24 May 2017

New APA Data Show Where Practitioners Work

New APA Data Show Where Practitioners Work

Most are in private practice and work with the white, heterosexual and adult population, finds the APA Center for Workforce Studies

Almost three-quarters of respondents to APA's 2015 Survey of Psychology Health Service Providers reported that they collaborated in clinical care with other professionals, most commonly psychiatrists, social workers, physicians and surgeons.

According to the new report from APA's Center for Workforce Studies, the most common form of collaboration was sharing a waiting room with other health professionals, reported by half of respondents. Thirty-nine percent of respondents shared electronic medical records with other professionals. And while only 19 percent saw patients alongside other professionals, 36 percent participated in multidisciplinary team meetings and 33 percent reported integrated treatment plans.

"There's a path toward integration, and a lot of psychologists are taking the first steps down that road," says W. Douglas Tynan, PhD, director of integrated health care at APA.

The increase in team-based care is just one of the findings from the survey, which offers a snapshot of who licensed psychologists in the United States are, how they work and their experience with older clients, cultural competence and team-based care, says report co-author Karen Stamm, PhD, a senior research officer in the center. More than 5,000 licensed psychologists across the country—75 percent of them APA members—responded to the survey. Other major findings include:

Most licensed psychologists are private practitioners. Consistent with past findings, most licensed psychologists are working in private practice: 45 percent of respondents cited private practices as their primary work setting (see chart). Clinical psychology was by far the primary specialty most often cited.

Respondents spent a mean of 36 hours weekly working at their primary positions, with half of that time devoted to providing direct care to clients. Respondents spent seven hours on administrative tasks each week, four hours on teaching and research, two hours on clinical supervision and an hour on other services.

Licensed psychologists are mostly treating white, heterosexual, adult populations. About 96 percent of respondents reported that they provide services frequently or very frequently to white clients. Just 38 percent served African-American clients frequently or very frequently and 34 percent Hispanic clients. The vast majority of respondents—83 percent—reported seeing adult clients ages 19 to 64 frequently or very frequently. In contrast, just 23 percent served children and 34 percent served adolescents frequently or very frequently.

Respondents' own demographic characteristics tended to mirror those of their clients, although the median age of survey respondents was almost 58. Almost 88 percent of respond

ents identified as white, for example, and 90 percent identified as heterosexual.

Few practitioners are serving patients age 80 and older. While 37 percent of survey respondents reported serving older adults frequently or very frequently, just 9 percent served the "oldest old"—those 80 and older.

Respondents spent an average of almost nine hours a week providing services to older adults. They spent more time providing psychotherapy than conducting assessments or offering consultations. They also spent much less time—fewer than two hours weekly—providing services to clients' family members.

About two-thirds of those working with older adults are Medicare providers. Thirteen percent reported that they were previously Medicare providers but no longer participated in the program. Almost 18 percent had never participated. Low reimbursement rates were the most commonly cited reason for not participating. Others said they didn't participate in any insurance programs or had caseloads composed mainly of non-Medicare patients.

Respondents were eager to learn more about geropsychology, calling for education on depression, adjustment to medical illness and disability, and grief and bereavement.

Practitioners believe they are prepared to serve an increasingly diverse nation. Almost 53 percent of respondents felt that their doctoral programs had prepared them well or extremely well to work with culturally diverse groups. Another 44 percent felt they were fairly well prepared or slightly prepared to do so. Just 3 percent felt they weren't at all ready.

Respondents' level of knowledge varied, however. More than half said they were not at all or only slightly knowledgeable about working with transgender clients, for example, compared with the 51 percent who rated themselves quite or extremely knowledgeable about working with lesbian, gay and bisexual clients.

The most helpful resources for learning about diverse populations were books and peer-reviewed journals, respondents said. The least helpful? Graduate training. That's not a slam against graduate training, Stamm explains. Instead, she says, the finding may simply reflect the demographics of respondents.

"The majority of the sample was in their mid-50s, so they're fairly far removed from their graduate training," she says. "They may have changed their practice patterns or emphases over time, so their graduate training is less relevant."

The survey findings point to the need for further research, adds Stamm. One priority area is to determine whether there are enough psychologists to meet Americans' needs. "This report has a lot of information about the supply side," says Stamm. "Now we'd like to focus on the demand."

To read the full report, visit www.apa.org/workforce/publications/15-health-service-providers/index.aspx.

Little diversity

  • 87.8%
  • 4.4%
  • 2.6%
    Black/African American
  • 2.5%
  • 1.7%
  • 0.3%
    American Indian/Alaska Native
  • 0.1%
    Native Hawaiian/Pacific Islander

By Rebecca A. Clay

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24 May 2017

Primary-Care Practices Appreciate Having Integrated Behavioral Health Consultants

Primary-Care Practices Appreciate Having Integrated Behavioral Health Consultants
When a new patient burst into tears in his office at Mercy Heath's Springfield Family Medicine Clinic in Cincinnati, physician Douglas L. Hancher, MD, suspected she needed more help than she would admit, even though she denied she was suicidal.

"In the old days, we would have had to look at her insurance, check who was in her plan and seeing new patients and refer her to someone who might have been 20 miles on the other side of town," says Hancher. "Then it could take six weeks to get an appointment."

