Category Archives: Graduate School

Integrated Healthcare and the Current State of Affairs

Experts from around the world met in November 2015, in Washington, D.C., to participate in a 2 ½-day summit,international “Global Approaches to Integrated Health Care: Translating Science and Best Practices into Patient-Centered Healthcare Delivery”.

Approximately 85 psychologists, physicians, public health workers and policy analysts met in person for the interdisciplinary summit as well as more than 400 virtual attendees from around the world, who viewed the proceedings via a live video simulcast. Two APAGS representatives, Justin Karr and Jerrold Yeo, attended the summit and provide their impressions and thoughts on this experience below.

Justin Karr

Dr. Tor Levin Hofgaard, the President of the Norwegian Psychological Association, spoke at the Summit and clarified a famous statement that he once made, in which he claimed that, “we should have psychologists at IKEA.” He meant that psychologist should be located where people are already going, decreasing stigma around mental health care and increasing the normality of seeing your psychologist. Integrated healthcare bears a special importance for health service psychologists, as we aim to collaborate with other medical professions by incorporating mental and behavioral health services into primary care. Ideally, psychological services can become as commonplace and de-stigmatized as a standard medical check-up, where people have a professional attend to their mental health within the same setting where they receive other medical services.

As a student, I saw the Summit as both awe-inspiring and daunting. The evidence promoting an integrated healthcare model is astounding. With cost-savings, improved health outcomes, and even higher clinician satisfaction ratings, there is an overwhelming amount of published research supporting the implementation of integrated healthcare. During a working group session of the Summit, one presenter actually stated, “We don’t need any more research,” clarifying that there is more than enough research to support moving forward with implementation. However, many barriers stand in the way of actualizing more widespread integrated services, including many changes that need to occur in funding structures, healthcare policies, current practices and educational standards.

Although the barriers are significant, the Summit left me with great optimism, as leaders across fields and occupational sectors came together to help make integrated healthcare a more common reality for the patients we serve. Dr. Arthur C. Evans, the Commissioner of Philadelphia’s Department of Behavioral Health and Intellectual disAbility Service (DBHIDS), shared one of his favorite sayings at the Summit, “Inherent in every community is the wisdom to solve its own problems.” As a community psychologist, he quoted this statement during a panel on special populations, emphasizing the involvement of local community members in the policy-making that directly affects their lives; however, I feel it also applies to our community as healthcare professionals. As Health Service Psychologists, we are members of the healthcare community, and with our colleagues across disciplines, we possess the wisdom to actualize integrated health care and support the well-being of the patients and clients that benefit from our services.

I look forward to seeing the continued integration of healthcare in my remaining time as a student, and over the course of my life as a psychologist. However, I do not see myself as merely an observer, but as a part of this change. As students, we will inherit many of the impending reforms coming to our clinical practice, and we must ensure that we voice both our support and concerns as these changes will surely impact our training and careers. Students must be actively engaged in the decision-making that determines training standards; not only during our graduate education, but also throughout our careers.

One discussion at the Summit emphasized the need to change patient expectations, where healthcare consumers expect access to integrated services every time they enter into a primary care facility. In the same light, we as students must expect effective training in collaborative practice that operates across disciplines. As consumers of graduate education, we are significant stakeholders in this enterprise, and we must have opportunities within our training to experience modern healthcare models in a way that best prepares us to work with other disciplines. In turn, I look forward to not only the changes that occur in practice following this Summit, but also the changes that will occur in education. As we prepare for an improved integration of care, I hope that we, as the next generation of psychologists, will become more appreciative of our fellow healthcare disciplines throughout our training; and in the same light, I hope that other disciplines will become more appreciative of health service psychology, understanding the unique and essential role of psychological services in the true integration of care.

Jerrold Yeo

Although the atmosphere of the summit was a little intimidating as it was well-attended by many key people in the field, I felt welcomed as a student representative attending the conference. I had never seen so many leaders of psychology from diverse cultures and backgrounds in the same room, and bouncing ideas and thoughts off them in addition to the networking experience felt surreal.

A number of points stuck with me as I listened to the many keynote speakers and panels throughout the summit. Listening to how different healthcare systems work in different countries and learning about the differences between them helped make me more aware of any challenges that I might face as a soon-to-be professional, (e.g., reimbursement, payment systems and Medicaid to aid lower-income families). It was also fascinating to hear a possibly controversial argument about not needing any more research on integrated care; but the take home message that I got from that was that we are doing good research on the topic, but have not been able to implement it as effectively as we would have liked.

