Developing a Postdoctoral Psychology Residency Program in Your Community Health Center
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Two years later, we continue to witness the pandemic’s toll on mental health – and a sustained increased demand for mental health services. Behavioral health care providers who are experienced in integrated care settings are needed now more than ever. Join this webinar to learn how your health center can establish its own postdoctoral clinical psychology residency program. This webinar will address considerations such as program structure, design, curriculum, the supervisor’s role, required resources, and the benefits of sponsoring an in-house formal postdoctoral clinical psychology residency training program. Panelists: • Dr. Tim Kearney, Chief Behavioral Health Officer, Community Health Center, Inc. • Dr. Chelsea McIntosh, Training Director, CHC Postdoctoral Residency Program, Community Health Center Inc.
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Developing a Postdoctoral Psychology Residency Program in Your Community Health Center
- 1. Developing a Postdoctoral Psychology Residency Program in Community Health March 29, 2022 12:00-1:00pm Eastern / 9:00-10:00am Pacific Tim Kearney, PhD; Chelsea McIntosh, PsyD
- 2. Continuing Education Credits In support of improving patient care, Community Health Center, Inc. / Weitzman Institute is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. A comprehensive certificate will be sent after the end of the series, Summer 2022. 2
- 3. Disclosure • With respect to the following presentation, there has been no relevant (direct or indirect) financial relationship between the party listed above (or spouse/partner) and any for-profit company in the past 12 months which would be considered a conflict of interest. • The views expressed in this presentation are those of the presenters and may not reflect official policy of Community Health Center, Inc. and its Weitzman Institute. • We are obligated to disclose any products which are off-label, unlabeled, experimental, and/or under investigation (not FDA approved) and any limitations on the information hat we present, such as data that are preliminary or that represent ongoing research, interim analyses, and/or unsupported opinion. • This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) as part of an award totaling $137,500 with 0% financed with non- governmental sources. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, or the U.S. Government. For more information, please visit HRSA.gov. 3
- 4. At the Weitzman Institute, we value a culture of equity, inclusiveness, diversity, and mutually respectful dialogue. We want to ensure that all feel welcome. If there is anything said in our program that makes you feel uncomfortable, please let us know via email at nca@chc1.com 4
- 5. National Training and Technical Assistance Partnership Clinical Workforce Development Provides free training and technical assistance to health centers across the nation through national webinars, learning collaboratives, activity sessions, trainings, research, publications, etc. 5
- 6. Why Start a Postgraduate Clinical Psychology Residency Program? Building the Case for Your Organization Today’s Objectives: 1. Understand the value that psychologists bring to a multidisciplinary behavioral health program in the context of an interdisciplinary client centered team. 2. Describe the nuts and bolts of how a postdoctoral psychology residency program works. 3. Begin to understand the considerations of developing a postdoctoral psychology residency program.
- 7. CHC Profile Founding year: 1972 Primary care hubs: 17; 200+ sites Staff: 1,200 Patients/year: 100,000 Specialties: onsite psychiatry, podiatry, chiropractic Specialty access by e-Consult Elements of Model Fully Integrated teams and data Integration of key populations into primary care Data driven performance “Wherever You Are” approach Weitzman Institute QI experts; national coaches Project ECHO®— special populations Formal research and R&D Clinical workforce development CHC Locations in Connecticut
- 8. Staffing and Utilization National 2020 UDS Data from 1375 Grantees PERSONNEL BY MAJOR SERVICE CATEGORY FTEs Clinic Visits (a) (b) Psychiatrists 913.22 829,947 Licensed Clinical Psychologists 972.15 505,717 Licensed Clinical Social Workers 4,944.73 2,290,125 Other Licensed Mental Health Providers 4,495.65 2,269,073 Other Mental Health Staff 3,160.20 901,128 Source: Table 5. (2020). Health Resources & Services Administration. Retrieved March 2022, from https://data.hrsa.gov/tools/data-reporting/program- data/national/table?tableName=5&year=2020
- 9. What Psychologists add to a BH Team • Readiness to practice post graduation • Skilled in psychological assessment • Research skills which may apply to QI work • Likely to have had EBT training and experience • In depth and intensive, often in specific areas (health psychology)
- 10. “RxP” –Prescribing Psychologists Prescriptive authority may be granted to psychologists with; – 2 years of postdoctoral training, or Continuing Education training in clinical psychopharmacology and related sciences, – followed by 1 – 2 years of supervised prescribing, or a Certificate from the Department of Defense program, or the Board Certified Diploma from the Prescribing Psychologists Register (FICPP or FICPPM) to enable them, according to state law, to prescribe psychotropic medications to treat mental and emotional disorders. Currently five states and one US territory permit certain psychologists to prescribe medications to their patients; Idaho, New Mexico, Louisiana, Illinois, Iowa and Guam.
