Psy 650 Final Paper

Week 6 – Final Project

Psychological Treatment Plan

It is recommended that students review the e-book The Complete Adult Psychotherapy Treatment Planner (Jongsma, Peterson, & Bruce, 2014) for additional assistance in completing this assignment.

Clinical and counseling psychologists utilize treatment plans to document a client’s progress toward short- and long-term goals. The content within psychological treatment plans varies depending on the clinical setting. The clinician’s theoretical orientation, evidenced-based practices, and the client’s needs are taken into account when developing and implementing a treatment plan. Typically, the client’s presenting problem(s), behaviorally defined symptom(s), goals, objectives, and interventions determined by the clinician are included within a treatment plan.

To understand the treatment planning process, students will assume the role of a clinical or counseling psychologist and develop a comprehensive treatment plan based on the same case study utilized for Case study 18: Julia A minimum of five peer-reviewed resources must be used to support the recommendations made within the plan. The Psychological Treatment Plan must include the headings and content outlined below.

Behaviorally Defined Symptoms

Define the client’s presenting problem(s) and provide a diagnostic impression.

Identify how the problem(s) is/are evidenced in the client’s behavior.

List the client’s cognitive and behavioral symptoms.

Long-Term Goal

Generate a long-term treatment goal that represents the desired outcome for the client.

This goal should be broad and does not need to be measureable.

Short-Term Objectives

Generate a minimum of three short-term objectives for attaining the long-term goal.

Each objective should be stated in behaviorally measureable language. Subjective or vague objectives are not acceptable. For example, it should be stated that the objective will be accomplished by a specific date or that a specific symptom will be reduced by a certain percentage.

Interventions

Identify at least one intervention for achieving each of the short-term objectives.

Compare a minimum of three evidence-based theoretical orientations from which appropriate interventions can be selected for the client.

Explain the connection between the theoretical orientation and corresponding intervention selected.

Provide a rationale for the integration of multiple theoretical orientations within this treatment plan.

Identify two to three treatment modalities (e.g., individual, couple, family, group, etc.) that would be appropriate for use with the client.

It is a best practice to include outside providers (e.g., psychiatrists, medical doctors, nutritionists, social workers, holistic practitioners, etc.) in the intervention planning process to build a support network that will assist the client in the achievement of treatment goals.

Evaluation

List the anticipated outcomes of each proposed treatment intervention based on scholarly literature.

Be sure to take into account the individual’s strengths, weaknesses, external stressors, and cultural factors (e.g., gender, age, disability, race, ethnicity, religion, sexual orientation, socioeconomic status, etc.) in the evaluation.

Provide an assessment of the efficacy of evidence-based intervention options.

Ethics

Analyze and describe potential ethical dilemmas that may arise while implementing this treatment plan.

Cite specific ethical principles and any applicable law(s) for resolving the ethical dilemma(s).

The Psychological Treatment Plan

Must be 8 to 10 double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center (Links to an external site.)Links to an external site..

Must include a separate title page with the following:

Title of paper

Student’s name

Course name and number

Instructor’s name

Date submitted

Must use at least five peer-reviewed sources in addition to the course text.

Must document all sources in APA style as outlined in the Ashford Writing Center.

Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center.

Week 6 – Final Project

Psychological Treatment Plan

It is recommended that students review the e-book The Complete Adult Psychotherapy Treatment Planner(Jongsma, Peterson, & Bruce, 2014) for additional assistance in completing this assignment.

Clinical and counseling psychologists utilize treatment plans to document a client’s progress toward short- and long-term goals. The content within psychological treatment plans varies depending on the clinical setting. The clinician’s theoretical orientation, evidenced-based practices, and the client’s needs are taken into account when developing and implementing a treatment plan. Typically, the client’s presenting problem(s), behaviorally defined symptom(s), goals, objectives, and interventions determined by the clinician are included within a treatment plan.

To understand the treatment planning process, students will assume the role of a clinical or counseling psychologist and develop a comprehensive treatment plan based on the same case study utilized for the Psychiatric Diagnosis assignment in PSY645. A minimum of five peer-reviewed resources must be used to support the recommendations made within the plan. The Psychological Treatment Plan must include the headings and content outlined below.

Behaviorally Defined Symptoms

  • Define the client’s presenting problem(s) and provide a diagnostic impression.
  • Identify how the problem(s) is/are evidenced in the client’s behavior.
  • List the client’s cognitive and behavioral symptoms.

Long-Term Goal

  • Generate a long-term treatment goal that represents the desired outcome for the client.
    • This goal should be broad and does not need to be measureable.

Short-Term Objectives

  • Generate a minimum of three short-term objectives for attaining the long-term goal.
    • Each objective should be stated in behaviorally measureable language. Subjective or vague objectives are not acceptable. For example, it should be stated that the objective will be accomplished by a specific date or that a specific symptom will be reduced by a certain percentage.

Interventions

  • Identify at least one intervention for achieving each of the short-term objectives.
  • Compare a minimum of three evidence-based theoretical orientations from which appropriate interventions can be selected for the client.
  • Explain the connection between the theoretical orientation and corresponding intervention selected.
  • Provide a rationale for the integration of multiple theoretical orientations within this treatment plan.
  • Identify two to three treatment modalities (e.g., individual, couple, family, group, etc.) that would be appropriate for use with the client.

It is a best practice to include outside providers (e.g., psychiatrists, medical doctors, nutritionists, social workers, holistic practitioners, etc.) in the intervention planning process to build a support network that will assist the client in the achievement of treatment goals.

