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The Pikes Peak Model for Training in Professional Geropsychology: Defining and Building Competencies

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Title: The Pikes Peak Model for Training in Professional Geropsychology: Defining and Building Competencies


1
The Pikes Peak Model for Training in Professional
Geropsychology Defining and Building
Competencies for Geropsychology Practice
  • Michele J. Karel, PhD
  • VA Boston Healthcare System, Harvard Medical
    School
  • Michele.Karel_at_va.gov
  • APPIC Conference, April 14, 2007

2
National Conference on Training in Professional
Geropsychology
  • Colorado Springs, June 2006
  • Thus, Pikes Peak Model
  • Working meeting to
  • Delineate attitude, knowledge and skill
    competencies for geropsychology practice
  • Define core features/principles of geropsychology
    training
  • Make training recommendations at graduate,
    internship, postdoctoral, and post-licensure
    levels

3
(No Transcript)
4
Conference Background
  • Older Boulder I Boulder, CO, 1981
  • Older Boulder 2 Washington, DC, 1992
  • Growth of gero internship/postdoc programs
  • Geropsychology recognized as proficiency by
    CRSPPP 1998, 2005
  • Guidelines for Psychological Practice with Older
    Adults (APA, 2004)
  • Geropsychology as growing area of practice and
    training - we need a training model!

5
Conference Planning
  • Co-sponsored by APA Division 20 (Adult
    Development and Aging) and Division 12, Section
    II (Clinical Geropsychology)
  • Co-chairs Michele Karel, PhD and Bob Knight, PhD
  • Committee members
  • Deborah DiGilio, MPH Michael Duffy, PhD, ABPP
    Barry A. Edelstein, PhD Deborah W. Frazer, PhD
    Paula Hartman-Stein, PhD Gregory A. Hinrichsen,
    PhD Jennifer J. Manly, PhD Victor Molinari,
    PhD, ABPP George Niederehe, PhD Sara Honn
    Qualls, PhD Forrest Scogin, PhD Susan
    Whitbourne, PhD Antonette M. Zeiss, PhD Richard
    A. Zweig, PhD

6
Conference Supporters
  • Retirement Research Foundation
  • American Psychological Association
  • APA Division 20
  • APA, Division 12, Section II
  • Psychologists in Long Term Care (PLTC)
  • APA Board of Educational Affairs (BEA)
  • APA Committee on Division/APA Relations (CODAPAR)
  • APA Division 40 (Clinical Neuropsychology)
  • Association of Psychology Postdoctoral and
    Internship Centers (APPIC)
  • APA Division 12 (Society of Clinical Psychology)
  • APA Division 42 (Psychologists in Independent
    Practice)
  • Council of University Directors of Clinical
    Psychology (CUDCP)

7
Conference Delegates
  • Division 12, Section II, Clinical Geropsychology
  • Division 20, Adult Development and Aging
  • Division 35, Society for the Psychology of Women
  • Division 40, Clinical Neuropsychology
  • Division 42, Psychologists in Independent
    Practice
  • Division 44, Society for the Psychological Study
    of Lesbian, Gay and Bisexual Issues
  • Division 45, Society for the Psychological Study
    of Ethnic Minority Issues
  • Psychologists in Long Term Care (PLTC)
  • APPIC
  • Council of Counseling Psychology Training
    Programs (CCPTP)
  • PLUS 19 at-large and 7 student delegates

8
Pikes Peak Model General Principles
  • Geared towards psychologists specializing in work
    with older adults, families, care systems
  • Competency-based model
  • Per Competencies Conference (2002)
  • Joint focus on high standards AND inclusivity
  • Train as many psychologists as possible to
    provide competent services to older adults
  • Multiple pathways to competence
  • Entry to Gero at varied points in training career
  • Open doors for generalist practitioners to
    enhance competence with aging clients