Not anymore. Thanks to Mercy Health's commitment to embedding behavioral health consultants in primary-care practices, psychologist Leslie Instone, PhD, was just across the hall and able to see the patient immediately. She discovered that the woman had tried to kill herself before and had a plan to try again soon. She sent the patient to the psychiatric emergency room, where she got the help she needed.

"I would have felt terrible if I had missed someone who was suicidal and she went on to commit suicide," says Hancher. "Having a back-up is good."

Stories like that are one reason why Mercy Health—one of the nation's 10 largest nonprofit health systems—is moving aggressively to integrate behavioral health consultants into its family medicine, internal medicine and pediatric clinics in Ohio and Kentucky. The goal is to achieve the triple aim of better health, lower costs and enhanced patient satisfaction, says Martyn Whittingham, PhD, the psychologist who launched the initiative in 2014 as chief of clinical integration and research at Mercy's Behavioral Health Institute. (Whittingham has since left the organization.)

According to Mercy Health's preliminary data, Hancher isn't the only physician who appreciates having a behavioral health consultant as part of the team. In a survey of 100 physicians and staff members at seven Cincinnati practices involved in the integration project, participants gave almost everything at least four points on a five-point scale:

  • Access to care. Providers and practice staff, such as practice managers and care coordinators, gave an average rating of 4.7 when asked how helpful integration has been for patients and how it has increased ease of access to behavioral health services for patients. That's an especially important figure given Mercy's mission of serving the underserved, says Whittingham.
  • Helpfulness. The survey also asked questions aimed specifically at providers. When asked how helpful having a behavioral health consultant was in terms of providers' ability to do their own jobs, for example, the average rating was 4.5.
  • Improved work flow. Providers gave a 4.2 average response when asked how much the integrated behavioral health model improved the work flow in their day-to-day practice. "The behavioral health consultant could have been seen as invasive or blocking work flow," says Whittingham. "Instead, they improve work flow, even in this really early stage."
  • Satisfaction. The 4.7 average score for a question about how likely providers are to recommend behavioral health integration to their colleagues is a key indicator of success, says Whittingham. "That's the final test," he says, adding that momentum is building as participating physicians like Hancher share their experiences with behavioral health consultants with their colleagues. "Physicians are coming to us and asking, 'When am I getting mine?'"

There are already 14 behavioral health consultants—primarily psychologists, plus a couple of social workers—in 24 of the system's 150-plus primary-care clinics. Another three are under contract but haven't yet started. And the system plans to hire many more this year. About 25 percent of the system's 600,000 patients already have access to a behavioral health consultant. It has been a challenge to find enough psychologists ready and willing to work in these fast-paced, integrated settings. "There aren't enough people trained in primary-care integration," says Whittingham, who earned his doctorate in counseling psychology from Indiana University in 2006. "I've visited multiple universities and told deans, 'If you train them, we have positions they can apply for.'"

To make up for that lack of preparation, Mercy Health has developed an intensive training regimen for new hires. In addition to watching training videos, new behavioral health consultants "shadow" more seasoned consultants in their own practices for a week. Then they flip positions, moving into their new settings with their colleagues alongside them to supervise them for a week.

On the medical side, physicians are discovering that behavioral health consultants can help not just with psychological problems but with physical problems, too, including medication adherence, exercise and smoking cessation, says Mbonu N. Ikezuagu, MD, MBA, the attending physician for the internal medicine residency program at Mercy St. Vincent Medical Center in Toledo.

"Integrating a behavioral health consultant into our office has moved us closer to achieving our goal of delivering amazing patient care," says Ikezuagu, adding that both the attending physicians and 36 residents use the service on a daily basis. "This is the wave of the future."

By Rebecca A. Clay

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24 May 2017

Self-assessment Tools and Strategies Can Help Practitioners Ensure They are Practicing Competently

Self-assessment Tools and Strategies Can Help Practitioners Ensure They are Practicing Competently
When W. Brad Johnson, PhD, was undergoing radiation therapy, he wasn't worried about whether his medical crisis was affecting his performance as a psychology professor in the department of leadership, ethics and law at the U.S. Naval Academy. But he should have been.

"I had an inflated sense of how well I was doing," says Johnson, describing how concerns about his health blinded him to the fact that he wasn't doing his job as well as before. "Things were slipping through the cracks."

That's when Johnson's closest friends in psychology stepped in to urge him to reduce his teaching load and other responsibilities. The experience underlined for him the importance of psychologists not just assessing themselves but also of being ready to intervene when a colleague is too impaired to function effectively.

During graduate education, students have people keeping an eye on them, gauging their competence and identifying areas in need of improvement. That stops the moment you become a practitioner, says Nadine J. Kaslow, PhD, a professor of psychiatry and behavioral sciences at Emory University School of Medicine who has championed the competency-based approach to psychology training. "You have to assess yourself," she says.

Fortunately, there are tools and strategies that can help practitioners ensure they are practicing competently, including the College of Psychologists of Ontario Self-Assessment Guide and Professional Development Plan, APA's Competency Benchmarks for Professional Practice, 360-degree evaluations or some combination of these. And APA's Advisory Committee on Colleague Assistance has suggestions for what to do when it's a fellow practitioner who is falling short.