Evaluation

  • List the anticipated outcomes of each proposed treatment intervention based on scholarly literature.
    • Be sure to take into account the individual’s strengths, weaknesses, external stressors, and cultural factors (e.g., gender, age, disability, race, ethnicity, religion, sexual orientation, socioeconomic status, etc.) in the evaluation.
  • Provide an assessment of the efficacy of evidence-based intervention options.

Ethics

  • Analyze and describe potential ethical dilemmas that may arise while implementing this treatment plan.
  • Cite specific ethical principles and any applicable law(s) for resolving the ethical dilemma(s).

The Psychological Treatment Plan

  • Must be 8 to 10 double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center (Links to an external site.)Links to an external site..
  • Must include a separate title page with the following:
    • Title of paper
    • Student’s name
    • Course name and number
    • Instructor’s name
    • Date submitted
  • Must use at least five peer-reviewed sources in addition to the course text.
  • Must document all sources in APA style as outlined in the Ashford Writing Center.
  • Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center.

 

Week 6 – Final Project

Psychological Treatment Plan

It is recommended that students review the e-book The Complete Adult Psychotherapy Treatment Planner(Jongsma, Peterson, & Bruce, 2014) for additional assistance in completing this assignment.

Clinical and counseling psychologists utilize treatment plans to document a client’s progress toward short- and long-term goals. The content within psychological treatment plans varies depending on the clinical setting. The clinician’s theoretical orientation, evidenced-based practices, and the client’s needs are taken into account when developing and implementing a treatment plan. Typically, the client’s presenting problem(s), behaviorally defined symptom(s), goals, objectives, and interventions determined by the clinician are included within a treatment plan.

To understand the treatment planning process, students will assume the role of a clinical or counseling psychologist and develop a comprehensive treatment plan based on the same case study utilized for the Psychiatric Diagnosis assignment in PSY645. A minimum of five peer-reviewed resources must be used to support the recommendations made within the plan. The Psychological Treatment Plan must include the headings and content outlined below.

Behaviorally Defined Symptoms

  • Define the client’s presenting problem(s) and provide a diagnostic impression.
  • Identify how the problem(s) is/are evidenced in the client’s behavior.
  • List the client’s cognitive and behavioral symptoms.

Long-Term Goal

  • Generate a long-term treatment goal that represents the desired outcome for the client.
    • This goal should be broad and does not need to be measureable.

Short-Term Objectives

  • Generate a minimum of three short-term objectives for attaining the long-term goal.
    • Each objective should be stated in behaviorally measureable language. Subjective or vague objectives are not acceptable. For example, it should be stated that the objective will be accomplished by a specific date or that a specific symptom will be reduced by a certain percentage.

Interventions

  • Identify at least one intervention for achieving each of the short-term objectives.
  • Compare a minimum of three evidence-based theoretical orientations from which appropriate interventions can be selected for the client.
  • Explain the connection between the theoretical orientation and corresponding intervention selected.
  • Provide a rationale for the integration of multiple theoretical orientations within this treatment plan.
  • Identify two to three treatment modalities (e.g., individual, couple, family, group, etc.) that would be appropriate for use with the client.

It is a best practice to include outside providers (e.g., psychiatrists, medical doctors, nutritionists, social workers, holistic practitioners, etc.) in the intervention planning process to build a support network that will assist the client in the achievement of treatment goals.

Evaluation

  • List the anticipated outcomes of each proposed treatment intervention based on scholarly literature.
    • Be sure to take into account the individual’s strengths, weaknesses, external stressors, and cultural factors (e.g., gender, age, disability, race, ethnicity, religion, sexual orientation, socioeconomic status, etc.) in the evaluation.
  • Provide an assessment of the efficacy of evidence-based intervention options.

Ethics

  • Analyze and describe potential ethical dilemmas that may arise while implementing this treatment plan.
  • Cite specific ethical principles and any applicable law(s) for resolving the ethical dilemma(s).

The Psychological Treatment Plan

  • Must be 8 to 10 double-spaced pages in length (not including title and references pages) and formatted according to APA style as outlined in the Ashford Writing Center (Links to an external site.)Links to an external site..
  • Must include a separate title page with the following:
    • Title of paper
    • Student’s name
    • Course name and number
    • Instructor’s name
    • Date submitted
  • Must use at least five peer-reviewed sources in addition to the course text.
  • Must document all sources in APA style as outlined in the Ashford Writing Center.
  • Must include a separate references page that is formatted according to APA style as outlined in the Ashford Writing Center.

Partnering With a Purpose: Psychologists as Advocates in Organizations

Contents

1. Organizational Advocacy

2. Advocacy and the Professional Training Model

3. Organizational Advocacy as Partnering

4. Organizational Advocacy as Communication

5. Conclusion

6. Footnotes

7. References

Listen

By: James K. Hill Waypoint Centre for Mental Health Care;;

Biographical Information for Authors: James K. Hill earned his PhD in psychology from the University of Saskatchewan. He currently works at Waypoint Centre for Mental Health Care and has previously worked in independent practice, hospital, community, and government settings. His areas of interest include professional practice issues, improving clinical standards, psychologically healthy workplaces, and knowledge translation.

Acknowledgement: I gratefully acknowledge Milton Almeida and Lara Robinson for their helpful comments on versions of this article.

