TASK FORCE ON THE FUTURE OF PUBLICLY FUNDED PSYCHOLOGY SERVICES IN CANADA
Dr Joyce D’Eon: Health Care and Hospital Psychology Task Force Co-Chair
Dr Lorne Sexton; Future of Publicly Funded Psychology Services Task Force Coordinator
In March 2012, the CPA Board passed the following motion: That a Task Force of the Future of Publicly Funded Psychology Services in Canada be formed. This will take the form of three separate but collaborative task forces of psychologists in hospital practice, education, and corrections. The task force mandate is to survey and deliberate the future opportunities and threats to publicly funded psychology services in Canada, recognizing that many psychologists are employed in these facilities and many members of the public obtain their care from publicly funded health, educational, and corrections services. These task forces are also charged with considering the establishment of guidelines as to the organizational structure and standards of psychological practice in public service.
The three task force groups share in common issues of the appropriate organization of psychology services (including leadership, practice standards, professional development and identity) and supply and demand (including training, recruitment, and retention).
Progress to Date
Progress to date includes:
- In March 2012, the Educational and School Psychology Task Force forwarded discussion points to the CPA Board concerning the practice of school psychology: (1) title, educational type/degree (2) supply/demand (3) professional integrity and autonomy.
- In November 2011, the Health Care and Hospital Psychology Task Force recommended the establishment of a CPA Section for Psychologists in Hospitals and Health Centers.
- In November 2011, the Corrections Psychology Task Force formed subcommittees for: (1) public education initiatives; (2) training in Correctional/Forensic Psychology; (3) communication with the judiciary; and (4) psychologist recruitment and retention in Canadian corrections.
On-going Task Force communication and discussion with CPA membership occurs through the relevant CPA Sections of Psychologists in Education, Criminal Justice Psychology, and the recently established CPA Section, Psychologists in Hospitals and Health Centers. Future directions for the task force will be established in consultation with these Sections as well as with the CPA Practice Directorate and the CPA Professional Affairs Committee.
EVIDENCE-BASED PRACTICE TASK FORCE
FINAL REPORT: Evidence-Based Practice of Psychological Treatments: A Canadian Perspective. Click here to view the final report.
Lynn Alden: Professor, University of British Columbia, Vancouver
Note: Considerable expertise from a variety of research, practice, knowledge-translation, consumer and community perspectives is represented among the task force members. Interestingly, most of the academics on the committee also have a small private practice. There is also good representation from different theoretical orientations, including interpersonal, emotion-focused, cognitive-behavioural and psychodynamic perspectives.
The purpose of this task force, in effect 2012-2013, was to operationalize what constitutes evidence-based practice in psychology, to make recommendations about how psychologists can best integrate evidence into practice to better inform patient care and to suggest strategies for dissemination.
SUPPLY AND DEMAND TASK FORCE
Elizabeth Church (School psychology, Mount Saint Vincent University)
Catherine M. Lee (Clinical, University of Ottawa)
Stéphane Beaulieu (l’Ordre des psychologues du Québec)
Jean-Paul Boudreau (Developmental, Ryerson University)
Arla Day (Industrial-organizational, St. Mary’s University)
Olga Heath (Clinical/Counselling, Memorial University of Newfoundland)
Kevin Kelloway (Industrial-Organizational, St. Mary’s University)
Bob McIlwraith (Clinical health psychology, University of Manitoba)
Karen Cohen (Canadian Psychological Association)
Lisa Votta-Bleeker (Canadian Psychological Association)
There are a number of pressing issues which need to be addressed regarding the supply of and demand for psychologists. A large proportion of the psychology workforce is approaching retirement. Who will take their places? How many people do we need to train? How should we plan to ensure that there are enough psychologists in areas such as prevention, health promotion and rehabilitation? Will we have an adequate number of psychologists to conduct research, train future students, and develop programs? We have data about the number of students entering and graduating from psychology programs, but little about the nature of their training, and even less about their career paths after graduation. We lack information on how many psychologists are actively practicing in the jurisdiction in which they are licensed, how many are publicly versus privately funded, how many are in health versus correctional versus school, how many are full-time versus part-time, etc. In 2008, CPA struck a task force to examine issues related to the supply of and demand for psychologists in Canada.
View the Spring 2009 issue of Psynopsis for an article on supply and demand issues and the task force.
The task force’s final report was submitted to and accepted by the CPA Board in November 2010. Click here to view the report.
