Psychological Assessment and Treatment of Persons with Serious Mental Illness/Severe Emotional ...

375 Pages·2017·2.63 MB·English

by  Martha B. Braswell

PETITION FOR THE RECOGNITION OF A
SPECIALTY IN PROFESSIONAL PSYCHOLOGY

THIS PETITION gives guidance to the types and amounts of information necessary for a formal
decision to be reached. Petitioning organizations may use additional pages where necessary.
The petitioning organization is free to provide any additional material deemed relevant.

NOTE: Complete responses to all questions posed in each of the criteria are required. Appendix
materials should not be considered as substitutes for the completion of responses to questions in
the criteria.

AMERICAN PSYCHOLOGICAL ASSOCIATION
750 First Street, NE
Washington, D.C. 20002-4242
[phone]

PETITION PACKAGE
Preamble

Knowledge and practice skills in psychology have expanded and become increasingly
differentiated over the past 50 years. Historically, the American Psychological Association (APA)
acknowledged four professional specialties in psychology: clinical, counseling, school, and
industrial/organizational psychology. It is important to note that these specialties first gained de facto
recognition through a process of historical evolution. The APA accreditation guidelines also reference
clinical, counseling, and school psychology as specialties.

A shared core of scientific and professional knowledge, skills, and attitudes is common to
professional specialties. This shared core has been recognized in several conference reports on the
future of professional psychology including the reports of groups and conferences of the National Council
of Schools and Programs of Professional Psychology, the Joint Council on Professional Education in
Psychology, and the National Conference on Scientist-Practitioner Education and Training for the
Professional Practice of Psychology. Nothing in this document precludes a provider of psychological
services from using the methods or dealing with the populations of any specialty, except insofar as they
do so “within the boundaries of their competence, based on their education, training, supervised
experience, consultation, study, or professional experience” (APA Ethical Principles of Psychologists and
Code of Conduct, 2002).

The public will continue to need the services of general practice specialists, such as those offered
by clinical, counseling, school and industrial/organizational psychologists. However, the emergence of
new specialties to provide needed psychological services must also be recognized and validated. There
must be a mechanism within the field to provide for the recognition of specialties.

Recent decades have produced what amounts to an explosion in professional knowledge and
areas of application. As a result, new areas of application of psychology's scientific and applied
knowledge have been organized around particular emphases in professional practice. The training to
acquire this knowledge and skill may occur at the doctoral and/or postdoctoral levels. Such a
proliferation of knowledge and an expansion of practice domains has resulted in a need to establish a
process for recognizing specialties in professional practice that are differentiated from core scientific and
applied professional foundations in psychology. At various times in past years, groups within and outside
APA have worked to articulate such an identification and recognition process. Acknowledgement is
given to the work of APA's Task Force on Specialty Criteria, the Board of Professional Affairs
Subcommittee on Specialization, and the Board of Educational Affairs Task Force on Scope and Criteria
of Accreditation, as well as the American Board of Professional Psychology for important contributions to
this process. Their efforts have been a part of the continuing evolution of a process to identify specialties
in psychology. It is now time for APA to exercise leadership in the design and implementation of a de
jure process for the recognition of specialties in psychology.

For purposes of this endeavor the following definition of a specialty is adopted:

A specialty is a defined area of professional psychology practice characterized by a distinctive
configuration of competent services for specified problems and populations. Practice in a
specialty requires advanced knowledge and skills acquired through an organized sequence of
education and training in addition to the broad and general education and core scientific and
professional foundations acquired through an APA or CPA accredited doctoral program.*
Specialty training may be acquired either at the doctoral or postdoctoral level as defined by
the specialty.
*
Except where APA or CPA program accreditation does not exist for that area of professional psychology

Although the specific dimensions of specialty programs may vary in their emphases and in available
resources, every defined specialty in professional psychology will contain: (a) core scientific foundations
in psychology; (b) a basic professional foundation; (c) advanced scientific and theoretical knowledge
germane to the specialty; and (d) advanced professional applications of this knowledge to selected
problems and populations in particular settings, through use of procedures and techniques validated on
the same.