- 11. For the common good For the good of the resident For the good of your agency Drivers: Why Start a Postdoctoral Psychology Residency Program?
- 12. For the Common Good To develop staff to address behavioral health needs of our clients, particularly using those trained to an integrated model of primary care and behavioral health
- 13. For the Good of Your Health Centers • Influx of new energy and enthusiasm with the most recent evidence based knowledge • Increased staff satisfaction • Professional development: • Learning to supervise • Increasing skill of clinical teaching • Recognition of skill • Passing on knowledge • Improved retention • Increased access for clients • Opportunity to build a strong talent pool from which to hire through training pipeline
- 14. For the Good of the Resident • Prepares residents to work with vulnerable populations in an FQHC setting • Builds confidence within a clinical setting to become an independent clinician with enhanced treatment abilities and leadership skills • Learn by doing and introject a picture of the role of a psychologist in an integrated care setting that informs professional self image at the start of a career • Prepares the resident for the EPPP licensing exam • Increases competitiveness in the job market for those who do not remain at their residency site by a broad clinical exposure
- 15. • If we want a team-based model of fully integrated primary care and behavioral health, we have to train the members of the team to that model • Licensed clinical psychologists are an invaluable member of the healthcare team and they must acquire supervised postgraduate hours for licensure in most states • Today, only a handful of 112 APA accredited postdoctoral residency programs are based in FQHCs
- 16. Preliminary Issues to Consider • Value postdoctoral residency adds to your program • What you can give residents • Your resources • Association of Psychology Postdoctoral and Internship Centers and American Psychological Association standards • State licensing regulations • Telehealth considerations
- 17. CHCI Postdoctoral Training Content • Direct clinical care • In integrated care settings, school based health centers, and homeless/domestic violence shelters • Minimum of 900 visits/year • Goal of three groups/week • Full age range • WHOs • Real time consults: reactive and proactive, face-to- face or remote • Brief screening with care planning • Supervision • Meets CT licensing requirements • 2 hours individual, 1 hour group • Multidisciplinary teams (peer supervision)
- 18. CHCI Postdoctoral Training Content (cont.) • Quality Improvement Training • Program development and methods of change • Integrated quality improvement project • Participation in quality improvement initiatives, Performance Improvement committee, BHQI committee • Weekly didactic seminar • Individualized training opportunities • IRB, school-based, Project ECHO • Supervision of practicum students with supervision of supervision
- 19. A year in the life CHCI Postdoctoral Residency Getting Ready • Our resident’s year runs Sept 1 to August 31st. The leadership team is working before the residents arrive • Minus 3 months: Postdoctoral leadership retreat to plan for coming year and recruitment one year out • Minus 2 months: Review training materials, ensure placements and supervisors are finalized, plan orientation • Minus 1 month: Make individualized templates for client scheduling, plan individualized schedules (time and place at each site), match outgoing residents’ clients with incoming residents
- 20. A year in the life of the CHCI Postdoctoral Residency Residents Arrive! September • Joint residency orientation with shared training and tracks for each specialty • Saturday brunch with supervisors, residents, and significant others/spouses • Individual and group training goals set • Shadow medical staff and supervisors • Start seeing clients (ramp up starting with intake, transfers and warm-handoffs): • Didactic seminar • Individual and group supervision • Reflective journal