Psychologists do not do a good job at advocating ( Fox, 2008 ), and they certainly do not advocate as well as other professions ( DeLeon, Loftis, Ball, & Sullivan, 2006 Lating, Barnett, & Hororwitz, 2010). This argument is the theme in almost every article that discusses professional advocacy within the discipline. Myriad reasons are put forth that explain why psychologists do not promote, or even defend, our discipline. Lack of time, lack of training in/understanding of advocacy, no guarantee of success, or finding professional satisfaction in other elements of the role may all partially explain psychologists’ disinterest in advocacy. Another barrier that may thwart many psychologists is that social advocacy seems so monumental that it is easier to focus on more familiar tasks. Most professional associations have some form of advocacy committee, but psychologists may not have the time or organizational support to join such groups. Advocacy within the workplace offers an initial step for psychologists who want to promote their discipline but are daunted by the unfamiliar territory of political advocacy (i.e., lobbying government, political contributions). By working with partners and promoting a clear message, psychologists in organizations can present their issues to decision makers.

Advocacy is a process of communicating benefits and ensuring that policymakers can access high-quality information.  Fox (2008)  defined advocacy as “the use of political influence to advance the profession through such means as political giving, legislative lobbying, and other active participation in the political decision-making process” (p. 633). Often the goals are to influence social policy funding and decision making that relate to issues core to the practice of psychology. Other efforts might be to highlight research findings applicable to public policy. Finally, advocacy may simply involve collaborating with others to better meet common goals.

In the workplace, psychologists can refine advocacy skills in an environment that builds on already established positive relationships that are part of their professional role. This is especially true in organizations in which psychologists are not supported by a departmental model but are simply another professional on the team. There may also be an immediate and tangible benefit to advocacy efforts by an increased potential of seeing one’s actions effect change. Once psychologists hone their advocacy skills within a familiar workplace environment, these skills can generalize to political and social advocacy. This article highlights the importance of organizational advocacy in developing skills to promote the profession of psychology as essential to effective client care.

Organizational Advocacy

For the present purpose, organizational advocacy is the process by which professional members influence organizational change so that the discipline’s clients, goals, programs, and interests can be met within the broader organization. This can be done within a structure that includes a psychology department, but even the sole psychologist on a team can engage in advocacy.  Table 1  summarizes some professional activities that offer potential for organizational advocacy, including the target audience commonly associated with the activity. Advocacy efforts can target both client services and the profession as a whole ( Fox, 2008 Lating et al., 2010). Psychologists interested in organizational advocacy would typically target their employer or contracting agency; however, there may be opportunities to advocate in partner organizations. For example, when receiving a consultation request or a referral, psychologists can take the opportunity to provide more details regarding the role or service options provided by the discipline. Many familiar professional issues could be advocated at the organizational level, such as clinical services, retention issues, evidence-based practice, or ethical issues. pro-44-4-187-tbl1a.gif Summary of Organizational Advocacy Activities

In discussing advocacy, Safarjan (2002) noted that there are four prerequisites in advocating change: (a) identifying a clear problem, (b) assessing the goal, (c) developing a strategy, and (d) implementing a plan. Of note, this is often psychologists’ approach when providing clinical services. Psychologists have a goal of helping clients change, moving from assessment to intervention to reach agreed-on goals. In fact, everyday clinical skills relate to advocacy: writing ( Radius, Galer-Unti, & Tappe, 2009 ), relationship building and maintenance ( DeLeon et al., 2006 Lating et al., 2010), public speaking (Lating et al., 2010), and high-level analytical skills to synthesize information. Clinical psychologists are also accustomed to providing clear, unbiased information and recommendations to decision makers regarding diverse clinical issues. When psychologists make recommendations, they are advocating for a specific plan; they use data to direct those recommendations. In social advocacy, psychologists report believing that they will have little effect, do not feel knowledgeable, or are simply unaware of key issues (Heinowitz et al., 2012). It is unlikely that these factors will be as pervasive at work. A positive intermediary step to building confidence would be to highlight how many skills psychologists use every day in the workplace related to advocacy.

In organizational advocacy, the target of change is ensuring that clients have access to prompt and effective psychological services within the organization. This may be easy in some organizations (e.g., hospitals with psychology departments), but can be a challenge if the system itself does not have clear psychology leadership (e.g., program-based systems). Thus, the goal in organizational advocacy is the promotion of psychological services within the organization, not as peripheral services or consulting, but as a vibrant discipline essential to client well-being. This strategy focuses on leveraging a psychologist’s activities with professional promotion and advocacy. To use this strategy, psychologists would highlight and celebrate their unique contribution to the team and organization. Of course, the success of this strategy depends on whether the organization facilitates such efforts or whether the barriers to change outweigh the psychologist’s ability and energy to advocate.

It is within organizations that psychologists can test their skills, use their expert role, set aside time to advocate, and see the fruits of their efforts. Psychologists often informally advocate in their organization and on their team. Organizational advocacy is part of the role, but can benefit from more structure and emphasis. Psychologists engaged in organizational advocacy must assertively educate leaders about psychology’s role and value in effective service delivery while maintaining professional integrity by using solid evidence grounded in theory and research.

Advocacy and the Professional Training Model

It is often noted that psychologists do not tend to include advocacy as part of their professional model ( Radius et al., 2009  Thompson, Kerr, Dowling, & Wagner, 2011 ). Physicians and nurses trained in professional schools are better at advocating for their patients while promoting their role as being essential to providing quality services ( DeLeon et al., 2006 Lating et al., 2010). These professions see the benefit of having their members at planning, policymaking, and leadership tables and support those interested in these leadership roles. Psychologists, on the other hand, seem content to focus on professional tasks related to a specific client or limited to issues related to their clients. Lating et al. (2010) point out that psychology is one of the few professions with a high-level academic training model as the norm (i.e., doctorate). Thus, training focuses less on developing a professional identity and more on developing an academic portfolio; publications and research often outweigh professional practice issues within universities. This bias may also explain why academic psychologists do not often discuss professional issues such as advocacy and the presence of psychology as a profession, and practitioners facing clinical demands often do not have time to write journal articles.