The relationship between a body of knowledge and a set of skills in reference to each of the parameters
of practice specified in Criterion VI below represents the most critical aspect of the basic definition of a
specialty.

A specialty is distinguished from a proficiency, which is a circumscribed activity in the general practice of
professional psychology or one or more of its specialties that is represented by a distinct procedure,
technique, or applied skill set used in psychological assessment, treatment and/or intervention within
which one develops competence.

The American Psychological Association and its Commission for the Recognition of Specialties and
Proficiencies in Professional Psychology (CRSPPP) will consider petitions for formal recognition of
specialties. Petitions that are received by CRSPPP will be reviewed and acted upon by the APA
Council of Representatives. CRSPPP will review the status of each specialty at least every seven
years and recommend whether the specialty should continue to be recognized.
Name of Proposed Specialty: Psychological Assessment and Treatment of Persons with Serious Mental
Illness/Severe Emotional Disturbance

Please check one:

X Petition for Initial Recognition
Petition for Renewal of Recognition
Petition for Recognition of Post-Doctoral Specialty in Psychological Assessment and
Treatment of Persons with Serious Mental Illness and Severe Emotional Disturbance

Table of Contents

Criterion I. Administrative Organizations ............................................................................................... 1
Criterion II. Public Need for Specialty Practice ....................................................................................... 5
Criterion III. Diversity ............................................................................................................................ 52
Criterion IV. Distinctiveness ................................................................................................................. 66
Criterion V. Advanced Scientific and Theoretical Preparation .......................................................... 110
Criterion VI. Advanced Preparation in the Parameters of Practice ................................................... 121
Criterion VII. Structures and Models of Education and Training in the Specialty ............................. 225
Criterion VIII. Continuing Professional Development and Continuing Education ............................. 271
Criterion IX. Effectiveness .................................................................................................................. 273
Criterion X. Quality Improvement ....................................................................................................... 284
Criterion XI. Guidelines for Specialty Service Delivery ...................................................................... 288
Criterion XII. Provider Identification and Evaluation .......................................................................... 291
Public Description ............................................................................................................................... 295
Appendix I: SMI/SED Education and Training Guidelines ................................................................. 297
Appendix II: Clinical Practice Guideline Toolkit .................................................................................. 325
Appendix III: SMI/SED Evaluation Instrument .................................................................................... 351
1

Criterion I. Administrative Organizations

The proposed specialty is represented by a specialty council or one or more organizations that
provide systems and structures sufficient to assure the organized development of the specialty.
Commentary: The evolution of a specialty generally proceeds from networks of psychologists
interested in the area to the eventual establishment of organized administrative bodies which
carry out specific responsibilities for the specialty and its practitioners. These responsibilities
include governance structures which meet regularly to review and further describe the specialty
and appropriate policies for education and training in the specialty.

1. Please provide the following information for the organization or specialty council submitting
the petition:

Name of organization or specialty council:

Council for Psychological Training in Assessment and Treatment of Persons with Serious Mental
Illness and Severe Emotional Disturbance.

Address: 8A – 1500 Alberni St.

City/State/Zip: Vancouver, BC V6G 3C9

Phone: [phone] FAX: NA

E-mail address:
2

Describe the purpose and objectives of the administrative organization or specialty council
submitting the petition.

This specialty petition is submitted by the Council for Psychological Training in Assessment and
Treatment of Persons with Serious Mental Illness and Severe Emotional Disturbance, hereafter referred
to as the Council. The Council is comprised of three primary organizations, all of which have an interest
in promoting specialized training and competency development for psychologists to work with individuals
who have, or are at risk of developing, serious mental health disorders. The Council consists of the
following organizational members: the APA Task Force on Serious Mental Illness/Severe Emotional
Disturbance, APA’s Division of Psychologists in Public Service (Division 18), and the Section on Serious
Mental Illness and Severe Emotional Disturbance of Division 18. Each of the organizational members
has two representatives who sit on the national Council.