- 21. A year in the life of the CHCI Postdoctoral Residency The Resident’s Ramp Up October – February • Building a caseload • Assignment to specialized training and other duties • Recruiting for the next cohort begins in the fall • Monthly supervisor meetings • First written evaluation in December • Halfway through! - structured feed back session with Residents in February • Residents participate in interviews for next year’s class Tentative discussions begin about interest in staying on post residency as the budget process for the next fiscal year gets underway in February
- 22. A year in the life of the CHCI Postdoctoral Residency The residents settle in March – June • Residents each lead one didactic seminar December to February (This is now the second half of the year) • Established relationships with medical providers lead to increased confidence • Deepening relationships with cohort. Program should provide ways to encourage this • Focus on skill development and self awareness as soon to be independent psychologists • Second formal written evaluation occurs in April • New class is finalized • Residents attend the Behavioral Health Annual meeting • Interviews for CHCI positions which will be open or created in the fall occur and job offers for those staying on are made
- 23. A year in the life of the CHCI Postdoctoral Residency Preparing to move on July and August • Future plans at CHCI or elsewhere are finalized • Those accepting academic appointments may need to plan to leave earlier than end of August • For some states EPPP may be taken when supervised hour requirements are met even prior to completion of postdoc • Transfer and termination of clinical cases completed • Third and final written feedback completed by supervisors and reviewed with Residents • Program ends last week in August • Graduation celebration for residents and families, supervisors, and clinical staff
- 24. Stories from the Field • Courtney Clark: Current Postdoctoral Resident at the CHC site in Middletown, CT. • Sita Nadathur: Former Postdoctoral Resident and Current Supervisor and Clinician at the CHC site in Middletown, CT. Questions: 1. What made you decide to join a Postdoctoral Residency Program? 2. What were you looking for when you came to CHC? 3. How do you feel the postdoc shaped you as a Psychologist?
- 25. What we have learned 1. Offering a Postdoc Residency is possible 2. Postdocs increase access for clients, bring their added strengths to clinical programs, and add current knowledge to administrative committees and processes 3. Supervisors and staff enjoy participating in the Residency program 4. Postdoc training is a great recruitment tool 5. APPIC membership is a worthwhile investment
- 26. What we have learned (cont.) 6. Plan ahead for the APA accreditation process – especially data on success of program 7. Supervision training is needed 8. One day per week for didactics, supervision, and cohort activity is invaluable 9. Be very clear about expectations and what you can and cannot offer 10. Post-docs improve processes and systems by providing feedback to staff about workflow issues 11. Post-docs aid in the testing of new initiatives 26
- 27. The Road to Developing a Postdoctoral Psychology Program • Answer the question: What are your drivers for starting a postgraduate program? • Learn the essential elements of a postgraduate program • APPIC/APA standards • State licensing requirements • Assess your own resources (physical, human, financial) • Secure board, leadership, and clinical buy-in • Develop financial and strategic plan including potential partners • Costs and benefits: • Direct and indirect costs • Return on Investment: immediate and longer term • Benefits beyond the financial return
- 28. Questions?
- 29. Contact Information 29 For information on future webinars, activity sessions, and learning collaboratives: please reach out to nca@chc1.com or visit https://www.chc1.com/nca
Editor's Notes
- Amanda
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- Tim
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- Tim UDS – updated 2020 https://data.hrsa.gov/tools/data-reporting/program-data/national/table?tableName=5&year=2020
- Chelsea
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- Tim It can be divided into 3 categories.