9
Geropsychology Competencies Informing Frameworks
  • Guidelines for Psychological Practice with Older
    Adults (APA, 2004)
  • Focused on attitudes, knowledge
  • Starting point for our review of attitude,
    knowledge, and skill competencies
  • Cube Model for Competency Development (Rodolfa et
    al, 2005)
  • Foundational competencies building blocks
    e.g., reflective practice scientific knowledge,
    methods ethical/legal/policy individual/cultural
    diversity
  • Functional competencies the work of a
    psychologist assessment/dx intervention
    consultation research-evaluation
    supervision/teaching management/admin
  • Stages of professional development Doctoral
    Internship Postdoc supervision Fellowship
    Continuing Competency

10
Geropsychology Competencies Attitudes
  • APA Guidelines (2004) highlight
  • Work within ones scope of competence
  • Recognize how ones attitudes, beliefs, feelings
    about aging and older adults may affect practice
  • Seek consultation or refer out when needed
  • Conference added
  • Expand awareness of how individual diversity in
    all of its manifestations interacts with
    attitudes and beliefs about aging.

11
Geropsychology CompetenciesKnowledge Base
  • Knowledge base is well-specified by APA 2004
    Guidelines
  • General knowledge about adult development, aging,
    and the older adult population
  • Foundations of clinical practice with older
    adults
  • Foundations of assessment of older adults
  • Foundations of intervention, consultation, and
    other service provision
  • Conference added
  • Some expansion and specification of recommended
    knowledge base within these domains

12
Geropsychology CompetenciesSkills
  • Professional Geropsychology Functioning
  • Or, Foundational Competencies
  • Assessment
  • Intervention
  • Consultation/Training
  • Delivery of Services in Different Settings
  • (Leadership/Advanced competencies
  • Supervision/teaching Research/evaluation
    Management/administration
  • Not a focus of the model)

13
Skills Professional Geropsychology Functioning
  • Competencies include
  • Apply understanding of interacting aspects of
    individual and cultural diversity among older
    adults to assessment, intervention, consultation
  • Apply ethical and legal standards, e.g.,
    capacity/competency, confidentiality, end-of-life
    decision making, elder abuse/neglect
  • Practice self-reflection, e.g., ageist
    assumptions/biases
  • Work with teams and other professionals
  • Practice appropriate documentation/billing in
    compliance with federal and state laws and
    regulations (Medicare/Medicaid)
  • Core principles/values
  • Respect
  • Self-reflection
  • Advocacy

14
Skills Assessment
  • Competencies include
  • Differentially diagnose common late life clinical
    issues
  • Tailor assessments to accommodate older adults
    specific characteristics and contexts
  • Evaluate decision-making, functional capacities,
    and risk issues
  • Use neuropsychological reports to clarify
    clinical issues and inform treatment plan
  • Communicate assessment results to various
    stakeholders with practical, clearly
    understandable recommendations
  • Core principles/values
  • Strengths and compensation (not only deficits)
  • Informant data, as appropriate
  • Assessments tailored for range of settings and
    populations
  • Practical recommendations
  • Ethical implications

15
Skills Intervention - Individual, Family, Group
  • Competencies include
  • Adapt interventions to accommodate
    biopsychosocial fx of older adults and distinct
    therapeutic relationship characteristics
  • Use evidence based treatments when possible
  • Use common late-life interventions (e.g., life
    review, caregiving, grief, end of life)
  • Use interventions to enhance health of diverse
    older persons
  • Core principles/values
  • Therapeutic optimism
  • Flexibility and clinical judgment
  • Evidence-based treatments when possible
  • Importance of systems (families, health teams,
    community), care coordination

16
Skills Consultation
  • Competencies include
  • Consult to families, professionals, programs,
    agencies/organizations, legal system
  • Participate in interprofessional teams, in
    geriatric care settings
  • Conduct trainings, e.g., in-services, workshops
  • Implement strategies for systems analysis and
    change
  • Collaborate and coordinate with other agencies
    and professionals serving older adults
  • Core principles/values
  • Consultation is critical for geropsychology
    practice/training
  • Appreciate and interface with gero service
    delivery systems