Self-assessment strategies

For Kaslow, self-assessment is something she typically does during a quiet period of self-­reflection at year's end. Often working with a colleague from what she calls her "inner core" to help ensure an accurate analysis, Kaslow takes stock of where she is, where her skills have grown rusty and what she needs to work on. She then sets goals for the coming year, outlines a plan for achieving them and reviews her progress each quarter. But there are other, more structured methods of self-­assessment psychologists can use, including:

The College of Psychologists of Ontario Self-Assessment Guide and Professional Development Plan. The college, a regulatory body that ensures competent, ethical psychological services, launched its self-assessment program in 1999 "to help members undertake an honest, personal assessment of strengths, weaknesses and any gaps in their current level of knowledge and skill," says Rick Morris, PhD, the college's registrar and executive director. While the self-assessment program is designed for use by the college's members, anyone can download the forms and go through the process themselves (see "Resources").

The first part of the Self-Assessment Guide asks users about their familiarity with legislation, standards, codes and guidelines. The second asks them to assess their competence in such areas as service to clients, supervision, teaching and research and then come up with a professional development plan. Members must complete the self-assessment every other year.

The finished self-assessment is strictly for members' own use as a self-improvement tool, but the college does want to make sure people actually go through the process. That's why members are required to send back a form attesting that they have completed the self-assessment, even though they don't have to submit the finished product to the college. "We know from consultations we've done and just common sense that when people are filling out evaluations of themselves and sending them to a regulatory body, they may not be as frank with themselves or the college as they might be," says Morris, adding that the college expects 100 percent compliance. If members fail to submit the attestation form after several reminders, the college requires them to send in their completed plans so that the college's Quality Assurance Committee can review them and provide feedback; the college also randomly selects members to undergo "peer-­assisted reviews" in which two peers review the member's practice and progress on his or her professional development plan.

Competency Benchmarks. APA's Competency Benchmarks lay out the core competencies students need to tackle before they are ready to enter practice. While the benchmarks aren't in widespread use as a self-assessment tool for those already in practice, they could be a helpful resource for that group, too, says Rebecca Schwartz-Mette, PhD, an assistant professor of psychology at the University of Maine in Orono. "It makes sense," she says. "If this is what we expect of entry-level practitioners, it could also be used as a benchmark for maintaining competence across the spectrum."

360-degree evaluations. While assessing yourself is important, it's not enough, says psychologist Jac J. W. Andrews, PhD, who has researched 360-degree evaluations—also known as multi-source feedback—and called for psychologists to make this strategy's use as common as it is with other health-care professionals. "We know that self-reflection isn't always consistent with reality," says Andrews, who chairs the school and applied child psychology department at the University of Calgary.

Self-assessment involves self-reflection and evaluation of professional strengths and limitations in functional and foundational domains and decisions about how to address developmental needs, Andrews points out. But, he says, "a major problem with self-assessment as an approach for evaluating competence is that very few self-assessment measures have established adequate psychometric properties, and they tend not to correlate well with ratings by peers or supervisors or with measures of performance."

Using well-constructed instruments, multi-source assessment incorporates self-­assessment along with assessments from peers, co-workers and clients or patients, who provide information about such areas as clinical competence, professionalism, case management, interpersonal relations and communication. What's most useful about 360-degree evaluations is the chance to compare feedback from different sources, says Andrews, explaining that psychologists should analyze where there's agreement and disagreement among reviewers and between others' perceptions and their own.

This approach offers a chance to identify psychologists' strengths and weaknesses in core competencies and provide useful feedback for professional development and enrichment, says Andrews. It could also increase psychology's accountability to the public, he adds. Consumers would see that psychologists are keeping up with their competencies and being judged by themselves and others as being competent, he says. National, provincial and state psychology associations as well as provincial and statewide psychology regulatory boards could even use information from multi-source feedback for oversight and governance of ­professional psychology, he points out.

Enlisting your colleagues

Another problem with self-assessment is that the psychologists who need it the most may be the ones least likely to do it. That's why you need a group of close colleagues who can monitor you, says Johnson. "A competence constellation is a deliberately created network of colleagues whom we stay in very close connection with," says Johnson, who laid out the idea of a communitarian approach to training in a 2014 paper with Kaslow, Schwartz-Mette and others in Training and Education in Professional Psychology. "They're the very first folks to recognize when we're getting into trouble or having a hard time."

How can practitioners invite what Johnson calls "intrusive collegiality" into their professional lives? For a solo practitioner, Johnson says, the people keeping an eye on you could consist of a personal psychotherapist, a consultation group or a close group of colleagues—anyone you've got a close enough relationship with that they're willing to give you difficult feedback if necessary. Johnson, for example, breakfasts regularly with a colleague who monitors whether Johnson is indulging in his bad habit of taking on too much.

You can and should consider intervening by sharing your observations and concerns, even if you're not especially close to a fellow practitioner, says Erica H. Wise, PhD, a past chair of APA's Advisory Committee on Colleague Assistance. Such conversations can be awkward, especially if you're not sure a colleague is engaging in professional behavior that falls below standards of competence, says Wise, who directs the psychology clinic at the University of North Carolina at Chapel Hill.

Situations can be ambiguous, Wise says, and APA's Ethics Code gives little guidance if a situation doesn't involve an actual ethical violation. For example, while the Ethics Code calls for refraining from activities when personal problems prevent a psychologist from providing services competently, says Wise, it can be hard to know where the cutoff is for yourself and even more so for others.