It was also very interesting to hear the patient perspective at a professional summit like this. I think it provided a very real touch to the whole summit as we get reminded of why we do this: for the people. E-patient Dave, who is an activist for healthcare transformation through participatory medicine and personal health data rights, also reminded us that we should try to engage patients in their own treatment, to empower them to find out more about their own difficulties and make informed decisions.

Many times during the summit I questioned myself: “What am I doing here? As a student, what can I do?” These questions kept running through my mind as I attempted to socialize and network with these high-flying professionals. Only during the second part of each day did my question get answered. The second half of each day was devoted to small group discussion and brainstorming. Justin and I were split up into different groups so that we could provide a unique student perspective.  Personally, I advocated for the education of the general public from a young age to expect integrated care, which appeared to be well received. Where we shined was that we, as students, were able to provide a perspective that could complement the policy changes that the leaders in the field were proposing.

Through this summit, I think that I became inspired to become more involved in the advocacy of integrated care and provide more comprehensive services to my clients. As a student attending this summit, it became clear to me that, as future leaders in the field, we have to pave the way for psychology to be a part of the integrated care system by establishing important connections with other professions and advocating for psychology to be used more effectively and efficiently in the provision of health care services.

Editor’s Note: Justin Karr (University of Victoria) is the current APAGS Member-at-Large for Membership Recruitment/Retention and Jerrold Yeo (University of Denver) is a former member of the APAGS Convention Committee.

Me: I'm so busy! You: Me too! Repeat ad nauseam

New Year’s Resolution: Stop Saying “I’m Busy”

Me: I'm so busy! You: Me too! Repeat ad nauseam

College, graduate school, and just about any time thereafter is remarkably eventful. We are pressed to do so many things just to stay in place. Usually quite innocently, when people ask how we are, we respond with some variation of “I’m really busy.”  When they ask us the next time, we’re are likely to repeat the same exact thing.

What is up with this glorification of being busy? Is it like talking about the weather in that it makes for a conversation filler? What if it is actually a conversation killer.

Some time ago, blogger Tyler Ward argued in this clever piece that our little over-used phrase leads nowhere good, and it doesn’t make us that special. He describes how one couple  decided to stop using the word “busy” for one entire year. The finding?

“We were forced to describe our own situations with more clarity, and without our best friend ‘busy’ to blame, we engaged with people more authentically. As we did, we noticed the general depth of conversations increase as we and those we were sharing with, were invited to communicate differently about our actual states of being.”

In his post, “Busy Isn’t Respectable Anymore” you can explore other compelling reasons to avoid communicating your busyness with the world.

Be sure to share your thoughts and reactions in the comment section. I’d love to hear reactions you get to saying or hearing “I’m really busy” – and ways to substitute the phrase with something better.

As the calendar just turned over to 2016, it’s as good of a time as any to try something new.

Living at the Intersection: Reflections on the Graduate Student Experience

Martyr MA PictureGuest columnist: Meredith A. Martyr, University of Minnesota – Twin Cities, Class of 2019

What social identities do you currently identify as most central to you? I identify as Pansexual, Feminist, and Cisgender Woman.

Progressing through my PhD coursework, I have become increasingly aware of my various identities and their impact on one another. Appearing as a cisgender woman, I am often assumed to be heterosexual by my classmates, professors, and colleagues. Appearing cisgender carries both a constant awareness of the privilege this provides me, and a continual reminder of the assumption that others make regarding my sexual orientation.

On one particular day, I was sitting in a doctoral seminar class discussing feminism in counseling psychology. Many of my classmates spoke very highly of feminism ideology and the “great progress” that has been made by the second wave feminist movement of the 1960-70’s. Identifying as pansexual and a feminist, I felt that it was pertinent in that moment to bring up the social oppression and silencing that occurred within the lesbian, bisexual, and pansexual communities at the hands of the cisgender second wave feminist movement. My classmates were confused by my critiques of second wave feminist ideology, and at that moment I felt it was important to share my sexual orientation in order to explain the conflicting appreciation and caution I have for the feminist movement. As I opened my mouth to share my pansexual identity, I feared hearing common microaggressions such as, “I never would have thought you would be pansexual,” “You don’t look like you would be into women,” or “I am relying on you to bring the gay perspective to this discussion.” Despite this fear, I experienced the compassion and increased self-awareness that can come from hearing and/or sharing a personal narrative. As I shared my narrative of how uplifting and restricting feminism could be for a pansexual individual, I felt an energy shift in the room from confusion to insight as my historically marginalized perspective was heard and acknowledged. It is my hope that by continuing to share my narratives, others may continue to develop a greater awareness regarding the fluidity of sexuality and gender.