PRESCRIPTIVE AUTHORITY TASK FORCE
|Lorne Sexton, CPA|
Craig Turner, CRHSPP
Rose-Marie Charest, ACPRO
Meghan Richards, CPA Student Section
Don Saklofske, CCPPP
Kerry Mothersill, CPA Clinical Section
David Nussbaum, CPA Psychopharmacology Section
Mary Broga, CPAP
JoAnn Leavey, CPA Rural and Northern Section
Kim Lavoie, CPA Health Psychology
In September 2008, in response to growing interest in the prescriptive authority issue, CPA initiated a Prescriptive Authority (RxP) Task Force.
Terms of Reference
To review all related issues and develop a statement for the CPA Board of Directors.
- CPA Sections
- Clinical Psychology
- Rural and Northern Psychology
- Students in Psychology
- Health Psychology
- Up to three other Section representatives from Brain and Behaviour, Adult Development and Aging, and/or Clinical Neuropsychology
The most important consideration is of a representative process which can assist the Task Force in dispassionately examining the issues in order to develop an integrative statement to present to the CPA Board of Directors.
Rationale and Mandate
At least one (Ontario) has started to develop advocacy plans for obtaining such authority. In the absence of material from Canadian Psychological Association, they will have to rely on material from the American Psychological Association.
In the United States, the American Psychological Association and state associations of psychologists have been advocating for prescriptive authority for psychologists. The American Psychological Association’s official position, as stated on their website, is:
“APA supports the efforts of state and provincial psychological associations and individual psychologists as they pursue the right of appropriately trained psychologists to prescribe psychoactive medications. Prescriptive authority for psychologists is a legislative, regulatory, and educational issue impacting the scope of practice of licensed psychologists.” (Boldface added for emphasis)
There are currently (2008) two states where psychologists have been granted prescriptive authority: New Mexico (2002); Louisiana (2004). In 2007 nine legislative attempts by state associations failed (National Psychologist, Sept/Oct 2007). It should be noted that support for this issue in the USA is mixed and there is continuing controversy regarding the appropriateness of seeking prescription privilege. The issue of prescriptive authority in the United States has also resulted in increased tensions between psychology and medicine, particularly psychiatry.
Up until this point in time, the Canadian Psychological Association has not developed a formal position statement on prescription privileges for psychologists. The training models for the profession, although similar in many ways, are different in the United States and Canada. Thus, the training models for the United States for prescriptive authority for psychologists may not be completely transferable to a Canadian education and training context. Issues around prescriptive authority involve clinical practice, provincial regulation, and education/training.
The CPA Board of directors thus commissions the Task Force to consider the relevant professional literature and diversity of opinion towards advising the Board as to the following issues regarding prescription privilege for psychologists:
- wisdom of the moving the profession in this direction: assessment of reasons for and against
- priority of prescription privilege as an advocacy issue
- implications for training in graduate programs
- adequacy of APA post-doctoral training model
- certification and regulatory issues
- other relevant issues as raised by Task Force membership
In June 2009, the Task Force circulated an interim progress report to the Board. See the Winter 2010 Issue of Psynopsis for a summary of the interim progress report.
The task force’s final report was submitted to and accepted by the CPA Board in November 2010. Click here to view the report.
PSY.D. TASK FORCE
Bob Robinson, Ph.D.
Harvey Brooker, Ph.D.
Psy.D. Task Force Summary and Final Report
In Spring 1997, CPA established a Psy.D. Task Force charged "with a review of education and training models in psychology." Based on an earlier Consultation Document, an Issues Paper and extensive consultation, the Psy.D. Task Force submitted its Final Report to the CPA Board of Directors on November 14, 1998. The Board received the Report and unanimously approved the Conclusions, Recommendations and Implementation Guidelines.
The Summary Statement of the Task Force states:
"The Psy.D. Task Force reaffirms the Scientist-Practitioner (Ph.D.) Model and conceptually supports a particularly articulated Scholar-Practitioner (Psy.D.) Model as appropriate; we conclude that there is need and interest in the Psy.D. application and that it would be strategic to support its development within a national accreditation framework. More specifically, the model is endorsed within university-based settings. At the same time, out of respect for Canadian constituencies concerned about issues of supply and demand and the links to regulatory realities, it is the Task Force’s responsibility to advise due caution in implementation."
Download the November 1998 Final Report of the Psy.D. Task Force to the CPA Board of Directors.
Psynopsis Meets the Chair of the CPA Psy.D. Task Force (Winter 1999)
Psynopsis: What was the composition of the Task Force? Who was involved?