Lating et al. (2010)  note the duality with respect to professional advocacy:

Fostering an attitude of advocacy is instilling the notion that as psychologists we may need to be the active voice for those who cannot speak for themselves. At other times, we may need to be the active voice that advances and protects our profession. (p. 203)

This duality is central to professional advocacy; psychologists advocate in those areas in which they believe their role will improve service quality. This concept needs to be more central to our professional training model and stated explicitly. Although advocacy seems central to our professional role, and provision of excellent services is a subtle form of advocacy, overt advocacy efforts are often minimized or ignored in our training and practice. In essence, psychologists need to see advocacy as consistent with, and perhaps essential to, their professional role ( Burney et al., 2009 ).

Finally, in understanding advocacy barriers, psychologists should be clear on their partners and their message. What unique contribution does psychology bring to the partnership? What benefits are there to the client, team, service, and organization of having a psychologist instead of another professional? Psychologists need to have the answers to these questions as they advocate so that they know their role in the partnership. For example the scientist–practitioner approach, which is often unique to psychologists, promotes critical evaluation and debate. Other professionals may not understand this cultural norm in psychology, which can result in misinterpretation. Those unused to this norm may personalize debate or dismiss psychologists as overly critical or not team players. A simple discussion around the traditional psychologist training model can clarify some misunderstandings. For example, the debating of ideas is a positive strategy that psychologists use to get to the best solution; it is unrelated to interpersonal conflict. Once this professional value is clear, it may be easier to highlight the benefits of fostering spirited discussion and debate with psychologists’ partners in the organization. Thus, this ability to be impartial and critical becomes a key role within advocacy partnerships instead of a professional liability.

Organizational Advocacy as Partnering

A collaborative approach to advocacy can be beneficial, with advocates educating others in the organization about the value of psychological services. Under this perspective, the goal of advocacy ceases to be convincing others to the psychological perspective but, rather, increasing potential partners’ understanding and support of psychology issues. By creating a partnership, psychologists position themselves as key players in solutions that meet the collective goals of the partnership. Even when the final goal is not what one first envisioned, the fact that the psychological perspective was part of the process is a positive outcome, and reasonable goal, of a successful advocacy partnership.

If psychologists believe they have something to offer, they need to offer it and take credit for its benefits, especially in the current social and economic climate. Psychologists in independent practice often need to show the benefits of their role by providing timely, effective, and targeted consultative services; those in organizations would be well served to adopt a similar approach. This might include prompt return of phone calls, efficiently completing written reports, providing summaries in user-friendly language, or including follow-up consultation meetings so that clients/teams/referring agents can ask questions once they have received the report. These approaches are good business in independent practice, and can be good business in organizations as psychologists use these methods to become more integrated with the team, decision makers, and organization. Under this perspective, judiciously using professional activities as opportunities to promote the discipline becomes the core avenue of advocating for psychological services. These avenues might also include providing clinical, research, or ethical consultations, which show psychology’s value to the organization at large. Thus, other disciplines become partners and advocates, arguing for inclusion of psychology in key sectors while lessening the likelihood that psychologists’ advocacy efforts will be perceived as self-serving ( Cohen, Lee, & McIlwraith, 2012 ). In my experience, having those outside psychology making such arguments has met with the most success in advocating for service change and improvement of psychological services. Thus, partnering can be essential to advocacy, especially in sectors in which psychology has less voice.

In discussing the health sector, Safarjan (2002) notes, “Psychologists have the knowledge, expertise, and experience necessary to change health care delivery system, yet in state hospitals, they are not positioned to easily promote change” (p. 949). This is true because psychologists often find themselves focused on service delivery, a role for which they trained and in which they feel comfortable. It is through partnering at the organizational level, however, that psychologists can position themselves to effect change and provide broader support for the discipline.  Cohen et al. (2012)  identify getting more involved in health care administration as one way to become better positioned. For example, psychologists sitting on committees within the organization automatically raise the profile of the discipline. Natural committees for psychologists often involve research and ethics, but other committees on professional issues or specialty populations are also good options. This helps to position psychologists as key stakeholders in organizational improvement and allows them to identify new organizational priorities. The key in working on committees is not simply promoting a psychological perspective, but also supporting other views that help improve services; this is also advocacy. Another opportunity is to identify and, if possible, fill service gaps. This raises psychology’s status as an essential service partner while providing an opportunity to advocate for both clients and the discipline. If psychologists cannot fill the gap, one can advocate by diplomatically noting the limitation of current resources and show how changes in psychological services might help meet ever-changing needs.

Another way to position oneself through partnering is to become the content expert on key service issues (e.g., competency models, evidence-based practice, trauma-informed care). Whether through a committee process or not, psychologists can provide organizational leaders with information that helps decision making. This education role, to which psychologists are accustomed, might be as simple as forwarding a research article or as complex as writing a briefing note or longer report. As psychologists build their reputation as an essential discipline in improving decision making, their influence improves. In organizations in which psychology has a strong history, such efforts may be more welcomed and effective. Often, when there is a limited history, good work can often be dismissed as being specific to that psychologist. Thus, it is essential for psychologists to explicitly state that their work is consistent with the discipline and not simply a skill unique to the individual psychologist. Psychologists interested in organizational advocacy would be well served to assess their specific skill sets and status within the organization and be realistic in choosing advocacy activities that fit their strengths. Advocacy efforts should emphasize natural relationships and grassroots partnering when one feels one has less influence on the broader organization or when working outside a departmental model.