I am appreciative and humbled by the openness, authenticity, and respect that I have received during my graduate education. The foundation that my graduate program has laid down has provided a space of safety and trust. The best advice I can pass on to others who have various intersecting identities would be to investigate the department’s involvement with different social justice movements and their approaches to working with a diverse set of identities. Additionally, I would recommend sharing your narratives only when you are ready or wish to do so. I would not have shared my intersecting identities with my professors and colleagues if I did not feel respected and safe within the academic environment created by my graduate program. As I move forward in my graduate training program, I look forward to expanding my own self-awareness and experiencing new opportunities to engage in meaningful and impactful discussions regarding the complexity of intersecting identities.

This column is part of a monthly series highlighting the experiences of students and professionals with diverse intersecting identities and is sponsored by the APAGS Committee on Sexual Orientation and Gender Diversity and the Committee for the Advancement of Racial and Ethnic Diversity. Are you interested in sharing about your own navigation of intersecting identities in graduate school? We would be happy to hear from you! To learn more, please contact the chair of APAGS CSOGD (Julia Benjamin, jzbenjam@gmail.com) or CARED (James Garcia, jjg0136@gmail.com).

The Texas State Capitol Building. (Source: StuSeeger on Flickr. Some rights reserved.)

Tackling the Internship Crisis Through Legislative Advocacy

The Texas State Capitol Building. (Source: StuSeeger on Flickr. Some rights reserved.)

The Texas State Capitol Building. (Source: StuSeeger on Flickr. Some rights reserved.)

They say everything is bigger in Texas, but there is at least one exception: The window for getting new legislation introduced and passed is tiny!  Despite the fact that the legislature only meets for 140 days every two years, the Texas Psychological Association (TPA)–with the help of its Student Division–was able to find legislative sponsors for the “Intern Bill” and mobilize TPA members and their representatives to support it.

This bill authorizes licensed psychologists to delegate services to a pre-doctoral psychology intern under their supervision.  Allowing licensed psychologists to delegate services to their interns is the first in a series of steps toward making internships more sustainable. As the Director of the TPA’s Student Division, I was given the opportunity to play a key role in advocating for this legislation.

Climbing the legislative ladder

At my first TPA Board of Trustees meeting as the Director of the Student Division, I learned they were planning to find legislators to sponsor the Intern Bill.  After having seen the video created by APAGS about the internship crisis, I was well aware that the lack of internships for qualified doctoral students had reached alarming proportions, with up to 29 percent of applicants not matching during the last five years.  I coordinated with TPA’s Grassroots committee to mobilize students to support this bill and ended up becoming personally involved in advocating for this legislation.

My efforts began by mobilizing the Student Division’s Board of Directors and Campus Representatives to begin spreading the word to colleges and universities across Texas about this bill and what it could do for psychology students.  One of the difficult things about advocacy is that you rarely get feedback about how your message is being received and whether it inspires others to take up the challenge.  I learned that our message was effective after TPA invited its members to spend a day together at the capital with legislators, speaking with them about bills we are sponsoring.

Students turned out in record-breaking numbers for this event, ready to take on the challenge of advocating for this much needed legislation.

I headed back to the capital a few weeks later, along with other key TPA members, to testify before the Texas Public Health committee about the importance of passing the Intern Bill.  This was an exciting opportunity.  I prepared my testimony by doing a little research and getting feedback from students who had not previously matched to an internship program.  After all this work, the amount of time I was allowed to testify was reduced from 10 minutes to about 2 minutes!  I had to be very concise, but I was able to speak about my most important points during this time (To watch, find the testimony from  04/07/2015 under Public Health, starting at 14:25).

Representative Garnet Coleman and Senator Kevin Eltife have been very supportive of the profession of psychology.  Their sponsorship of House and Senate versions of this bill, combined with the persistence of students and TPA members, led to a majority vote with almost no opposition by the House and Senate. The bill became law in June 2015.

The power of student advocacy

My advice to those involved with other organizations interested in promoting similar legislation falls into three categories: awareness, student involvement, and focus.

Awareness: Even in academic settings, people are largely unaware of the severity of the internship crisis.  Laying out the numbers gives people a clear view of the problem.  Once they have been armed with the facts, people are more likely to become involved in changing the situation.  For me, presenting the percentage of students who did not match to accredited internship programs had the greatest impact.  These statistics can be found on the APPIC website.