The Council provides guidance and the structures necessary for coordination of the specialty. The
Council identifies issues important for the organized development and implementation of the specialty
and provides a mechanism for information exchange and coordination. The Council also ensures that
training guidelines for the specialty remain current and the Council disseminates updates on training. The
Council also conducts regular training for site visitors who will make recommendations to the CoA
regarding accreditation of post-doctoral programs applying for accreditation in this specialty.

The Council is the organizational home for specialized psychological training for psychologists
and other mental health professionals who are interested in working with people with serious mental
health disorders (SMI) and those with emerging severe emotional disturbances (SED). The Council
oversees the development of curriculum materials, establishment of competencies to work with these
populations, evaluation mechanisms to ensure competency of professional psychologists for this work,
conducts training, and encourages research and publications in this area.

The Council also works to promote understanding of the etiology, nature, impact, and
amelioration of SMI/SED among psychologists and the general public by posting information, research,
links to relevant organizations, and other pertinent information on its website.

Please append the bylaws for the petitioning organization or specialty council if bylaws are not
provided on the website.

Please see Specialty Council website (PsychTrainingSMI.com) for the Council bylaws.

Outline the structure and functions of the administrative organization or specialty council
(frequency of meetings, number of meetings per year, membership size, functions performed,
how decisions are made, types of committees, dues structure, publications, etc.) using the table
below. Provide samples of newsletters, journals, and other publications, etc.

An annual meeting is held at the APA Convention and a conference call is held once each
quarter. Council business is conducted primarily via e-mail and conference calls.
3

Name of Organization Council for Psychological Training in Assessment and Treatment of
Persons with Serious Mental Illness and Severe Emotional Disturbance
Frequency of Meetings Quarterly
Number of Meetings per year 4
Membership size 3 organizational members
Functions Performed Oversight of development of curriculum materials, establishment of
competencies to work with individuals with SMI/SED, evaluation
mechanisms to ensure competency of professional psychologists for
this work, encouragement of research and publications in this area,
conduct of training about SMI/SED and for potential accreditation site
visitors, and promotion of understanding regarding the etiology,
nature, impact, and amelioration of SMI/SED among psychologists and
the general public.
How are decisions made Representatives from each organization speak for their members
during meeting discussions, convention meeting and via e mail
regarding shared documents
Types of committees Executive, Research, Training and Evaluation, Accreditation, Practice,
Marketing and Communications
Dues Structure None
Names of Publications None
Website http://www.PsychTrainingSMI.com

Present a rationale that describes how your organization or specialty council provides systems
and structures which make a significant contribution to the organized development of the
specialty.

The Council was begun as a result of recognition by the three primary members, the APA Task
Force on Serious Mental Illness and Severe Emotional Disturbance (hereafter referred to as the APA
Task Force), APA’s Division 18, Psychologists in Public Service (hereafter referred to as Division 18),
and the Division 18 Section on Serious Mental Illness/Severe Emotional Disturbance (hereafter referred
to as the Division 18 Section) of the following: a) there is considerable public need for psychologists who
are specially trained to work with people with serious mental illness and those with severe emotional
disturbances; and b) there is interest among psychologists in learning more about how to work with these
populations to help individuals recover from the effects of their illness and realize their goals and full
potential. After considerable discussion and planning, the APA Task Force, Division 18, and the Division
18 Section determined that a formal petition to APA should be developed to request recognition of a
post-doctoral specialty in the Psychological Assessment and Treatment of Persons with Serious Mental
Illness/Severe Emotional Disturbance.