Psychologists can view partnership as part of working for improvement in service delivery. Focusing on areas of growth is essential to moving forward and initiating change. Many have noted that senior management is often ignorant about problem areas within their organization (Jurkiewicz, Knouse, & Giacalone, 2002Tourish, 2005Tourish & Robson, 2006), and the respectful sharing of information may be invaluable to leaders. Psychologists’ skills in partnering and motivating are useful in highlighting difficult messages. This is the point of advocacy: If leaders already agreed, then there would be no need to advocate. Yet being too open in sharing negative information may have an equally negative impact on one’s position in the organization ( Eisenberg & Witten, 1987 ); open communication and advocacy come with some risk. The key elements of reducing risk when sharing criticism in the organization are to (a) use a professional approach, avoid personalizing; (b) build on already established relationships; and (c) be transparent and accountable.

By maintaining a respectful, professional approach to providing constructive feedback, the target audience may be more willing to listen. Furthermore, building on positive relationships already developed via the professional role can be important to targeting the message. Kassing (2001) labeled open dissent to organizational decision makers as articulated dissent. People perceive articulated dissenters as being less argumentative and verbally aggressive than those who use more passive ways to dissent. Furthermore, observers assessed articulated dissenters as having high-quality relationships with supervisors and believing that the organization would welcome input. Much depends on the organizational culture. Do leaders encourage open discussion, or do they ignore the constructive nature of the process and dismiss criticism? Correctly assessing the culture helps to identify key partners for relationship building. Psychologists should partner with leaders in the organization who meet goals by encouraging autonomy, manageable workloads, work–life harmony, service accessibility, and valuing relationships ( Robertson & Tinline, 2008 ).

On establishing a receptive audience within the organization, it is essential that there is a clear message to communicate. Interviews with current staff, surveys, focus groups, and so forth can serve as data-gathering devices to highlight core issues faced by psychologists in the organization. Questions can focus on two related areas: (a) Internal: What can the discipline do to support its members; and (b) External: What organizational issues impact professional psychology practice? These questions could be added to a psychology meeting agenda or, depending on the situation, a more formalized interview process may be necessary to cover all issues. Using a formalized process to gather the information reflects systematic data gathering. A formalized process communicates the goals and priorities of the initiative so that people can make an informed choice regarding participation. A formalized process also sends a signal to the rest of the organization that the results reflect the professional nature of the activity and should be taken seriously. The power of documentation also means that psychologists will need to be careful about how they conduct any data-gathering process and report the results; however, these skills are generally part of the psychologist’s repertoire.

Organizational Advocacy as Communication

Identifying partners and having a clear message are elements of building a cogent communication strategy. Safarjan (2002) describes several principles for advocates, three of which are particularly relevant to organizational advocacy and communication: (a) Improve quality of life, (b) do not make assumptions, and (c) speak their language. The goal in organizational advocacy is the improvement of services and quality of life of clients, the discipline, and professional service partners. Psychologists need to educate administrators and management about their unique contribution and not assume leaders already know how psychology helps them meet organizational targets. Psychologists can also use leader language by understanding and linking corporate goals and pressures to their core interests. Advocacy at its best creates win–win solutions to complex problems. Thus, psychologists also need to recognize the organizational and social realities of what can be improved and ensure that their advocacy efforts fit within those realities, giving decision makers room to interpret messages so that everyone can have success ( Eisenberg & Witten, 1987 ). For example, advocating for increased assessment services might allow several solutions (hiring a psychologist, hiring a psychometrist, increased part-time/contract use, use of overtime, improved technology), whereas advocating for a new psychologist may end with no change. Being clear on the goal but vague on the solution allows effective communication to build collaborative partnerships.

Informal avenues of communication can be successful depending on the willingness of leaders to hear and act on concerns. Many psychologists, however, do not provide information in a way that is useful to leaders. At best, an informal conversation can serve to vent frustration, brainstorm ideas, or even plan in a targeted meeting. Savvy psychologists might follow up informal meetings with an e-mail to highlight issues, but these rarely rise to containing the level of information managers need to understand and become partners in advocacy efforts. Communication must become two-way, with both management and psychologists working together to meet common goals. Motivating leaders to listen can be a big challenge in organizational advocacy, especially when psychologists are not decision makers. Not listening may not be disinterest, but simply a reflection of workload demands or not truly understanding what leaders can do to facilitate change.

An easy way to support and motivate managers, especially in large organizations, is to help managers meet their goals. For example, if managers are focused on best practices and meeting externally set targets, a briefing note on the research evidence related to key practices may be welcome. If management is dealing with a professional ethical issue, such as dual relationships, then psychologists might provide a description of how they grapple with that professional issue. Another useful strategy to highlight commonalities is targeted messaging ( Fox, 2008 ). By targeting communication to specific groups, psychologists can have a greater influence. The central element of targeted messaging is to merge psychologists’ interests with the interest of the target audience, similar to lobbying in the political realm (Galer-Unti, Tappe, & Lachenmayr, 2004). For example, if a manager is working on a 3-year plan, it can be useful to provide clear easily understood information about psychology’s activities and workload projections. For example, I maintain a generic psychologist position business case that can be modified in partnership with managers to highlight why their specific service might want to add a psychologist. Communicating solutions can be a much more effective form of advocacy than simply indicating deficits ( Cohen et al., 2012 ).