- Tim For the common good Increase the pool of qualified, effective well trained psychologists Provide quality training settings for upcoming psychologists who need supervised hours for licensure Shape the future of the field by teaching postdocs how to conceptualize the role of the psychologist by what they see and what they do in their last year of supervised experience prior to licensure
- Tim Have students increases staff satisfaction – by giving staff the opportunity to expand their own professional skills in learning how to supervise and the opportunity for clinical teaching (often across discipline). Staff consistently tell us they enjoy the experience and learn from their students by increasing variety of daily activities for staff – varied work day is consistently linked in the literature to job satisfaction by being recognized as a role model and someone who is able to teach how to be an excellent clinician. by passing on knowledge and feeling the reward of watching a resident’s skill level increase Of course not all of these apply to every supervisor, and some staff have no interest or no skill in clinical teaching and would not want to (and probably should not be asked) to supervise, but for most of our staff participating in the program in a big plus In addition to the rewards for staff, residents in and off themselves, may bring many benefits to the agency, including increased intellectual rigor to clinical team meetings and supervision. While those of us in the clinical setting for decades keep up with continuing education and some professional reading, our postdocs are fresh out of school with great ideas and current knowledge – some tremendously applicable to our settings, some maybe a little ivory towerish, all of it blowing a breath of fresh air into our agency postdocs bring additional minds and hands to put to work for program development – fresh, trained eyes may spot something we do not see or bring us ideas we can borrow from another setting where they saw something in action we can adapt to our situation, and their lowered clinical load allows them time to work to plan and implement ideas postdocs require supervision ( 3 per week for us) and didactic training (another 2 for us) as well as the real time consultations that occur during the clinical day, but on balance, they see clients for many more hours per week than we spend in teaching, supervision, and consulting and that represents a net gain in access for our clients depending on how your state allows for billing for work done under supervision (most private insurances not allow it but the CT Medicaid program does under specific conditions which our postdoc program meets) you may find that your postdoc program is a break even or even a moneymaking operation. Many agencies who cannot bill find the other benefits compelling and start a program anywayl As we will show you on the next slide, postdoctoral residencies also give the opportunity to train a group of bright young psychologists to our model and then hire the best of them who want to stay in the area. And as a segue into the next slide, even if they don’t stay we have helped to produce a good employee who can continue to contribute to the field elsewhere.
- Tim For the Good of the Resident: High quality setting that prepares the postdoc for the job market Further clinical experience, training, and the consolidation of professional identity Build confidence within a clinical setting to become an independent clinician with enhanced treatment abilities and leadership skills,. Experience in the job setting will increase postdocs success at first independent job setting and thus improve retention and morale
- Tim : In the psychology world, after completing all degree requirements and being awarded a doctoral degree (typically Ph.D. in Clinical Psychology/Counseling Psychology or Psy.D. Doctor of Psychology.) we still need about a year’s worth of supervised experience before being able to sit for the EPPP (expand it) or national exam and in many states a state exam to get licensed to practice independently. Most states require a postdoc fellowship, though some (about a dozen) no longer require a formal program but accept an equivalent of supervised. (Note to any staff you have who may be on the Psych licensure tract – those that do not all have quite different quirky requirements so probably best to do the post doc unless you are sure you are going to practice in one state only your whole professional career). Specifics of licensure requirements vary from state to state – so you have to be sure to be sure to build your program to meet your specific state’s licensing standards. Additionally APPIC (expand it) and APA have specific requirements for membership and accreditation respectively ,which you should bear in mind while planning and implementing your program. More on all this in our next webinar As you might surmise from all those, when you have seen one postdoc residency, you have seen one post doc residency. Though they will all share some characteristics, each is unique in focus and training goals. Let me give you the 5,000 foot view of our postdoc, and you will hear about Salud’s shortly.