That said, there's plenty practitioners can do when they're concerned about a colleague, says Wise. Practitioners should think carefully about what their concern is and what they actually know, then find a time to talk to the person. "Use ‘I' statements: Say ‘This is what I'm noticing, why it concerns me and what I think we need to do about it,'" says Wise, adding that some state psychological associations have colleague assistance programs that can help. "It should be presented as concern, not ‘I think you're not OK,'" she says.

Of course, she adds, when a psychologist is aware that a colleague has engaged in behavior that is clearly unethical or harmful, the best approach is to consult with the state psychology board about making a report.

Wise and others believe that this communitarian approach to competence should be ingrained in the Ethics Code, which will undergo revision in 2017. In the meantime, says Schwartz-Mette, it's important to remember that self-assessment is meant to help practitioners improve, not to be punitive.

"We don't want to stigmatize individuals who are struggling," says Schwartz-Mette, noting that there will always be times in your career when you fall short. "There are always ways to seek and get support to improve functioning if need be."

APA's Advisory Committee on Colleague Assistance has developed several resources on psychologist wellness. Access them at www.apa.org/practice/resources/assistance/index.aspx.


By Rebecca A. Clay

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23 May 2017

A Collection of Educational Psychology Articles Booklet

A Collection of Educational Psychology Articles Booklet

Psychologists working in the field of education study how people learn and retain knowledge. Their research unlocks clues about the way people process information that can help every student learn.

This booklet, A Collection of Educational Psychology Articles from APA Journals, zeroes in on a range of educational issues from student challenges in learning mathematics to improving teacher-student relationships.

If you enjoy these articles, don’t stop here. APA’s Journals Program maintains a database of hundreds of papers on educational psychology. And as an APA member, you enjoy highly discounted access that enables you to explore these and other research topics online at www.apa.org/pubs/journals.


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23 May 2017

Crossing Cultural Borders with Kenneth Wang

Crossing Cultural Borders with Kenneth Wang
Ken Wang
APA Fellow Kenneth Wang's interests include perfectionism, cross-national psychological adjustment, cross-cultural and multicultural psychology, and Asian and Asian American mental health.

Kenneth Wang, PhD, now based in Pasadena, Calif., struggled to navigate two cultures growing up. Born and raised in Taiwan, he spent five years in Tuscaloosa, Ala., as a young boy. Even today, Wang says, "I'm not 100 percent comfortable" in either China or the United States.

From his experience, Wang is convinced that leaving one culture behind to live in another, even temporarily, can shake a person's identity. His sense of the potential impact of that common transition has shaped his work. An associate professor in the School of Psychology at the Fuller Theological Seminary in Pasadena, Calif., Wang specializes in educational counseling, and he does much of his research with students. He also has a private practice.

"I've conceptualized crossing cultural borders as experiencing loss — the loss of relevant knowledge and a sense of belonging," he says. "This is not an original idea, but I draw on my own experience and observations of that."

Wang and his colleagues have specifically addressed the adjustment trajectories of hundreds of international students in the United States, as well as factors that might affect their transitions, like perfectionistic tendencies. He's also studied the constellation of traits that can help students find their feet, which has been dubbed cultural intelligence, or CQ. His research shows that some students fret most before they ever leave home; others are blindsided by culture shock, then adjust. ​​Yet another group suffers psychological distress that's more about them as individuals than their transition to another culture.

"International students are not all alike in the way they adjust" to new situations, Wang says. He'd like to be part of an effort to identify and encourage supports to help students and other visitors, refugees and immigrants achieve "belongingness" quickly in their new societies.

Wang is also known for his work assessing perfectionism among individuals in different groups. These are not necessarily people from other countries; for example, he has looked at perfectionism and identity issues in African-American and religious students as well.​ Still, these people can experience a tremendous amount of stress when mainstream values conflict with those of the subculture they grew up in.

The child of professor parents, Wang lived in Tuscaloosa between the ages of 5 and 10 while his father pursued a PhD at the University of Alabama. Wang was the first Asian student ever to attend his Tuscaloosa elementary school. When soccer teams formed along racial lines, the white kids versus the black kids, it was up to him to decide which team to join. He felt he didn't fit in, and he experienced some bullying, he says. His struggles continued even after his return to Taiwan. While he looked like everyone else, "I felt different. I didn't know the songs or games, and I struggled to learn to read and write Chinese, to fit in, to function in that cultural context. I thought there was something wrong with me," he says.

A number of basic values were different as well, Wang says. "Self-promotion is critical in the United States," for example, but humility is important in Taiwan. And always, Wang was held to tough standards, no matter where he was.

For Asians and Asian-Americans, perfectionism is "not just individual but collectivistic," he says. Instructors in Asian schools tend to "focus on where people have gone wrong, where they can improve," in contrast with mainstream American society, which may try to reinforce "feeling good about yourself," even if a student's performance is below par. Asian students have a "more realistic view" of how they're doing and "where they fit in," Wang says, but the Asian approach can take a toll. Even if the culture views the student's distress as constructive, the individual may not get much satisfaction from his or her own success, which can lead to anxiety and depression.

As an adult, Wang worked for years in business, first in marketing and then in planning, until he noticed he was more interested in a colleague's marital problems than in his work. The most frustrating part of that for Wang was that he wasn't able to offer any helpful advice.

