training directors’ roles i n addressing the internship crisis: a social justice perspective
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Training Directors’ Roles i n Addressing the Internship Crisis: A Social Justice Perspective. Nadine J. Kaslow, PhD, ABPP APA President-Elect [email protected] Greg Keilin, PhD APPIC Match Coordinator [email protected]. Introduction. Topics Why a social justice perspective - PowerPoint PPT PresentationTRANSCRIPT
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Training Directors’ Rolesin Addressing theInternship Crisis:
A Social Justice Perspective
Nadine J. Kaslow, PhD, ABPPAPA President-Elect
Greg Keilin, PhDAPPIC Match [email protected]
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• Topics• Why a social justice perspective• State of the internship crisis• Proposed solutions from the field• Human impact of the internship crisis• Social justice perspective• Role of training directors
Introduction
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• Format• Presentation• Conversation• Group involvement• Attention to own feelings and thoughts• Format and social justice• Enhances engagement• Empowers all parties• Leads to greater understanding and better
solutions
Introduction
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Why a Social Justice Perspective
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• Barriers to a critical pipeline transition – access problems to the profession• Lack of truth in advertising• Arbitrary criterion for advancement and
success• Exploitation of students who don’t match• Financial issues • Guilt of the “haves” and shame of the “have
nots”
Why a Social Justice Perspective
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Current Snapshot: State of the Internship Crisis
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Internship Crisis
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2500
3000
3500
4000
4500
Applicants Positions
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Matched332674%
Unmatched115526%
2013 APPIC MATCH
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Matched275290%
Unmatched31910%
2002 APPIC Match
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Matched to Accredited
56%
Matched to Non-Accred-
ited18%
Unmatched26%
2013 APPIC Match
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Resolution Passed byAPA Council of Representatives
August, 2013
• Graduation from an APA/CPA accredited doctoral program and an APA/CPA accredited internship program is required:• For Health Service Psychologists• For Licensure for Independent Practice
• Unaccredited programs must become accredited:• Doctoral Programs – 2018 (5 years)• Internship Programs – 2020 (7 years)
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• By 2018, doctoral programs must be APA- or CPA-accredited for students to participate in the APPIC Match
• Non-accredited doctoral programs granted an initial site visit by APA may participate for up to two years without accreditation
• APPIC has not established a policy regarding accreditation of internship programs
APPIC Policy onDoctoral Program Associates
June, 2013
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Potential Impact of Universal Accreditation
• Currently: Of the 1,150 unmatched applicants:• 650 find a position outside the APPIC Match (e.g., CAPIC,
unpaid, etc.)
• 500 wait and participate in the following year’s Match
• Greg’s Assumptions:• Half of all non-accredited doctoral programs and
internship sites will become accredited
• Licensing boards will require accreditation
• Applicants will seek only accredited internship positions
• No growth in applicants or positions until 2018
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2017 2018 2019 2020
Applicants 4,250 5,030 5,780 6,600
Positions 2,950 2,950 2,950 2,950-------- -------- -------- --------
Unplaced 1,300 2,080 2,830 3,650
Potential Impact of Universal Accreditation
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Proposed Solutions from the Field
• Promote a paradigm shift• Use a multi-organizational governance
system with a multifaceted approach• Find cooperative solutions among multiple
bodies, moving beyond self interest, shared responsibility
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• Engage in difficult dialogues across training councils to develop shared solutions (Courageous Conversations)• Analyze comprehensively and pay
attention to both the supply and demand side of internships• Form a shared governance structure to
manage the resource pool
Proposed Solutions from the Field
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• Encourage graduate schools to practice voluntary restraint with regard to admissions and development of new programs• Educate prospective students about the realities
(national match rates) and the school’s match rate (truth in advertising)• Have doctoral councils reach consensus on
minimal requirements for eligibility to participate in the Match• Limit number of applicants who can apply
simultaneously from the same doctoral program
Proposed Solutions from the Field
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• Change which doctoral programs can participate in the Match – limit to only accredited programs• Hold doctoral programs accountable for
Match rates vis-à-vis accreditation (50%)
Proposed Solutions from the Field
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• Change the sequence of training (National Conference on Sequence of Training) - CoA recently affirmed that internships will remain predoctoral)• Replace one year experience with
alternative, part time experiences• Change licensure laws to ensure that only
a quality supervised experience will qualify for licensure
Proposed Solutions from the Field
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• Understand and decrease barriers for internship programs to be accredited• Support more programs in becoming
accredited• Psychology Internship Toolkits for new and
