Mission & Overview
The Department of Psychology at East Tennessee State University is pleased to announce our new program in Clinical Psychology, which admitted its first class of students for fall 2007.
The mission of this program is to provide doctoral training in Clinical Psychology for rural behavioral health and practice in the context of integrated primary health care.
Our curriculum is a scientist-practitioner model with innovative curricular elements utilizing our collaborative relationship with Quillen College of Medicine and building on its national recognition as a leader in the training of rural Family Medicine researchers and practitioners. We would like to thank our community and academic partners in assisting with the development and implementation of this program, and particularly the Health Resources and Services Administration (HRSA) for providing grant funds to facilitate this process.
Our program has been developed following American Psychological Association (APA) guidelines, and we will apply for accreditation as soon as allowable under APA rules. APA does not consider accreditation until there is at least one student matriculating in every year of the program, including the internship year. This means that a program must be active for 3 to 5 years before submission for APA accreditation is possible.
"Award of 'accredited' status is effective on the final day of the site visit preceding the Commission on Accreditation’s (CoA) decision to grant such status. Students who are in the program on that date and subsequently complete the program are considered to be graduates of an accredited program, provided, of course, that the program maintains an accredited status through the date of the students' graduation. Thus, programs are accredited beginning with the site visit, and accreditation is not retroactive." (http://www.apa.org/ed/accreditation/when.html).
The primary objective of the articulated master’s/doctoral program in Clinical Psychology at ETSU is to provide training in clinical psychology emphasizing Rural Behavioral Health and Practice in the context of Integrated Primary Healthcare. ETSU, along with the Quillen College of Medicine and Division of Health Sciences has a unique relationship with its surrounding community and region. Because of this relationship the program is unique in what it can offer students in the field of health services psychology.
Again, the clinical psychology program is guided by the scientist-practitioner model, and it places a strong emphasis on research and interdisciplinary clinical training. Though diverse in respect to methods of inquiry and areas of study, the faculty is of one mind in promoting scientific inquiry as the foundation of clinical psychology.
Our students receive traditional classroom and field training in psychological assessment, diagnosis and intervention. However, our program emphasizes evidence-based intervention and empirically-based assessment and treatment strategies and inter-professional training. Most importantly, our program is on the cutting edge of training clinical psychologists to work with primary care providers in an integrated rather than segregated fashion. Students participate in classes and field experiences with students and faculty from our medical school, medical residencies, nursing, social work, public health, physical therapy, and pharmacy programs.
Thus, our program includes the following competency components not often found in traditional clinical psychology training.
Competencies
1. Biological Components of Health and Illness
a. General knowledge of human anatomy, physiology, and pathophysiology
b. General knowledge of pharmacology with a special focus on medications with known effects on behavior
2. Cognitive Components of Health and Illness
a. Knowledge of health belief models of patients and their families and how these beliefs influence the identification of health problems, help seeking and adherence to treatment regimens
b. Knowledge of beliefs and attitudes that mediate help seeking
c. Knowledge of cognitive factors that influence reactions to initial diagnoses and the processing of health information
d. Knowledge of the impact of biologic factors on cognitive functioning
3. Affective Components of Health and Illness
a. Knowledge of how affect influences cognition and attitudes that mediate help seeking
b. Knowledge of affective factors that influence reactions to initial diagnoses and the processing of health information
c. Knowledge of medical problems that can present as affective disorders (e.g. thyroid disorders, steroid reactions, etc.)
d. Knowledge of affective reactions to illness, injury, and disability
4. Behavioral and Developmental Aspects of Health and Illness
a. Behavioral risk factors for problems seen in primary care
b. Relationships among coping styles and health
c. Relationship among age, developmental context and health
d. Impact of psychopathology on response to illness and recovery
e. How operant and classical conditioning affect health and health behavior
5. Sociocultural Components of Health and Illness
a. The impact of interpersonal relationships on health and health behavior and awareness of
i. Partner and family influences
ii. Impact of health professionals, patient, and family communication on health
iii. The positive and negative effects of social network and health
iv. Relationships among ethnicity, race, culture, and health behavior
v. Socioeconomic and sociopolitical factors specific to local community with respect to practice and resources
b. Relationships between religion and health
c. Relationships between sexual orientation and health
d. Issues related to disability and health
e. Issues related to gender and health
f. Health care consumer groups and their impact on health policy
6. Health Policy and Health Care Systems
a. Impact of health policy on health and health care including
i. Health care financing
ii. Behavioral health carve-outs as impediments to integrated primary care
iii. Underinsured and uninsured health care needs and community strategies to care for them
iv. Knowledge of trends in health policy
b. Specific characteristics and sociopolitical features of the health care system
i. Primary care in the current health care system and its differences from mental health care
ii. Similarities and differences in various primary care settings
7. Common Primary Care Problems
8. Clinical Assessment of Common Primary Care Behavioral Health Conditions
a. Common medical assessment methods and ability to move through a medical assessment process to case formulation using the biopsychosocial model
b. The ability to detect sub threshold clinical problems