His future wife was taking a counseling class as part of her education curriculum, and introduced him to the idea of empathy, "of being in another person's shoes, and reflecting," he recalls. That changed his life. Wang decided to go into a helping profession and came back to the United States, to Wheaton College, a small Christian school in Wheaton, Ill. Deciding against the ministry, he got a master's degree in counseling. When he finished, he returned to Taiwan and went to work in the Disability Resources Center at National Dong Hwa University in Hualien.

But counseling in Taiwan was not what it might have been in the United States. Wang had few clients and his time was taken up with administrative work. "I might as well have stayed in business," he says. Restless again, looking at various PhD programs, he noticed that at Pennsylvania State University in State College, some professors were studying perfectionism, including Robert Slaney, PhD, who had created the influential Almost Perfect Scale–Revised.

"That resonated with me," Wang recalls. The high standards he had grown up with, the "constant striving and pressure to perform well" made him want "to learn more about how that impacts a person." Wang's first publication, in 2006, was a paper he wrote with Slaney on perfectionism among Taiwanese students.

For Wang, his present job at the seminary affords him the opportunity to continue to explore cross-cultural differences, but with the added benefit of being able to travel to China several times a year. Fuller has strong ties to China and Taiwan through its China Initiative ministry, and that connection offers research and other collaborative opportunities.

Wang says, "Psychology encourages us to be who we are, and accepting of who we are. I've come to accept that I'm a cross-cultural person."

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22 May 2017

A Collection of Clinical Psychology Articles Booklet

A Collection of Clinical Psychology Articles Booklet

Clinical psychology is a complex and diverse specialty area within psychology. It addresses a breadth of mental, emotional and behavioral disorders, integrating the science of psychology with the prevention, assessment, diagnosis and treatment of a wide variety of complicated human problems. Clinical psychologists help people live healthier lives, applying the research and science of behavior change to the problems their patients experience.

This booklet, A Collection of Clinical Psychology Articles from APA Journals, highlights recent papers on everything from post-traumatic stress disorder to medication for childhood depression and the role of self-determination in mental health recovery.

If you enjoy these articles, don’t stop here. APA’s Journals Program maintains a database of hundreds of papers on clinical psychology. And as an APA member, you enjoy highly discounted access that enables you to explore these and other research topics online at www.apa.org/pubs/journals.


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12 May 2017

How Did You Get That Job? A Q&A with User Experience Researcher Dr. Laura Faulkner

The knowledge, skills and experience gained through your psychology education and training can successfully transfer to a variety of jobs that you may never have considered. As a user experience researcher, Dr. Laura Faulkner, PhD, utilizes her psychology expertise to help companies better understand how people perceive and respond to products or services. In this webinar, Dr. Faulkner discusses her "21-year love affair" in the user experience field. Learn how you can apply your psychology background to a similar career path.

Laura FaulknerSpeaker:

Dr. Laura Faulkner is the head of user experience research at Rackspace, a managed cloud computing company that helps businesses tap the power of cloud computing without the complexity and cost of managing it on their own. She has worked in user experience (UX) for over twenty years at companies and institutions: Pearson, FalconDay Consulting and the University of Texas-Austin. In all her roles, Dr. Faulkner’s focus is on “human beings: users as humans, development teams as humans, leadership as humans, all of whom need information and designs that move them forward in what they are doing and wanting to do. My goal is to collaborate and lead from inception through successful use, to make a difference.”

Garth FowlerHost:

Dr. Garth A. Fowler is an Associate Executive Director for Education, and the Director of the Office for Graduate and Postgraduate Education and Training at APA. He leads the Directorate’s efforts to develop resources, guidelines, and policies that promote and enhance disciplinary education and training in psychology at the graduate and postdoctoral level.

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11 May 2017

Should you use an app to help that client?

Should you use an app to help that client?

As the use of mental health and behavioral apps grows, psychologists must weigh their benefits and limitations

Today there are more than 165,000 health-related apps worldwide, helping users track their diet and exercise, monitor their moods and even manage chronic diseases, according to a 2015 report by the IMS Institute for Healthcare Informatics. Nearly 30 percent of these apps are dedicated to mental health. While the apps present new opportunities for psychologists to boost patient support and supplement the therapeutic relationship, their sheer number and variety can make it difficult for psychologists to determine which are the most effective, safest and most useful.

"There's been an explosion of apps, and clinicians don't have time to keep up with all of them," says Stephen Schueller, PhD, a clinical psychologist at Northwestern University's Center for Behavioral Intervention Technologies. "It's not their job and it's impossible for them to do it."

But since one in five Americans uses these apps, staying informed about broad trends in app use is important for psychologists, says David Luxton, PhD, co-author of "A Practitioner's Guide to Telemental Health" (APA, 2016).

"If you're not familiar with these technologies today as a clinician, it's time to start paying attention because our patients are demanding them," he says.

Why use apps?

Many practitioners find that mental health apps are a valuable adjunct to psychotherapy because they allow therapists to maintain a better connection with their patients and improve their ability to track clients' symptoms and moods. Some of the most widely used of these apps include T2 Mood Tracker, developed by the National Center for Telehealth and Technology (T2), and Optimism Online, a mood charting app that allows clinicians to monitor client entries and receive alerts to help catch problems as they arise.

San Francisco-based clinical psychologist Keely Kolmes, PsyD, says that many of her clients prefer apps to the paper-based tools that she's used in her practice for years, for recording thoughts and tracking moods.

