditation of their internships. If we are going to ask that there be substantial costs to taxpayers in the form of internship fees paid to APA and the VA staff-costs associated with the time-intensive process of maintaining accreditation, we must ensure that there is at least some evidence that an APA-accredited internship has some impact on competence over an equivalent internship that was not accredited by APA. There is no evidence that demonstrates that an APA-accredited internship has any different impact on competence than an equivalent internship.

Nadine J. Kaslow, PhD, ABPP

Details about my views on VA psychology (PDF, 68KB) 

1. What advocacy efforts would you propose to maintain positions for psychologists in public (i.e., county, state and federal) agencies?  What do you see as the possible expansion of the roles psychologists provide in public settings (e.g., being head of treatment teams, prescription privileges with limited formulary, writing orders for behavioral treatments, etc.)?

As professor and vice chair in Emory's Department of Psychiatry and Behavioral Sciences, I am the chief psychologist at Grady Hospital. Grady is a public sector health care system, where I have worked for over 20 years doing administration, direct service, clinical-research and teaching/supervision. Prior to that, I worked in the Connecticut Mental Health Center, affiliated with Yale University School of Medicine, another public sector institution. In my role as past chair of the Association of Psychology Postdoctoral and Internship Centers (APPIC) and my involvement in the competencies movement in professional psychology, I have been engaged in the training activities that are of critical importance in different public service systems. I also worked closely with Dr. Toni Zeiss after Hurricane Katrina to replace those interns and postdoctoral fellows displaced by the hurricane to other VA systems nationally. In addition, I was president of the American Board of Professional Psychology (ABPP) when Police and Public Safety Psychology became an ABPP specialty and thus am familiar with this important area of specialization.

I have a strong background in advocacy at the state and federal levels. I received a Heiser Award for my legislative advocacy related to the Health Care Fairness Act, as I helped ensure that health disparities funds could be used to support biobehavioral research, not solely biological work. This demonstrates my comfort advocating on behalf of psychology. Participating in a Primary Care Public Policy Fellowship through the Health Resources Services Administration provided me with many pertinent tools and strategies with regard to advocacy.

There are a variety of issues that I would advocate for related to psychologists in public service. The following are a few key examples.

  • At the state level, I helped secure behavioral order writing privileges for psychologists in Georgia. The inpatient unit on which I work served as the model program in the state to demonstrate the effectiveness and appropriateness of this activity. Thus, I would be extremely supportive of such efforts nationally. 

  • For over two decades, I have served as the head of an interdisciplinary treatment team. Many of the psychology faculty at Emory/Grady hold a similar role, because this has been a position that I have valued highly and have advocated for vigorously. Thus, I would prioritize campaigning for such roles for psychologists across public service settings. 

  • More globally, I would initiate much needed conversations among all parties (i.e., county, state, federal agencies) with a goal of securing more positions for psychologists in public agencies. While psychologists have a central role in many public service settings, there are many other contexts in which there are few, if any psychologists and/or in which psychologists have very limited roles. 

2. What is your vision for psychology's roles in the national health care service system?

Psychologists should be major players in the collaborative interdisciplinary health care movement and in the medical homes model that are central to the evolving health care system. Working in a university-affiliated public sector health care system, much of my day-to-day practice, educational efforts and clinical-research relate to integrated primary care.

One of my APA presidential initiatives relates to family-centered health care and I would be interested in finding ways to have family-centered health care be a more significant aspect of the integrated primary care efforts within public sector health care systems. In addition, I know that those in various public sector health care systems with expertise in integrated primary care will be wonderful allies and partners in moving forward a family-centered healthcare initiative in the evolving healthcare climate.

3. What is your stance on RxP? Specifically, do you have plans for addressing this issue? If so, could you describe them? If not, please describe why you do not find this an issue of importance for the field.

My APA presidential theme is to Unite Psychology for the Future. As a result, I support all movements that aim to increase access to services for individuals in need of behavioral health care. With the upcoming changes in health care, there are not enough behavioral health care professionals to cover the millions of patients entering the insurance rolls. I have and would continue to work to promote the idea that professional psychologists are in a unique position to offer integrated care because our training encompasses a true biopsychosocial model that places importance on case formulation and clinical decision making. Pharmacotherapy can be viewed as one part of integrated care.

APA has taken a number of very important steps in support of prescriptive authority. The APA Practice Guidelines Regarding Psychologists Involvement in Pharmacological Issues are excellent. In addition to providing guiding principles and discussing the assessment, intervention and consultation activities of prescribing psychologists, the guidelines focus on the requisite education and the importance of collaboration with other professionals. I support APA's policy related to Recommended Postdoctoral Education and Training Program in Psychopharmacology for Prescriptive Authority, as well as the designation system for postdoctoral education and training programs in psychopharmacology for prescriptive authority of psychologists. APA has created a model licensure act for psychologists trained to prescribe. Moreover, states find the Prescription Toolkit to be valuable and informative. In addition, APA has supported and advocated for states striving to enact legislation related to prescriptive authority. The APAPO and the APA Practice Directorate efforts in working closely with State, Provincial and Territorial Associations to develop multi-year strategies to support prescriptive authority initiatives are very important.