- Chelsea Begin by recapping a few points from the first webinar in this series in which we talked about issues to consider when determining whether your site was ready to launch this endeavor– and I refer you to the webinar itself which can be seen at XXX.XXX.com- because your response is to each of these issues will shape your program. And today we will be sharing our responses and discussing what we do and why as a model to help you think about what you might do. The first 3 issues really are interactive and need to be considered in designing what kind of program you can develop. Value postdoc adds: increased access for our clients, growth opportunities for our psychologists, increased job satisfaction and retention, influx of latest EBTs and thinking, research ideas and staffing, training workforce What you give: licensing hours! access to wide variety of clinical experience – age range, socioeconomic range, racial and cultural mix, multiple languages, multiple modalities; training in how to work in specialized FQHC/PCMH integrated care setting, research opportunities Your resources: financial – for us running postdoc is a wash to a slight positive financially. CT allows us to bill for up to w unlicensed providers under the license of a psychologist. Direct implications as to how many postdocs you can have, especially if you also train at the extern or internship level, space, enough clients. APPIC and APA gudelines and standards - read them and understand them as you start planning. Don’t need to follow either, but why would you not want follow best practices and get the support and input of those already doings the task? APPIC is a useful organization that helps to structure and organize the postdoc programs nationally and APA accredits programs (we are in the process of applying for initial accreditation now, having submitted the exhaustive application and waiting to hear about a site visit. State regs: make sure you know the licensing requirements in your juristiction, not only the number of hour of clinical experience and supervision but any other restrictions or specifications that impact what your program needs to look like.
- Chelsea Lets start with an overview of our program – based on our answers to the issues raised about in our setting, we designed the following program to meet the needs of the residents and CHCI. We wanted to utilize postdocs to increase access throughout our system while supporting our program needs, to maximize their variety of clinical experience, and to train them to working in an integrated interdisiplinary setting in a PCMH (hence the emphasis on WHOs) So they are placed in all of our settings, given a goal of 75% of a FTE staff member, and have one day a week set aside for didactic seminars and group supervision Supervision is for clinical training and designed to meet CT licensing requirements for posdtdocs. You will need to be familiar with the requirements in your states – and postdocs who plan to practice in another state should check sooner rather than later re what they will need in the other state their needs can be me if at all possible. Two years ago we had a postdoc who wanted to qualify for a MA license and so we made sure he got the extra supervision time needed so that he could do that. Our postdocs each have two supervisors each one for one hour per week. One is in person face to face and the second may be via zoom videoconferencing. Group supervision is for all postdocs and the Chief BH Officer and/or the Training Director and covers topics of concern to the residents, case consultations, and agency wide issues. Post docs often are the group that tries out a new procedure and gives feedback during the seminar time and this forum allows leadership tp to hear about concerns that arise at one or more of the sites the postdocs are stationed in.
- Chelsea Psychologists will play a role in program planning and PI/QI efforts, so we have intentionally included both didactic and experiential training in this area through training in the model we use for our PI efforts and in the 2016-2017 year we will be adding postdoc PI projects to the program offering the opportunity to work with our BHQI committee and PI staff to develop and carry out at least one PI project in their year with us. Our didactic seminar is 2 hours weekly - we focus on issues related to integrated care, bring in expert CHC staff (both psychologists and those from other disciplines) and invite outside speakers in topics of interest. Also, each postdoc is required to lead at least one seminar per year and given feedback and coaching as this too – serving as a clinical teacher to peers – is an important part of what we do as psychologists.