existing programs• Mentoring programs
Proposed Solutions from the Field
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• Conduct a workforce analysis with regard to where psychologists are needed and use this to argue for more internships relevant to those needs• Find innovative ways for accredited sites to
increase the number of slots available• Allow and encourage doctoral programs to
develop their own internship sites – captive affiliated• Encourage schools and community sites to
partner to form new programs and positions
Proposed Solutions from the Field
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• Find new ways to fund internships• Increase advocacy efforts to find
internship funding• Consider an internship stimulus package –
done in 2012• Advocate for additional training dollars,
including increased GPE funding• Consider whether interns need to be paid
Proposed Solutions from the Field
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The Human Impact of the Internship Crisis
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Pre-Internship At Graduation$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$70,000
$100,000
$84,569
$100,725MedianMean
Psychology Graduate Student Debt Load
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Ph.D. Programs Psy.D. Programs$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$140,000
$30,000
$120,000
$53,644
$126,922MedianMean
Psychology Graduate Student Debt LoadPhD vs PsyD Doctoral Programs
2012 Match Applicant Survey Data
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White (Non-Hispanic) Non-White$0
$20,000
$40,000
$60,000
$80,000
$100,000
$120,000
$60,000
$90,000 $80,752
$96,237
MedianMean
Psychology Graduate Student Debt LoadRacial/Ethnic Identification (2012)
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APPIC Applicant Survey
“How has the current imbalance between applicants and positions affected you, personally and/or professionally? In other words, if you had the ear of the Education and Training community, what would you like to tell them about this issue? How has your life and the lives of others been affected? You may wish to share your own personal experiences, the impact on yourself, other students, and/or your academic program, suggestions for how to improve the situation, or other thoughts, feelings, and/or concerns.”
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“For me, it means putting off my life for yet another year. It means putting myself through
hell for another year for a *chance* at matching next year. For some of my classmates, it means waiting one more year before having children. For others, it means considering quitting now,
leaving the program, and getting a masters-level job. For all of us, it means prolonging our wait to
become a psychologist, all while accumulating even more debt. My classmates and I have shed
many tears in this process. I hope that future cohorts will not have to endure such pain.”
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“This process was horrendous. I did not match last year and I considered this past year my ‘year
of hell.’ My self-confidence was shattered and my family had to live with my angst.”
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“[It] means I have to wait to have a child one or two extra years ... This increases my chance of
fertility difficulty. If I want IVF or adoption after that, it costs a LOT of money and, when added to the extra debt I will have incurred being stuck in grad school two extra years, may bankrupt me.”
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“Not matching almost broke me in multiple ways. This shouldn't be how I am feeling during the end of graduate school. I should be feeling
excited & proud of myself & eager to begin. Instead, I feel defeated. I am grateful for
matching the second time around & being able to move forward but I don't think I'll ever be able
to get past not having matched the first time.”
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“The fact that we, as supposed experts on human behavior, have not been more attuned to
this is mind-boggling. Many people do have geographic limitations at this age range - young families or aging parents they cannot leave. … The argument that it is "only a year" does not
hold weight at a personal level - try explaining to a two-year old that her father will be gone for
‘just a year.’ ”
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“… the imbalance between applicants and positions is an utter disaster. It is destroying lives,
sundering professional relationships, and I believe it is endangering the credibility of our
field. My program now has student pitted against student, faculty members angry at each other, and the worst match rate in program history,
which may reduce the funding the department gets from the university.”
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“I want the education and training community to know that this process and the devastation it has brought … has stripped me of my belief that I am
a capable, successful, and hard-working student.”
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“On a personal level, I am truly beginning to feel that I made a terrible decision coming into this
field”
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“I have dedicated so many years of my life to the pursuit of a doctorate in clinical psychology (a field I love and have admired for so long), and
now feel betrayed and disappointed by the field.”
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“At this point, the only people suffering are the students. How incredibly disgraceful is that? The emotional strain that is placed on students who
must navigate the match process again … is cruel. One must question the scruples of a
profession that would subject its up and coming professionals to this treatment. I am very
disappointed. I expected better of my chosen profession.”