c. Knowledge of mental health problems such as anxiety and depression, how they might present differently in primary care than in specialty mental health clinics and their association with certain medical illnesses
d. Expertise in targeted brief interviewing methods
e. Expertise in the use of empirically supported psychometrics relevant to common primary care conditions and
i. Awareness of limitations of traditional measures in primary care settings
ii. Normative data relevant to primary care
iii. Skills with brief screening instruments
iv. Expertise in triage – obtaining information from collateral persons; working under time demand pressures; starting with an undifferentiated clinical population and sorting through various domains of information quickly; skills in targeting the assessment to the referral question in language meaningful to the person who made the referral; ability to conduct assessments in medical settings such as an examination room, ER or hospital bed
9. Clinical Interventions in Primary Care Psychology
a. Developing a psychological treatment plan to include in collaborative care
b. Skills in individual, couples and family and group therapy
c. Skills in supportive, cognitive-behavioral, crisis intervention family systems approaches, psychoeducation and relapse prevention
d. Skills in case management
e. Skills in negotiating treatment plans that are mutually acceptable to the patient, health care team and family
f. Skills in implementing interventions through other providers
g. Knowledge of community resources
h. Skills in designing culturally sensitive interventions for local populations
i. Practical, concrete, problem-solving skills
j. A plan regarding when to refer patients who need a more intense level of treatment
10. Inter-professional Collaboration in Primary Care
a. Knowledge of other disciplines integrally involved in primary care
i. Roles and functions
ii. Education and training background
iii. Scope-of-practice and boundary issues
iv. Values and priorities
b. Expertise in collaboration with other professions
11. Ethical and Professional Issues in Primary Care Psychology
Experiential Training
Beginning with the second semester in the first program year, Master’s level students shadow psychologists and other health care practitioners participating in multidisciplinary teams in health care settings. In subsequent rotations, students participate in specific clinical activities such as interviewing and case management. Clerkships involve 4-5 hours per week in a primary care setting.
Also beginning in the second semester, students are placed in the on-campus training facility, the Behavioral Health and Wellness Clinic (BHWC). Initially, the students will provide phone coverage, scheduling, and structured intake experiences and observation of advanced students and faculty. Students provide coverage 4-6 hours per week. The breadth and depth of clinical services in which the student participates will vary from individual to individual and be based on supervisor recommendations.
During the Practicum semesters, students move to more in depth clinical activities including formal assessment, diagnostic interviews, and group, family, and individual intervention. In the fourth program year, doctoral students may participate in the supervision of first year students.
Throughout matriculation, students will provide service in the clinic for 4-6 hours per week. Intensive, 20-hour per week, paid field placements occur in the third and fourth years of the program, with students providing clinical services under the supervision of licensed psychologists and other health care professionals in mental health and primary health care settings in both rural and semi-rural areas.
Behavioral Health and Wellness Clinic (BHWC)
The BHWC is an outpatient clinic designed to provide assessment, evaluation, and counseling services in the context of a wide range psychological and health related concerns; behavioral problems, depression, anxiety, stress, ADHD, relationship problems, etc.
In addition to clinical-based services, the BHWC is also designed to be a resource for consultation regarding a variety of clinical and non-clinical subjects in psychology; human development, behavioral and cognitive neuroscience, social psychology, statistics, and research design. The main facility of the BHWC is on the main ETSU campus. However, the activities of the BHWC extend well beyond the walls of the center to the greater community and surrounding region. For example, our students and faculty provide services to through not-for-profit programs, primary care clinics, and school-based programs.
Brief Overview of Integrated Primary Care Models
There is not just one model of integrated primary care, and since our program is empirically based, we assume that our model of training will evolve just as evidence-based practice evolves based on the research. Primary care/behavioral healthcare integration can be depicted as having five levels (Doherty, McDaniel, & Baird, 1996).
Level One: Minimal Collaboration- is where mental health and other health care professionals work in separate facilities, have separate systems and rarely communicate about cases. This is the traditional model that is still practiced in most agencies and private practices in the U.S.
Level Two: Basic Collaboration at a Distance- is where providers have separate systems at separate sites, but communicate about specific patient issues. Operations, records are separate, and there is no sharing of responsibility or treatment decisions.
Level Three: Basic Collaboration On-Site- is where mental health/behavioral health professionals and primary care providers share the same site, but have separate systems. There is more regular communication about shared patients, but no shared patient care as a team. Medical physicians have the responsibility and decision-making authority.
Level Four: Close Collaboration in a Partially Integrated System- is where mental health and other health professionals share the same sites and have some systems in common such as records and scheduling. There are regular face-to-face interactions about patients, coordinated treatment plans, and a shared appreciation for others’ roles and professional cultures. Operational discrepancies remain, such as differences in reimbursements. Medical professionals have greater power and influence on the collaborative team.
Level Five: Close Collaboration in a Fully Integrated System- is where mental and other health care professionals share the same sites, same vision, and same systems in a seamless web of biopsychosocial services. The expectation is of a team offering prevention and treatment where all professional are committed to a systems paradigm and in-depth understanding of each other’s roles and professional cultures with a conscious effort to balance power and responsibility.
11/11/08