By clearly identifying the discipline’s role in meeting objectives and emphasizing leadership, psychologists may counter management’s natural tendency to dismiss criticism (Tourish, 2005).  Fox (2008)  notes that accurate and current information is important in advocacy, but that targeted messages that speak to leaders’ concerns can be effective in gaining influence. Targeting efforts by directly linking psychologists’ issues to the corporate vision, mission, and core values can increase the likelihood they will be heard. One might briefly review how the issue is consistent with stated corporate values and how it diverges. Corporate values are often aspirational, so identifying areas of growth can be helpful in understanding how to progress. One might also show how proper support and use of psychologists increase the chances of meeting stated goals. By engaging leadership partners in a collaborative discussion, psychologists become allies in meeting goals and any requests are not dismissed as more demands on limited resources. Most leaders understand that they are responsible for leading the organization to live stated values.

Finally, communicating results can have an impact on the success of advocacy efforts. If the target audience ignores a detailed report, psychologists could provide a one-page briefing note. If a full business case is overwhelming, they can provide a one-page cost–benefit analysis. If leaders are uninterested in the issues important to psychology, they can ensure that reports go to colleagues or potential partners in the organization. Deciding whether a written report should be detailed or simply a brief one-page highlight depends on two interrelated elements: (a) the message and (b) the audience. If the message is clear and concise, a brief report might be best. In these cases, the hope is that those reading the report will want to follow up, giving an opportunity to provide more detail in person. Providing clear information that helps busy audiences quickly understand key points also gives structure to any future discussions. This approach also helps to “plant a seed” so that even if there is no immediate follow-up meeting, the discipline’s issues are now known. Complex issues or messages may warrant a more detailed report, allowing discussion of the conflicting issues. Although psychologists might find the issues interesting, others may not; psychologists should motivate the audience by highlighting common ground. Interested audiences are more likely to read and absorb a detailed report if it helps reach goals. Part of having an effective message is having something to say; the remainder is how it is communicated.

Psychologists should target and coordinate the message and identify the paths of least resistance so that ideas can build momentum. They should avoid making an end run around managers and ensure that sharing the information is constructive criticism not venting frustration. If a report is too critical, they should tone down those elements so that some goals are met and be realistic in what one can achieve. As  DeLeon et al. (2006)  point out, “… half a loaf really is better than none” (p. 150). Advocacy is about coordinating a message to increase its chances of being heard and then working to improve the system for clients and psychologists. If one’s voice is discounted at the outset, or the message is seen as offensive, one is unlikely to see the change one hopes to achieve.

Conclusion

Organizational advocacy offers a strategy for psychologists to develop political advocacy skills within a known environment: their own workplace. By trading on their positive professional relationships, psychologists can look at honing their communication and partnering skills to serve their clients, their discipline, and the organization as a whole. This can be especially important to psychologists who work outside a departmental model, who might struggle with raising professional service issues beyond their immediate team. One motivator to this targeted form of advocacy over political advocacy is that psychologists may enjoy immediate feedback as they see their efforts improve their daily work. A key part of communicating a targeted message is to base the message on solid data and partnering with the audience and key decision makers. Linking to corporate goals helps psychologists partner with leaders and promote the discipline while improving their workplaces and client service. If psychologists are to be seen as a core constituency in society, they must promote themselves as a core constituency within their organizations.

Footnotes

1  This article focuses on health care environments, but the arguments are equally applicable to other settings: schools, correctional facilities, businesses/organizations, and human resource departments.

References

Burney, J. P., Celeste, B. L., Johnson, J. D., Klein, N. C., Nordal, K. C., & Portnoy, S. M. (2009). Mentoring professional psychologists: Programs for career development, advocacy, and diversity. Professional Psychology: Research and Practice40, 292–298. doi:10.1037/a0015029

Cohen, K. R., Lee, C. M., & McIlwraith, R. (2012). The psychology of advocacy and the advocacy of psychology. Canadian Psychology53, 151–158.

DeLeon, P. H., Loftis, C. W., Ball, V., & Sullivan, M. J. (2006). Navigating politics, policy, and procedure: A firsthand perspective of advocacy on behalf of the profession. Professional Psychology: Research and Practice37, 146–153. doi:10.1037/0735-7028.37.2.146

Eisenberg, E. M., & Witten, M. G. (1987). Reconsidering openness in organizational communication. Academy of Management Review12, 418–426.

Fox, R. E. (2008). Advocacy: The key to the survival and growth of professional psychology. Professional Psychology: Research and Practice39, 633–637. doi:10.1037/0735-7028.39.6.633

Galer-Unti, R. A., Tappe, M. K., & Lachenmayr, S. (2004). Advocacy 101: Getting started in health education advocacy. Health Promotion Practice5, 280–288. doi:10.1177/1524839903257697

Heinowitz, A. E., Brown, K. R., Langsam, L. C., Arcidiacono, S. J., Baker, P. L., Badaan, N. H., . . .Ralph, E. (2012). Identifying perceived personal barriers to public policy advocacy within psychology. Professional Psychology: Research and Practice43, 372–378. doi:10.1037/a0029161

Jurkiewicz, C. E., Knouse, S. B., & Giacalone, R. A. (2002). Are exit interviews and surveys really worth the time and effort?Review of Public Personnel Administration22, 52–62. doi:10.1177/0734371X0202200103