"Apps help prompt my clients to log things like their mood or whether they exercised or drank alcohol or slept well, so that I can have an accurate picture of their week, as opposed to them trying to reconstruct things on paper the day before therapy or during therapy, which is much less reliable," she says.

Apps are also available to patients 24 hours a day, seven days a week, and can be a great source of educational information, particularly at times when a client's clinician is unavailable. These include several apps by T2, such as PTSD Coach and CPT Coach, as well as Day to Day, which delivers a daily stream of advice, support and other information throughout the day to boost a user's mood. Day to Day is one of 14 apps included in IntelliCare, a suite of apps developed by Northwestern University's Center for Behavioral Intervention Technologies that target depression and anxiety arising from various causes.

While more research is needed, several studies indicate that the use of health apps can also improve patient outcomes and satisfaction. A 2015 meta-analysis led by Harvard Medical School psychiatrist John Torous, MD, for example, looked at 10 studies examining the use of apps in the treatment of mood disorders. The analysis found that patients who used these apps reported improved depressive symptoms (Internet Interventions, 2015). And a 2013 study led by University of New South Wales psychologist Tara Donker, PhD, found that participants who used apps reported the apps were a useful way to get self-help for mental health concerns and disorders (Journal of Medical Internet Research, 2013).

Apps can also help clinicians gather data about their practice, says APA's director of legal and regulatory affairs, Stacey Larson, PsyD, JD. For example, several apps provide HIPAA-compliant note-taking (such as Insight Notes and Mobile Therapy) and can generate graphs or tables showing client improvement as well as areas that still needed to be worked on. "A provider can use them to help determine which interventions are working best and which should be changed, and this information can be shown individually or charted for a practitioner's whole practice, to determine how interventions are working more broadly across their patient population," Larson says.

Potential limitations

Despite their popularity, behavioral health apps are not regulated and many are not research-based, says Marlene Maheu, PhD, executive director of the Telemental Health Institute in San Diego.

"We're scientists—we need to have evidence that something works before we use it with our clients," she says.

Schueller agrees, and encourages clinicians to look for apps that come with documentation of the evidence on which they are based, including research on the intervention underlying the app, such as cognitive-behavioral therapy, as well as research specifically associated with the app itself.

"The most reputable apps are generally those affiliated with academic research institutions or government funding agencies, as they are the most likely to detail the app development and validation process," he says. (See list below.)

Patient privacy and security concerns also need to be addressed any time technology is used in clinical practice. Some apps, for example, allow communication between therapists and patients between sessions—a feature some therapists might want and others might not—and it's crucial that this communication be HIPAA compliant, Maheu says. It's also important for providers to understand what, if any, data are being collected when a patient uses an app, and to make sure patients are informed about this, Larson says.

"Mobile mental health apps can be either passive or active," she explains. "Active apps require direct participation from the patient—such as completing mood logs, self-symptom ratings or recording personal experiences, but passive apps are able to access information independently and gather data through smartphone functions such as GPS without the patient or provider even noticing. Though it may be beneficial, some people may not like the potential invasion of privacy associated with this type of data gathering." And Schueller advises clinicians to show patients how to put a screen lock or password on their phones for additional security.

Integrating apps into your practice

With all of these limitations in mind, how can practitioners ensure the best use of apps in practice? Schueller recommends asking colleagues how they may use apps in therapy, and posting questions on listservs to find out what others have found works best. Several organizations provide resources and reviews of mobile health apps, to help clinicians stay abreast of the most effective and safest technologies. (See list below.) APA and the Center for Technology in Behavioral Science also hosted a webinar in May exploring the role of apps in clinical practice. The organizations received an overwhelming response to the one-hour event, with more than 1,700 clinicians registering for the event, says Maheu, CTiBS president and CEO. Two more webinars are being scheduled for the fall. It's also imperative that psychologists take time to test an app themselves before endorsing it with their clients, Luxton says.

"Install it and try out every single possible scenario inside that app so that you know it very well," he says. And always get feedback from patients on how an app is working for them, Schueller says. "As you start to learn more about which apps are really resonating with the population of clients you're working with, it will help get your practice more in line with what your clients want."

And most important, he adds, clinicians must be mindful of how apps fit into the goals of therapy. "Apps are not a panacea," Schueller says. "There's a lot of enthusiasm here and some of it is warranted. But be cautious; they will not completely fix everything."

APA does not endorse any of the apps mentioned in this article.

Mobile health app resources

By Amy Novotney

This article was originally published in the November 2016 Monitor on Psychology

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11 May 2017

Can I work here?

Can I work here?

Industrial/organizational psychologists offer their advice for helping job seekers determine whether a potential employer offers a good fit

Workers who feel valued by their employers are more likely to be satisfied with their jobs and be motivated to do their best. They're also less likely to want to leave the organization in the next year, according to APA's 2016 Work and Well-Being Survey, which polled more than 1,500 U.S. workers.

The survey also found that work-life fit—or how well a job fits with the rest of an employee's life—plays an important role in employee retention, says David W. Ballard, PsyD, MBA, who directs APA's Center for Organizational Excellence. "Americans spend a majority of their waking hours at work and, as such, they want to have harmony between their job demands and the other parts of their lives," Ballard says. That means that to remain competitive, employers need to create environments where employees feel connected to the organization and have a work experience that's part of a rich, fulfilling life.