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“I am a survivor of Hurricane Katrina. The results of this match will have a bigger effect on my career path than that devastating storm did.”
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A Social Justice Perspective
•Melba Vasquez• Former APA President / ACCTA Member• “Psychology and Social Justice: Why we do
what we do” (American Psychologist, July-August, 2012)• Aldarondo’s (2007) Definition of Social Justice:
• “to decrease human suffering and to
promote human values of equality and fairness.”
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A Social Justice Perspective
• Caldwell & Vera (2010): Identified two critical incidents that most influenced the development of a Social Justice orientation by students:• “Exposure to Injustice”
• “… incidents of personally experiencing a form of injustice or witnessing others’ experiences of injustice”
• “Influence of significant persons”• “… individuals who played an influential, important,
or significant role in their development into social justice advocates.”
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“This process has soured me on the [profession], perhaps permanently. This system is broken,
immoral, and unacceptable and psychologists and the [profession] should be ashamed of
themselves for tolerating a system that so thoroughly victimizes students. Shame on us all
for doing this to our most vulnerable members in a field which is, at root, supposed to help others.
The financial and personal burdens of this process are an embarrassment to the field. … [This
profession] has sent me to the wolves and I will not forget it. Clearly this is not [a profession] that
cares about me or my well-being. ”
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The Internship Crisis:Conflicts among Allies
“Sometimes intense conflicts occur among groups of allies (people who ordinarily share values). At times, when those closest to us, those from whom we most expect understanding or empathy, those with whom
we have shared struggles and values, adopt a different perspective, opinion, or behavior, a sense of
betrayal is experienced more intensely”
(Vasquez, 2012)
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Role of Training Directors
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Role of Training Directors
•Why should we care? We are in the driver’s seat• Our biggest issue is that we get too many
applications and get to pick from great applicants•We want our interns successfully matched• From a selfish perspective, we are
benefitting
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Role of Training Directors
•We have a lot of power in this situation•We have unique choices about how to use
it•We control the resource that everyone
wants•We are the owners of the resource that
everyone is clamoring for
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POWER IMPACT WHO
HIGH LOW ?
MEDIUM MEDIUM ?
LOW/NO SEVERE ?
The Internship Crisis:Power Analysis
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Role of Training Directors
• From a social justice perspective• The right thing is to do something• The good thing is to do something• The right and good thing is to have solutions
that target all aspects of the problem, including supply and demand
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Role of Training Directors
• From a social justice perspective, we must• Be aware our power• Do something with our power• Use our power to create solutions without
disempowering or disenfranchising others
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Role of Training Directors
•What can we do with students?• Model, teach, and reinforce negotiation,
conflict management, having difficult conversations, and a communitarian approach• Move beyond teaching students how to win to
teaching them how to be an empowered and active member of the community that will solve this problem• Reduce the financial penalties of not matching
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Role of Training Directors
•What can we do with students?• Give voice to the views and experiences of
graduate students, interns, postdoctoral residents, and early career psychologists• Engage them in brainstorming and creative
problem-solving• Local• National level
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Role of Training Directors
•What can we do with students?• Empower them to be collaborative partners in
implementing solutions• Attend to and build upon students’ grassroots
efforts
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Role of Training Directors•What can we do at the local level?• Advocate for new positions at home institution
(complex)• Find new sources of funding to support new
positions• Support creation of new paid slots in home
community and offer mentorship and guidance so positions can be accredited
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Role of Training Directors•What can we do at the local level?• Reach out in community to encourage creation
of new positions and programs• Partner on teams to develop local internships
that are ultimately accredited• Target mental health shortage areas (also a
national issue)
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Role of Training Directors
•What can we do at a national level?• Existing existing and develop new
collaborative organizational infrastructures to determine, implement, and evaluate innovative solutions• Exert pressure on the system– e.g., only
take students from accredited programs• Advocate for accreditation guidelines and
self-study processes to be more realistic for internship programs
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Role of Training Directors
•What can we do at a national level?• Advocate for accreditation efforts aimed at
ensuring that doctoral programs are responsible for having the majority of their students match• Advocate for more funding• Publicize the value of quality internship
training