Kassing, J. W. (2001). From the looks of things: Assessing perceptions of organizational dissenters. Management Communication Quarterly14, 442–470. doi:10.1177/0893318901143003

Lating, J. M., Barnett, J. E., & Hororwitz, M. (2010). Creating a culture of advocacy. In M.Kenkel & R. L.Peterson (Eds.), Competency-based education for professional psychology (pp. 201–208). Washington, DC: American Psychological Association. doi:10.1037/12068-011

Radius, S. M., Galer-Unti, R. A., & Tappe, M. K. (2009). Educating for advocacy: Recommendations for professional preparation and development based on a needs and capacity assessment of health education faculty. Health Promotion Practice10, 83–91. doi:10.1177/1524839907306407

Robertson, I., & Tinline, G. (2008). Understanding and improving psychological well-being for individual and organisational effectiveness. In A.Kinder, R.Hughs, & C. L.Cooper (Eds.), Employee wellbeing and support: A workplace resource (pp. 39–49). Hoboken, NJ: Wiley. doi:10.1002/9780470773246.ch3

Safarjan, B. (2002). A primer for advancing psychology in the public sector. American Psychologist57, 947–955. doi:10.1037/0003-066X.57.11.947

Thompson, A., Kerr, D., Dowling, J., & Wagner, L. (2011). Advocacy 201: Incorporating advocacy training in health education professional preparation programs. Health Education Journal. Advance online publication. doi:10.1177/0017896911408814

Tourish, D. (2005). Critical upward communication: Ten commandments for improving strategy and decision making. Long Range Planning38, 485–503. doi:10.1016/j.lrp.2005.05.001

Tourish, D., & Robson, P. (2006). Sensemaking and the distortion of critical upward communication in organizations. Journal of Management Studies43, 711–730. doi:10.1111/j.1467-6486.2006.00608.x

Submitted: February 1, 2012 Revised: March 1, 2013 Accepted: March 19, 2013

 

This publication is protected by US and international copyright laws and its content may not be copied without the copyright holders express written permission except for the print or download capabilities of the retrieval software used for access. This content is intended solely for the use of the individual user. Source: Professional Psychology: Research and Practice. Vol. 44. (4), Aug, 2013 pp. 187-192) Accession Number: 2013-25315-001 Digital Object Identifier: 10.1037/a0033120

 

 

 

Identifying Perceived Personal Barriers to Public Policy Advocacy Within Psychology

Contents

1. Statement of Problem

2. Method

3. Results

4. Descriptives

5. Pearson Correlations

6. Stepwise Linear Regression

7. Principal Components Analysis

8. Discussion

9. Implications

10. References

Listen

By: Amy E. Heinowitz Nova Southeastern UniversityKelly R. Brown Nova Southeastern University Leah C. Langsam Nova Southeastern University Steven J. Arcidiacono Nova Southeastern University Paige L. Baker Nova Southeastern University Nadimeh H. Badaan Nova Southeastern University Nancy I. Zlatkin Nova Southeastern University Ralph E. (Gene) Cash Nova Southeastern University

Biographical Information for Authors: Amy E. Heinowitz is currently a fourth year PhD student at Nova Southeastern University. She previously received her Master of Arts in Psychology from Adelphi University. Her areas of professional interest are in developmental psychology, attachment theory, contextual approaches to trauma resolution, substance use, and professional issues in advocacy work.

Kelly R. Brown is currently a fourth year PhD student at Nova Southeastern University, where she previously received her Master of Science in Clinical Psychology. Her areas of professional interest include advocacy advancement and stigma reduction, child and family psychology, crisis intervention, peer victimization and youth violence, and suicide prevention.

Leah C. Langsam is a fifth year PsyD student at Nova Southeastern University, where she also received her Master of Science in Clinical Psychology. Her areas of professional interest are in child and adolescent trauma, the assessment of psychopathology in youth, and professional issues in advocacy work.

Steven J. Arcidiacono is currently a fourth year PhD student at Nova Southeastern University where he also received his en route Master of Science in Psychology. His primary areas of research and practice include youth physical fitness, behavioral issues in adolescents, research methodology, and advocacy in psychology.

Paige L. Baker is currently a second year PsyD student at Nova Southeastern University. She previously received a Bachelor of Arts in Psychology and in Women & Gender Studies from Georgetown University. Her areas of professional interest include multicultural and diversity issues, military psychology, and professional issues in advocacy work.

Nadimeh H. Badaan is currently a third year PsyD student at Nova Southeastern University. She obtained her Masters of Arts in Forensic Psychology from John Jay College of Criminal Justice. Her professional interests are in forensic psychology, battered women syndrome, posttraumatic stress, child sexual abuse, and the psychology of advocacy.

Nancy I. Zlatkin is a fifth year PsyD student at Nova Southeastern University. She holds her Master of Science degree from Nova Southeastern University as well. Her professional interests include substance abuse, bullying, solution focused therapies, telehealth, and professional advocacy.

Ralph E. (Gene) Cash received his PhD in School Psychology from New York University. He is an associate professor and director of the School Psychology Assessment and Consultation clinic at Nova Southeastern University. His areas of research and practice include suicide prevention, the psychology of public advocacy, and school psychology.