B. Robinson: There were 11 of us. Seven with Ph.D. backgrounds, two masters level psychologists (one from New Brunswick and one from Quebec), and two students. The students were interesting. One is a Canadian who chose to attend an American university-based Psy.D. programme and is now in a CPA accredited internship. Our other student comes from a CPA accredited Ph.D. programme, is attending a CPA/APA accredited internship and has already accepted a faculty position for next September in a CPA/APA accredited doctoral programme. All our doctoral members have either core university appointments (4) or are associated faculty (3). Two are chairs of accredited Ph.D. programmes in Clinical Psychology and one is a Dean. Two of us helped establish long-standing CPA/APA accredited internships which have primarily served Ph.D. students. We have three former Presidents of CPA, one former Honorary President of CPA, four former Accreditation Panel chairs, and one former co-chair of CPAP.
Psynopsis: How would you describe yourselves?
B. Robinson: Actually as you can see, we’re a rather traditionalist group, yet we quickly discovered we initially held rather divergent opinions (pro and con) on this issue of the Scholar-Practitioner Model. Much of it was based on beliefs and images and we had much to learn.
Psynopsis: Some have suggested that you were a special interest or advocacy group. What’s your response?
B. Robinson: Far from it, we were all drafted. If there was any conflict of interest, as we moved to consider the appropriateness of the Scholar-Practitioner, for many of us it was with our own faculties and staff and life-long colleagues because of the strongly resistant views held in some quarters. We also discovered equally compelling and articulate support from many other sectors. However, I am pleased to say, amidst all the debate a common commitment to Canadian psychology shone through.
Psynopsis: Many psychologists asked why get into this review in the first place — said another way "if it ain’t broke, why fix it?"
B. Robinson: There were times we wondered, too. However, as we explored our mandate to review the appropriateness and the realism/viability of different education and training models in professional psychology, the timing became more imperative and less leisurely.
Psynopsis: What is that context?
B. Robinson: The knowledge base required by both the practice and science demands in professional psychology is expanding almost exponentially. In fact, the Canadian Council of Professional Psychology (CCPPP) conducted a survey several years back and encouraged a beefing-up of the clinical content in the core curricula of Ph.D. programmes and better preparation for expanded hospital roles, eg., in programme development, evaluation and consultation. In the meantime we have maintained our scientific rigour in training and more recently CCPPP (both doctoral and internship directors alike) have advocated putting a cap on practicum hours. Obviously it puts pressure on programmes to be all things to all people. The extra 1 1/2 more years that it takes to complete a Ph.D. programme than a Psy.D. programme and the sad fact of the numbers of ABD’s (all but the dissertation) speak to the problems. Then we looked at career tracks and found most Ph.D. clinicians do not remain scientifically productive after graduation. An American survey found that only 7% of Ph.D. clinician’s time was spent in research. In parallel a Canadian survey found that for the vast majority "original research was neither part of the job or a career interest." That is part of the reason the Mississauga Conference recommended multiple education and training models. One size (and shape) does not fit all. The third element was the views of masters level psychologists looking back on their training or considering doctoral work. Several surveys in Quebec suggested they did not feel fully prepared for professional life and the CPA/CPAP Task Force on Mid-Career Training suggested master’s level practitioners were looking for more flexible doctoral programmes with solid academics, but ones with a more applied focus in both practice and research.
Psynopsis: What was the Task Force’s view of education and training models?
B. Robinson: Well, we certainly did not desert our roots. We strongly reaffirmed the scientist-practitioner model. And we came to support a particular scholar-practitioner (Psy.D.) model (university-based, accredited, with small numbers and requiring a dissertation perhaps of a more applied sort, which could be published, for instance in a professional journal.) We know there was confusion about all those freestanding professional schools in the States (by the way they offer both Ph.D.’s and Psy.D.’s). That was never what we were looking at. If you examine some solid university-based Psy.D. programmes in the U.S. (e.g. Rutgers, Baylor, Nova Southeastern) they don’t take large numbers even in their context (10-15 per year). They have scientifically grounded curricula, illustrious faculty and their grads perform as well as our Canadian Ph.D. graduates on the EPPP exam (and they perform strongly!).
Psynopsis: Assuming the model is supportable on a conceptual basis, is it realistic right now; after all it’s a doctoral model and our regulation in Canada is predominately masters or two-tiered?
B. Robinson: Well, we never proposed it as a panacea, but in combination with the Ph.D. and with the collaboration of provincial associations/regulatory boards, CPAP, CRHSPP and CPA maybe we can push back toward the doctoral standard.
Psynopsis: That’s well and good, but do we have the financial resources and the practica/ internship capacity to support these new or converted programmes?