At the same time, the APA secured funding from the Substance Abuse and Mental Health
Services Administration (SAMHSA) to develop a curriculum to train psychologists in the concepts of
recovery from serious mental illness and the interventions to assist people to achieve their full potential;
these interventions are known are psychosocial or psychiatric rehabilitation (PSR) interventions. A draft
of the curriculum was pilot tested and it was also reviewed by members of the APA Task Force, the
Division 18 Section, psychologists at several universities, members of the public with SMI/SED disorders,
and the members of the two committees established by APA to guide the project. The completed
curriculum (American Psychological Association & Jansen, 2014) was released by APA in 2014 and
contains a comprehensive overview of the information and competencies psychologists need to
undertake psychological work with individuals with serious mental illnesses. The full curriculum and
4

accompanying slides are available from APA (http://www.apa.org/pi/mfp/psychology/recovery-to-
practice/training.aspx) and a link is provided on the Council website (www.PsychTrainingSMI.org).

In 2013, during the time that the curriculum was being developed, the Council was officially
formed. Once fully formed, the Council began regular meetings and began work on developing the
remaining structures needed to govern the specialty once it is recognized. Some examples of the work of
the Council include continued identification of doctoral and post-doctoral programs that offer training in
this area, securing of funding for a meeting to identify necessary competencies, presentation of CE
symposia and workshops at the APA convention, development of initial evaluation mechanisms and a
clinical practice guideline tool.

4. Signatures of official representing the organization or specialty council submitting the petition:

Name: Mary A. Jansen, Ph.D. Title: Executive Officer Date: December 31, 2017

Mary A. Jansen, Ph.D.

Reference

American Psychological Association & Jansen, M. A. (2014). Reframing Psychology for the Emerging
Health Care Environment: Recovery Curriculum for People with Serious Mental Illnesses and
Behavioral Health Disorders. Washington, DC: American Psychological Association.
5

Criterion II. Public Need for Specialty Practice

The services of the specialty are responsive to identifiable public needs
Commentary: Specialties may evolve from the professions’ recognition that there is a
particular public need for applications of psychology. Specialties may also develop from
advances in scientific psychology from which applications to serve the public may be
derived.

1. Describe the public needs that this specialty fulfills with relevant references. Under each need
specify the populations served and relevant references.

Definitions

The literature base is well developed for those with psychotic disorders, especially schizophrenia
and schizoaffective disorders, but less well developed for bipolar disorder, clinical depression, personality
disorders, and concurrent addictive disorders. While some studies exist, most researchers have
assumed that the findings from major studies of individuals with schizophrenia would generalize to others
with serious mental illnesses. Due to the paucity of research specific to these disorders, we likewise
assume to generalize the findings to these populations as well, although some information about bipolar
disorder and treatment interventions for this condition are also presented.

Prior to responding to the questions in this Criterion, we present the definitions for Serious Mental
Illness (SMI) and for Severe Emotional Disturbance (SED). We follow in this petition the definitions set
forth by the U.S. federal government for SMI.

For SMI:

Precursors to the term serious mental illness have included terms such as “chronic mental illness” or
“severe and persistent mental illness.” The change in terminology to SMI/SED represents a shift in
emphasis, focusing less on diagnosis and duration of illness and more on functional impairment.
SAMHSA defines SMI as follows:

SMI among people ages 18 and older is defined at the federal level as having, at any time during
the past year, a diagnosable mental, behavioral, or emotional disorder that causes serious
functional impairment, which substantially interferes with or limits one or more major life activities.
Serious mental illnesses include major depression, schizophrenia, and bipolar disorder, and other
mental disorders that cause serious impairment. Downloaded from:
http://nrepp.samhsa.gov/05f_glossary.aspx#S.

For SED:

Children with SED are defined as persons:

From birth up to age 18, who currently or at any time during the past year have had a diagnosable
mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria
specified within DSM- III-R, that resulted in functional impairment, which substantially interferes
with or limits the child's role or functioning in family, school, or community activities….these
disorders include any mental disorder (including those of biological etiology) listed in DSM-III-R or
their ICD-9-CM equivalent (and subsequent revisions) with the exception of DSM-III-R `V' codes,
substance use, and developmental disorders, which are excluded, unless they co-occur with
another diagnosable serious emotional disturbance….Functional impairment is defined as