Student involvement: Students are willing to get involved in legislative advocacy.  When reaching out to them, it is important that you to provide several avenues to express their support.  Those who have the resources to travel to their state’s Capital (or live nearby) should be encouraged to make their position known in person before legislative committees, or set up appointments with their representatives individually.  Providing links to online petitions and to the contact information for the state’s representatives can help others get involved.  Also, encourage your peers to address these issues with their professors and advisors.

Focus: When giving testimony before legislators keep the focus narrow enough so that you don’t become bogged down in unfamiliar jargon.  Present a brief overview of the statistics and then turn your attention to the impact the internship crisis has on individual students and their constituents.  Once they understand that billing for interns will lead to increased access to mental health care for their state’s residents, supporting the legislation becomes that much easier.

Don’t be afraid to ask

If you are a student, it is important to be involved in both a national organization, such as APAGS, and your state psychological organization.  It was through APAGS that I discovered that the internship crisis existed, which prompted me to get more involved with TPA in trying to do something about it.  All I had to do was ask TPA to help with the Intern Bill–they were ecstatic that a student was willing to get involved.

The bottom line is: Don’t be afraid to ask.  Ask your state psychology organization to introduce an Intern Bill; ask other students and psychologists to support it; ask your state government to pass it.

It is my hope that the success we have experienced in Texas will make it easier for other state governments to say yes to an Intern Bill.

Amanda Phillips

Editor’s Note: Amanda S. Phillips is a doctoral student in clinical health psychology at the University of North Texas. She is also the 2014-2015 Director of the Student Division of the Texas Psychological Association. 

Living at the Intersection: Reflections on the Graduate Student Experience

Bianca poindexter

Bianca Poindexter

Guest columnist: Bianca Poindexter, Northeastern University, Class of 2015

What social identities do you currently identify as most central to you? I identify as Black, Queer, Cis-Woman, Able-Bodied, 24, and Christian

If you could go back in time, what advice related to your intersecting identities would you give to your former self upon applying for and entering graduate school? The advice that I would give my former self when applying for graduate schools would have been to think even bigger and go even further out of my comfort zone. I would have also said to search for programs that had more people with intersecting identities, including both the students and the professors; to expand my horizons. I would have explained to that young woman entering graduate school to not be so anxious, intimidated, and not feel so unworthy of where she was; that she deserved to be there, like everybody else, and to not be ashamed of who she is.

Describe an instance where you were “forced” to choose or represent one identity over another. How did you negotiate this instance? What did you learn from this experience? I was put in the position of representing the voice of the LGBTQ population on several occasions in the classroom. I was not “forced,” but I felt that if I did not speak to the reality of some of the issues that the LGBTQ population was facing, then no one would. I felt that many people in my cohort knew very little about that population or had blinders on to those issues. Some were not understanding of the fact that those issues affect not only myself and others in the class, but also a large population of people whose voices are finally being heard, or that such issues could affect people they know who are afraid to come forward. I felt that it was my duty and obligation to make sure they understood that the LGBTQ population has a face and a name. Not everyone but some of them definitely needed to be woken up to what the reality of the situation is.

How have you found support and spaces to talk about your intersecting identities as they relate to graduate school and your quality of life? Coming into this program at Northeastern University, I was already intimidated and felt like there would be no one to express my whole self with. I somehow lucked out to meet another woman in my cohort, Amanda Weber, who I could identify with. She and I built a friendship on like interests and we could discuss our identities, as well as school together and not feel judged. I found others in the program who turned out to be very accepting, as well as my academic advisor, Dr. Tracy Robinson-Wood. It was amazing and relieving to have a group of people to vent my frustrations and my struggles to. These people helped me get through the program and understood where I was coming from on different levels. I have two friends in the program who are Black, several who are women, and one who identifies on the LGBTQ spectrum. It was exactly the group that I needed to make the graduate experience less isolating, as well as my friends and my mother back home in Georgia who had great listening ears.

This column is part of a monthly series highlighting the experiences of students and professionals with diverse intersecting identities and is sponsored by the APAGS Committee on Sexual Orientation and Gender Diversity and the Committee for the Advancement of Racial and Ethnic Diversity. Are you interested in sharing about your own navigation of intersecting identities in graduate school? We would be happy to hear from you! To learn more, please contact the chair of APAGS CSOGD (Julia Benjamin, jzbenjam@gmail.com) or CARED (James Garcia, jjg0136@gmail.com).