How can psychologists determine whether a potential employer will give them that positive experience and work-life fit? Some industrial/organizational (I/O) psychologists point to the importance of matching an employee's values with that of the organization. Others say previous work experiences—such as the factors they did and didn't like about a job or supervisor—are key indicators of what to look for in a new role. Overall, though, determining whether an organization is a good match has to start with a thorough understanding of your career priorities, I/O psychologists say. "It is as much about what your needs and preferences are as it is about the organization," Ballard says.

Look inward. Before the job search, psychologists should pinpoint what their work interests are, says I/O psychologist Edgar Schein, PhD, a professor emeritus at the MIT Sloan School of Management. Start by conducting a self-analysis of your career to date to help you determine your strengths, your values and what motivates you—or, as Schein calls it, your "career anchor." His research on career anchors has shown that most people place different amounts of emphasis on the importance of eight categories or preferences. They are technical/functional competence; general managerial competence; autonomy/independence; security/stability; entrepreneurial creativity; service/dedication to a cause; pure challenge; and lifestyle.

So, for example, among clinical psychologists, some want to work for an organization because they are more security/stability oriented, while others want to set up private practices because they want to be on their own.

He points out, however, that often one's anchor can't truly be discovered before spending several years in the workforce. "This really is a deeper level of knowledge about oneself that isn't usually something people know when they graduate," he explains. "They need 10 years of experience to really figure themselves out."

Network with experts. Early on in your career, Schein recommends reaching out to psychologists who are in jobs you can imagine moving into. "Find someone ahead of you in your career and get a sense of what work is like for them at that job," he says.

Determine personal priorities. Job seekers also have to think about their personal priorities and interests before they start their job searches, says Helena Cooper-Thomas, PhD, a professor of organizational behaviour at Auckland University of Technology in New Zealand. Her point is backed by new research: In a meta-analysis of 92 studies with nearly 35,000 participants, employees whose interest profiles matched their job profiles were more likely to perform better, help others in the organization and stay with the company longer. The study, led by Michigan State University I/O psychologist Christopher Nye, PhD, shows that it's not a person's overall interest in a particular kind of work, but how their interests across various types of work match with the skills and tasks involved in a particular job. The researchers surmise that this match—known as person-environment fit—is a much better predictor of job performance than the more general interest or personality measures often used by college career centers (Journal of Vocational Psychology, 2017).

One way job seekers can determine whether their interests match with those of other company employees is to search for the employer on LinkedIn, Ballard says. There, you can often find employees' public-facing profiles, which can offer insight into the skill sets and longevity of people who work there.

Consider a "misfit" job. Candidates should also consider where they can tolerate or even benefit from "misfit," Cooper-Thomas adds. "If you're the type of person who likes to have fun at work by playing pranks or telling jokes, you probably wouldn't do well in a secure facility, while those with a competitive streak may conflict with the compassionate and calm values found in some health-care settings," she says.

But having knowledge or skills that are different from one's colleagues can result in more innovative ideas and helpful solutions, which can help employees get noticed and accelerate their careers, she points out.

Do more research. Once psychologists determine the factors that matter most to them in a job, they should read up on any organization they are interested in, paying particular attention to its mission or values statement, says Ballard. "Something that's often telling about an organization's attention to employee well-being is whether or not it has something about creating a positive or healthy work environment and supporting staff built into its mission statement or values," he says. He also recommends doing an Internet search using both Google and Glassdoor to see how the organization is portrayed and whether, for example, they've been embroiled in any controversy. "Look not just at the things the organization itself posts, but also the kinds of comments, statements and reactions they get from other people," he says.

Get specific in your interview. Of course, it's always helpful to ask about an organization's culture during the interview process—the drawback is that there is no guarantee that the recruiter's espoused values are the values in use, warns Cooper-Thomas. What can be more helpful, she suggests, is asking your interviewers to be more specific by sharing an incident at work that reveals the organization's values in action. Interviewers could discuss a time they were particularly proud of their employer, for example.

Cooper-Thomas also notes that every organization has different layers of culture, so job seekers should try to ascertain whether they would fit with the people they would work with on a daily basis, such as supervisors and colleagues. She suggests paying particular attention to how employers treat people: Is the receptionist friendly and helpful? Did the interviewers show respect by arriving on time? Did they answer the job seeker's questions honestly?

Gauge your potential support system. Also ask interviewers about the amount of autonomy employees have within the organization, the organization's structure and the kinds of support available, Ballard says. For example, if you're looking for a job where you're providing clinical services, you'll want to know whether there is administrative, billing and collection support.

In addition, pay attention to how formal or informal the work environment appears to be, as well as how diverse and inclusive it is, Ballard says.

And if it's important to you, talk to the recruiter and your potential supervisors about flexibility and work-life fit to find out if you'd have the ability to modify when, where, and how much you work to accommodate your needs.

Think about the "fun factor." Early career psychologists have spent many years studying and planning their career paths, and are usually quite passionate about further developing them, says University of Chicago Booth School of Business professor Ayelet Fishbach, PhD. But when it comes to sticking with a job, people thrive most when they're doing interesting work with people they like, according to research by Fishbach and behavioral science doctoral candidate Kaitlin Woolley (Journal of Personality and Social Psychology, 2015). So, in addition to looking for benefits such as career development opportunities, it's important to consider whether you can expect to enjoy, be challenged, fulfilled and experience social connections in a work setting, the authors say. "A workplace that offers immediate benefits in terms of engagement and enjoyment is a place where people stay," Fishbach says.