- Tim – photo from Ann Marie Hess A word about recruitment. We did not know our first year if we would have any applicants. We notified training directors of CT schools, and utilized APPIC listserv of internship and program training directors to send out announcements. We have continued to do this over the years, and word of mouth has increased as we continue to offer training. We also have an annual training lunch for all local BH schools where we invite training directors from psychology, social work, psychiatric nursing, counseling, and marriage and family programs to come and share lunch, learn about our program, and give us feedback. Graduating postdocs have also referred others to our program. As you can see from the slide, in addition to recruiting we begin the focused work on each years program in June of the preceding clinical year. About a month before the new class comes, our training director nails down the logistics of sheduling. We’d like to focus a on that for a moment. Our residents are each placed in at least two settings for clinical work – a large fixed site, and some combination of a smaller one, a school based health center, and/or a homeless or domestic violence center site. Each site has a template that is set up to show client visits types – intakes, 30 and 45 minute slots, times dedicated to warm handoff and clinical team meetings, and other resident commitments. Wednesday is a nonclinical didactic day for the weekly group supervision, the two hour didactic seminar, and some individual supervision sessions (others take place during the week at the sites) Here is a shot of what a schedule might look like: Adriana do you have one of the schedules you send out to the Officer Manager’s we can stick in here as slide 10A
- Chelsea Residents are seen as one year employees with a decreased clinical expectation and added training components. As we go through the year they function more and more independently as fitting the fact that this is their last year of training prior to sitting for state and national exams and being set free to operate as independent providers. Initial orientation is a shared Postgraduate Residency Interdisciplinary Orientation with specific tracks for each discipline in break out sessions. We off Postdoc, Medical Nurse Practitioner, and Psychiatric NP Residencies. Orientation process reflects this dual nature with Review CHCI Postdoctoral Residency Manual, Behavioral Health Policies and Procedures Week long standard CHCI orientations For several years we have had an informal brunch for supervisors, residents, and spouses/sig others. Residents like having their partners know who they are working with and meeting families at the beginning of the training year gets us off to a nice start. Setting goals. – competency evals (self) with same form used at 6 month and 12 month point and by supervisors at 4, 8, and 12 months specialty training opportunities assigned (IRB, agency wide work groups and committees/ Reflective Journal – borrowing a tool from our NP colleagues, we ask our residents to reflect on some aspect of their experience in the program every week. The journals are read by the CHBO and the Training Director and one or both give regular written feedback. This is one important qualitative tool we use to assess the program. In a upcoming seminar on Accreditation, we will talk further about quantitative assessment (such as goal settings and competency evaluations) and q
- Tim Residents build their caseloads - continuing to do intakes 2 to 3 times a week, meet with transfers, and form groups. Expectation is to have at least one group up and running by December 1. Assignments to trainings, PI projects, specialized opportunities in place by November1 Applications for the next year’s class start in early fall, with interviews in February in which residents’ participate. Supervisors need support and training too – you will need to think through how you want to do this, we have a monthly meeting of all supervisors which includes discussion of any difficulties that arise and a resident by resident review of how the program is going.
- Chelsea pod photo (from previous webinars) This second half of the training year sees a shift in emphasis from training to the interdisciplinary model and skill development to skill consolidation and increasing self awareness of the end of a long training period and the beginning of life as independently licensed psychologists. Relationships are established with other professional groups leading to more referrals to BH and increased communication within the pod. This models how professional relationships are formed and maintained, and you will need to be ready to problem solve and trouble shoot any rocky relationships, including giving what may be difficult feedback to residents about how they come across to others and ways they may need to change their presentation and approach. Parallel to the development of one year’s cohort, the selection of the next year’s class is finalized. Our post docs have participated in both Round 1 and Round 2 interviews. As the staffing needs for the coming fiscal year as clearer, conversations about staying at CHCI and/or interviews for the next step professionally occur.
- Tim Plans for next year come into focus Those with academic appointments may need to leave earlier – you will need to take this into account in planning EPPP national exam may be taken at different times in different states depending on where postdoc is seeking licensure Clinical wrap up – transfer and termination
- One of this years residents (Courtney and Tanesha, Chelsea asking tomorrow) 3 minutes each
- TIM ALDON: Should be done by 3:25-3:27
- Chelsea
- Tim/Chelsea What were some of the largest barriers you encountered in building a postdoc and how did you navigate those barriers? How did you select didactic curriculum to focus on in training?
- Amanda