The amount of attention paid to this agenda has been dwindling, in part due to shrinking resources. This is compounded by the fact that it is a controversial topic within the health care field in general. The first step would be to more fully utilize our existing policies, some of which were enumerated above. This will include disseminating them more broadly, addressing barriers to their implementation and finding creative solutions to overcome these obstacles. This will then more effectively set the stage for various activities to advance this agenda.

4. What are the skills and areas of knowledge that you think will increase the capacities of psychologists who identify science as their primary work focus? What are the skills and areas of knowledge for psychologists who identify their primary work as practice? What are the skills and areas of knowledge for psychologists who identify their primary work as education?

As a leader in the competencies movement in professional psychology (Fouad et al., 2009; Johnson, Barnett, Elman, Forrest & Kaslow, 2012; Kaslow, 2004; Kaslow et al., 2004; Kaslow, Dunn, & Smith, 2008; Kaslow et al., 2009; Kaslow et al., 2007), I have worked with countless colleagues to identify the foundational and functional competencies that all professional psychologists should possess vis-à-vis science (scientific knowledge and methods, research and evaluation), practice (assessment, intervention consultation) and education (supervision, teaching).  They also must demonstrate a high level of professionalism, reflective practice, capacity of positive interpersonal relationships, awareness of and sensitivity to individual and cultural diversity, and ethical engagement.

Over and above that, the knowledge, skills and attitudes that will increase the capacities of psychologists who identify science as their primary work focus should include the capacity for scientific-mindedness. They must be able to think critically, as well as independently apply scientific knowledge and skills appropriately and habitually to solve critical problems. Their work should be informed by practice and should in turn inform practice. However, the actual capabilities required depend in large part on their role and context, as well as their area of research focus.

In terms of the skills and areas of knowledge for psychologists who identify their primary work as practice, it behooves them to have knowledge and understanding of the scientific foundations as applicable to their practice endeavors. They must be able to flexibly apply evidence-based concepts into practice and to do so in a fashion that is culturally and developmentally informed. They must be able to design and implement interventions that aim to ameliorate distress and promote resilience in individuals, groups and organizations. It is essential that they be comfortable practicing in interdisciplinary systems and on interdisciplinary teams.

For those who identify their primary work area as education, they must be familiar with the current zeitgeist, which focuses on the identification, assessment of, and training in competencies. It behooves them to be cognizant of a competency-based approach to clinical supervision. Such an approach must be sensitive to the developmental needs of the learners. Of course, effective educators are competent in the areas in which they supervise and teach.

5. What is your position on the role that public sector psychology plays in training? How would you support this role and what would you do to enhance training opportunities within the public sector for the next generation of psychologists?

As a psychologist who works and trains others in a public service setting, I am passionate about ensuring that more psychologists are trained in and ultimately employed by such settings. One of my APA presidential initiatives relates to enhancing the pipeline for students and early career psychologists. Thus, I would work actively with diverse public service settings to add/expand placement options for students seeking practicum placements, internships and postdoctoral residencies. I would encourage nonaccredited public sector internships to apply for APA internship stimulus funds to help their programs become accredited. Given the VA's investment in training future generations of psychologists, throughout the country, VAs have many innovative internship and postdoctoral residency programs that I would like to highlight so that they can serve as models for training programs in other sites. Most importantly, I would meet with psychologists in diverse public sector settings to learn more about the various ways in which they would like to expand their training efforts, help them problem-solve effective ways to meet this goal, and encourage them to work collaboratively with psychologists in other public sector and nonpublic sector settings to advance training efforts and activities within our profession.

Fouad, N. A., Grus, C. L., Hatcher, R. L., Kaslow, N. J., Hutchings, P. S., Madson, M., et al. (2009). Competency benchmarks: A model for the understanding and measuring of competence in professional psychology across training levels. Training and Education in Professional Psychology, 3, S5-S26. doi: 10.1037/a0015832
Johnson, W. B., Barnett, J. E., Elman, N. S., Forrest, L., & Kaslow, N. J. (2012). The competent community : Toward a vital reformulation of professional ethics. American Psychologist. doi: 10.1037/a0027206
Kaslow, N. J. (2004). Competencies in professional psychology. American Psychologist, 59, 774-781. doi: 10.1037/0003-066X.59.8.774
Kaslow, N. J., Borden, K. A., Collins, F. L., Forrest, L., Illfelder-Kaye, J., Nelson, P. D., et al. (2004). Competencies Conference: Future directions in education and credentialing in professional psychology. Journal of Clinical Psychology, 80, 699-712. doi: 10.1002/jclp.20016
Kaslow, N. J., Dunn, S. E., & Smith, C. O. (2008). Competencies for psychologists in academic health centers (AHCs). Journal of Clinical Psychology in Medical Settings, 15, 18-27. doi: 10.1007/s10880-008-9094-y
Kaslow, N. J., Grus, C. L., Campbell, L. F., Fouad, N. A., Hatcher, R. L., & Rodolfa, E. R. (2009). Competency assessment toolkit for professional Psychology. Training and Education in Professional Psychology, 3, S27-S45. doi: 10.1037/a0015833
Kaslow, N. J., Rubin, N. J., Bebeau, M., Leigh, I. W., Lichtenberg, J., Nelson, P. D., et al. (2007). Guiding principles and recommendations for the assessment of competence. Professional Psychology: Research and Practice, 38, 441-451. doi: 10.1037/0735-7028.38.5.441