Find out what a typical day would really look like. Finally, Schein encourages job seekers to get personal with the people they're interviewing. That means spending time to get to know the one or two people you have met in the organization by asking them why they got into the field and how they like their jobs. This tactic works best toward the end of the interview process, he says, or even as a follow-up call once a job is offered.

"What you really need to find out is not about all the benefits and bonuses that might be available to you, but what you'd really be doing day by day and would the people around you be supportive of that," Schein says. 

Trust your gut

Before you take a job, ask yourself the following questions:

  1. Will I be pursuing my true interests in this position?
  2. Will I have the work-life balance I want?
  3. Do my co-workers seem to mirror my values?
  4. Will I feel valued by this employer and in this position?

By Amy Novotney

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10 May 2017

7 Things to Consider Before Starting a Side Hustle

7 Things to Consider Before Starting a Side Hustle

Making extra money on the side sounds great, right? Thanks to the internet and mobile technology, new ways of making money after work are becoming a norm in our society. Side hustles can serve several different purposes – from creating an emergency fund, retiring early, or making a down payment on your first house.

It seems like there are endless stories about people striking it rich from a random side gig, but there's actually much more to it than meets the eye.

Side hustles, no matter how small, are still a business. Just like you have to hustle to get ahead in your actual job, the same goes for side hustling, and it may be even harder because you are building it from the ground up!

Here are 7 things to seriously consider before starting a side hustle:

1. Do you have a business model?

This can be a fairly intimidating aspect of starting any type of business, especially if you don't have any prior experience. The most important part of building a successful brand is learning how to plan correctly and find your target market.

Here are a few things you'll want to think about when you are planning your side-hustle strategy:

  • Does the service you are providing actually provide value?
  • How will you advertise and find clients or customers?
  • What is the realistic amount of time it will take to get your business up and running?
  • Is there a specific legal structure that would work best for your type of business?
  • What are the tax implications that you may face later down the road?

While you may be thinking that your business will just be a hobby that you do in your spare time, it's always smart to make sure that you understand every aspect of your business before getting started.

Don't be afraid to hire an attorney to help you create a strong legal structure that will separate the business from your personal assets. If you don't, it's possible that your personal assets could be vulnerable in the unfortunate circumstances of a lawsuit.

You may also want to pay an accountant to give you guidance on the best tax strategy for your side hustle moving forward. If there is anyone you don't want to forget about, it's the IRS.

2. You may need startup capital

In addition to the professional services mentioned above that you may need to cover the cost for up front, there are also other business expenses that you may need to prepare for.

Even a service as simple as pet-sitting requires extra money in gas and potentially pet insurance.

Many side hustles don't require a massive amount of startup capital, but it's always a good idea to sit down and create realistic estimates on what it will cost you to run your business.

3. It can take more time than you think

The time that it takes to run a successful side hustle has to come from somewhere, and it's usually what would be your time to relax on the couch or go to a movie on the weekend.

Depending on the nature of your side hustle, you may need to schedule your time very carefully to make sure you are still able to do things that help you recoup from your actual job.

4. Your primary income comes first

It's easy to get obsessed about the extra income that is coming in from your side hustle, but your primary job still needs to come first.

One of the biggest risks involved with creating secondary income streams is that you are essentially burning the candle at both ends. The last thing you want to do is experience "burnout" at your main job or have your performance slip to a point where you could be fired.

No matter how great your side hustle is, if it doesn't at least match or even exceed your day job income – it needs to take a back seat.

5. Do you have a goal?

With as much time as side hustles actually take to become successful, you'll want to make sure that you have a goal going into it that will help keep you motivated to put in the extra work.

It could be as simple a goal as saving extra money for vacations, or as big a goal as retiring from your job 10 years earlier than you originally planned. Whatever it is, make sure that it's important enough to push you to put in the extra time.

6. You'll probably have to learn to sell

The reality of keeping a business alive is that you'll have to feed it with new sales. If you have no background in sales at all, trying to convince other people to give you their money for a product or service can be fairly intimidating.

While there are certainly sales strategies and tactics you can learn – it's going to take trial and error. Every time you have a successful sale, there may be ten times that you get turned down.

Just like with anything else, practice makes perfect.

7. It could fail

Before you take the leap into part-time entrepreneurship, you need to understand that your venture has a real chance of not making it. There are a number of reasons for this, but at the end of the day it's just the nature of business.

They just don't always make it.

Fortunately, if you provide a great service or product that gives value to your target consumers, you're much more likely to thrive.

Don't let this list discourage you

Even though the above list may make side hustles seem like an intimidating challenge, they are still an incredible tool for getting ahead financially and meeting your biggest goals sooner than you originally planned.

As long as you take your side gig seriously and treat it like a real business, you have a great chance to find success and create a viable second income stream.

-- Bobby Hoyt is a former high school teacher who paid off $40,000 of student loan debt in a year and a half. He now runs the personal finance site MillennialMoneyMan.com full-time, and has been seen on CNBC, Forbes, Business Insider, Reuters, Marketwatch, and many other major publications.

The opinions and advice expressed in this article are those of the author and do not necessarily reflect those held by the American Psychology Association (APA).

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