B. Robinson: That was the big issue even among people who saw significant value in the scholar-practitioner model. And the Task Force itself was concerned. We handled it in a number of ways. There are cautions about the numbers of programmes and numbers of students (there’s quality control in CPA Accreditation), and we suggested that universities first consider upgrading terminal masters programmes or converting doctoral tracks. To be realistic, new funding lines will need to be found and perhaps new philosophies regarding student tuition and scholarships may be considered. And practica and internship placements will need to be identified. However, there is no need to panic, we would not see the first group of Psy.D. interns for at least three, and up to five years assuming Psy.D. programmes were mobilized immediately. Some have argued that we should (must!) conduct a massive and rigorous market survey prior to this model endorsement, but I found an interesting quote from Cynthia Belar in the March 1998 American Psychologist. Cynthia is not exactly a friend to either professional schools or the Psy.D. — she’s staunchly opposed. But her words are interesting. "To better understand these issues, there are frequent calls to gather more data concerning supply and demand in educational systems and the marketplace. Given psychology’s heritage, we think of data as the Yellow Brick Road that must be followed to find the place where all problems can be solved. For psychology, however, extant data are insufficient to estimate future needs for practitioners. The marketplace itself changes with economic pressures and is changed by the discipline itself through the creation of new knowledge relevant to practice." In other words, the future is a moving target which is not contemporaneously measurable.
Psynopsis: With a Canadian Scholar/Practitioner (Psy.D.) template what are the implications for the influx of American freestanding programmes and for CPA/APA Accreditation agreements?
B. Robinson: We have been blunt on this point. This is made-in-Canada, university-based, and that is the enduring premise of CPA doctoral accreditation. It also strengthens our hand as we explore mutual recognition with APA. There would have to be a university-based Psy.D. "carve-out" to any agreement. We cannot recognize that which is not mutual!
Psynopsis: How have you communicated all this and what has been the reaction?
B. Robinson: First there was a Consultation Document in February 1998, and then an Issues Paper in May 1998. We had a few lively debates in Edmonton, and we have received written feedback all along. The feedback has been really mixed, and while there has been a tremendous amount of mutual education, when the rubber hits the road and it’s decision time, positions haven’t changed much in the last round of feedback.
Psynopsis: How do groups align pro or con?
B. Robinson: Some obvious reactions. Some of the long established Ph.D. scientist-practitioner programmes are vehemently opposed on conceptual and pragmatic grounds. (However, not all of their graduates agree with their mentors.) And of course, Psy.D. graduates and university-based Psy.D. programmes thought we were on the right track. Then more formally we received endorsements and interest from Alberta, Quebec, Newfoundland, and from a doctoral programme in Ontario. The CRHSPP Executive endorsed the proposal and the CPA Accreditation Panel supported it in principle leaving the details to the Task Force. And amongst other colleagues we heard loud and clear. UBC, Waterloo, McGill, Dalhousie and Western went on record that we should abandon course or rigorously study the issue further. And from CCPPP which overlaps with the above group there was a straw ballot at CPA; 31 in attendance: 4 for, 6 abstained and 21 opposed. Resistance was both conceptual and pragmatic related to supply and demand, regulation and cross-border worries. The Clinical Section of CPA also raised significant practical questions, but never formally took a stance.
Psynopsis: With such divergent views where did that leave the Task Force?
B. Robinson: We discussed it, wrestled with it, and debated, and then during a lengthy conference call we took a collective deep breath and reached a consensus. We had a summary position, we had reached conclusions, we would forward recommendations and strongly advise caution around implementation. I found an interesting quote from Donald Peterson, who has been an academic leader in the Psy.D. movement. I think his words travel well across the border. "Critics who argue that our profession must not abandon its base in science are correct. That is our special strength in the broad field of human services. The demands of a science-based profession, however, do not require every practitioner to contribute general knowledge to science nor hold the Ph.D. degree. They do require every practitioner to acquire comprehensive knowledge of psychology and the flexible but rigorous skills of disciplined inquiry. As a community, psychology can learn to get along with less interprofessional derision, less enthusiasm for fratricidal politics, better communication, and more active cooperation than we have seen in the recent past. Fears that the development of psychology as a profession will somehow lessen or destroy psychology as a science are irrational. Whenever the professional forces grow too strong, the forces of science come into play." The scholar-practitioner model is a respectable and appropriate alternative. Not all will agree. We all share concerns about the uneven and possibly weakened state of regulation in Canada, and of course issues of supply and demand abound. However, very different strategies are proposed. The Psy.D. Task Force suggested that we bravely, but nevertheless carefully step into the future concluding that it is both valid and strategic to do so. The Board agreed and now hopefully we can move forward together. The Task Force Report sits available for those interested as a Canadian template to protect our education and training interests.