Title: The Pikes Peak Model for Training in Professional Geropsychology: Defining and Building Competencies
1The 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
2National 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)
4Conference 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!
5Conference 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
6Conference 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)
7Conference 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
8Pikes 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
9Geropsychology 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
10Geropsychology 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.
11Geropsychology 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
12Geropsychology 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)
13Skills 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
14Skills 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
15Skills 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
16Skills 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
17Skills 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
18Core 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
19Core 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
20Training 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.
21Internship
- 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
22Training 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.
23Postdoctoral 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
24Of 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
25Pikes 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