17
Skills Delivery of Services in Different Settings
  • Competent to work with older adults in at least
    two of these settings
  • Outpatient mental health services
  • Outpatient primary care/medical settings
  • Inpatient medical service
  • Inpatient psychiatric service
  • Long-term care
  • Nursing homes, assisted living facilities, home
    care, day programs
  • Rehabilitation
  • Hospice/palliative care
  • Community-based programs
  • Forensic settings
  • Research

18
Core Features of Geropsychology Training
  • Facilitated experiences to gain self-awareness
    about ones responses to aging
  • Wide diversity of older adult experiences, and
    ones reactions to these
  • Recognize biases, blind spots, over-identification
    that may distort perceptions and judgments
  • Explicit training in normal aging, to appreciate
    what is abnormal/disease
  • Experiential learning across settings and
    populations
  • Physical and cognitive functioning (hearty to
    frail)
  • Settings of care
  • Cultural diversity
  • Individual diversities and aging

19
Core Features of Geropsychology Training (cont)
  • Experience working with teams
  • Understand other disciplines
  • Models, skills and strategies for team fx
  • Setting X team interactions
  • Experience interfacing with systems in which
    older adults live, receive care
  • Families, health care, residential, community
  • Supervised experience with gero-competent
    supervisors, using observational methods
  • Explicit focus on ethical issues, practice
    standards
  • E.g., client capacity/competency issues,
    end-of-life, documentation and billing

20
Training RecommendationsInternship
  • Mission for internship level geropsychology
    training, e.g., through a rotation To develop
    interest, skills, and knowledge of
    geropsychologyto provide opportunities for
    experiential application of knowledge to promote
    professional development and identity of the
    trainee as a geropsychologist to prepare the
    intern for future career development. Upon
    exiting the internship, the trainee will not be
    expected to be an expert in all areas of
    geropsychology but should be competent in the
    areas in which they received training.

21
Internship
  • Address variable student preparation
  • Initial competency assessment - some may need
    more extensive didactic/mentoring help
  • Clinical settings
  • At least one clinical setting with older adults
  • Diversity of settings/populations, including
    exposure to healthy and diverse older adults, is
    ideal
  • Didactics
  • Access to gero books, journals
  • Gero seminar, or integration of gero into intern
    seminar
  • Faculty/resources
  • At least one gero-competent supervisor
  • Intensive supervision, incl. modeling and
    observation
  • Necessary assessment tools, related materials

22
Training RecommendationsPostdoctoral Fellowship
  • Mission for postdoc level geropsychology
    training
  • For those who come in with incrementally obtained
    and substantive preparation, to reach a level of
    advanced practice in geropsychology and/or entry
    into research, academic, or training roles
  • For those with lesser degrees of geropsychology
    preparation/exposure, to transition to full
    autonomous professional functioning and
    competence in geropsychology practice or research.

23
Postdoctoral Fellowship
  • Initial assessment of competencies to inform
    training plan evaluation of these over course of
    year
  • Clinical settings
  • Access to variety of settings, populations,
    varied levels of physical/cognitive fx
  • Work with teams, care systems, consultation
  • Didactics
  • Seminar(s) with substantive geriatric content
  • Faculty/resources
  • At least one self-identified geropsychology
    expert
  • Access to peers, geropsychology professional
    organizations, library resources

24
Of noteGero Intern and Postdoc Programs
  • APA 12-2 Directory of Internships with Clinical
    Geropsychology Training Opportunities (2006)
  • 40 internships returned data
  • APA 12-2 Directory of Clinical Geropsychology
    Postdoctoral Fellowships (2006)
  • 20 fellowships returned data
  • Directories at www.geropsych.org

25
Pikes Peak Model Next Steps
  • Publication of geropsychology competencies and
    training model recommendations in progress
  • Council of Professional Geropsychology Training
    Programs being formed stay tuned!
  • Develop tools for self-assessment and evaluation
    of geropsychology competencies
  • Informed by parallel efforts in the field, APA
    Task Force report
  • Develop/share resources for training at grad,
    internship, postdoc levels
  • Develop further opportunities for post-licensure
    training, including consultation and supervision
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