Acknowledgement:

There is an urgent and growing need for professional and social justice advocacy within the psychological community (Ratts & Hutchins, 2009; Kiselica & Robinson, 2001; Ratts, D’Andrea, & Arredondo, 2004; Toporek, Gerstein, Fouad, Roysircar, & Israel, 2006). Psychology, as a field as well as a profession, aims to reduce negative treatment outcomes and to enhance personal well-being through research and practice (Council of Specialties in Professional Psychology, 2009American Psychological Association, 2010b). The viability of the profession and its capacity to provide fundamental and essential services are directly affected by legislation and regulations (Barnett, 2004). As a result, advocacy is integral to the roles of all psychologists, with the future and success of their profession and careers depending on their incorporation of advocacy into their professional identity (Burney et al., 2009). Despite the recognition and high appraisal of advocacy, little information is known about how, why, and to what degree individual professionals within the psychological arena participate in public policy advocacy.

The essential question is what does the advocacy role entail? That is the first concern that negatively influences advocacy rates—the vague, ill-defined, and at best multifaceted definition applied to this concept (Trusty & Brown, 2005). It is likely that the act of advocating is conceptualized in markedly distinct ways from one practitioner to the next and, in some cases, may even be inaccurate (Lating, Barnett, & Horowitz, 2009). Lating et al. (2009) describe advocacy as “a process of informing and assisting decision makers, [which] entails developing active ‘citizen psychologists’ who promote the interest of clients, health care systems, public health and welfare issues, and professional psychology” (p. 201). Trusty and Brown (2005) offer a streamlined summary of the various descriptions of advocacy as “identifying unmet needs and taking actions to change the circumstances that contribute to the problem or inequity” (p. 259). Regardless of definition, advocacy remains a necessary component of the psychology profession (Burney et al., 2009Fox, 2008).

Advocacy can be divided into three sectors: public policy, social justice, and professional advocacy (see Figure 1). Public policy advocacy is defined as the attempt to influence practice, policy and legislation through education, lobbying and communication with legislators and elected officials. Social justice advocacy, most broadly, involves championing for the basic human and civil rights of all people regardless of race, class, gender, or socioeconomic status. In the context of psychology, however, social justice advocacy can more aptly be understood as the recognition “that fairness and justice entitle all persons to access to and benefit from the contributions of psychology and to equal quality in the processes, procedures, and services being conducted by psychologists” (American Psychological Association Code of Ethics, 2010a). Lastly, professional advocacy is a synthesis of both public policy and social justice advocacy. Professional advocacy in the field of professional psychology demands that clinicians advocate not only for fair access to appropriate services but also for the important legislative changes necessary to enhance the quality of life of patients and at-risk populations. pro-43-4-372-fig1a.gif Figure 1. Three facets of advocacy roles for professional psychologists. Social justice advocacy entails those efforts that are aimed at facilitating the fair, beneficent, and just treatment of all individuals. Public policy advocacy addresses the more legislative and governmental efforts. Lastly, professional advocacy encompasses both social and public policy advocacy.

The literature cites several important triumphs within the field (e.g., mental health parity) that can be attributed to the efforts of diligent advocates. Perhaps one of the greatest events was the combined advocacy effort of individual psychologists working with the National Association for the Advancement of Colored People (NAACP) in response to the Brown v. Board of Education Supreme Court case in 1954 (Benjamin & Crouse, 2002). Awareness of these accomplishments is important to understanding psychology’s roots in public and social advocacy and to provide impetus for continuing advocacy efforts. However, it should be noted that a great deal more work is still necessary (DeLeon, Loftis, Ball, & Sullivan, 2006Fox, 2008). Expanding and protecting markets, maintaining funding, providing education and training, and disseminating important information to the public are just a few current initiatives requiring ongoing advocacy (Fox, 2008). Fox (2008) advised, “addressing such an agenda will require efforts far beyond the scope and magnitude of all our past efforts put together” (p. 634).

Despite the acknowledgment of advocacy as an essential responsibility for psychologists, many individuals remain uninformed and uninvolved. With regard to financial support, psychologists rank among the lowest contributors when compared with other medical professions (Pfeiffer, 2007). Furthermore, psychologists have maintained poor political representation at the national level (DeLeon et al., 2006). Of utmost concern resulting from this lack of involvement is the forfeiture of opportunities to provide input on critical issues. This, in turn, would affect the overall future of the profession as well as the future careers of individual psychologists and the well-being of clients.

Previous research has identified a number of potential barriers to public policy advocacy, which reinforces the immediate need for further research, not only to identify obstacles, but also to pave pathways of enhanced efforts. Myers and Sweeney (2004) initially introduced an exploration of obstacles to professional advocacy via a survey of 71 professionals in the counseling community in local, regional, or national leadership positions. Fifty-eight percent of respondents cited inadequate resources as their primary obstacle to advocacy. Additionally, 51% indicated there was opposition by other providers, 51% noted a lack of collaboration, and 42% suggested a lack of training was responsible for insufficient advocacy efforts. While these findings highlight important structural and fiscal challenges, it is prudent to examine the personal barriers, which may further hinder psychologists’ participation in advocacy.

Individual experiences and personality traits may impede psychologists’ participation in advocacy in significant ways. Previous literature highlights the impact of awareness (Gronholt, 2009) and professional agendas (Lating et al., 2009) on psychologists’ participation in advocacy endeavors. More specifically, Gronholt (2009) revealed that despite active participation in academia, students and faculty cited an absence of interest in advocacy and inadequate awareness of advocacy issues and opportunities as the most significant factors inhibiting participation. These findings suggest that a lack of training or education is a considerable and consistent obstacle in advocacy participation.

When assessing the impact of awareness and training upon psychologists’ underrepresentation in the advocate role, it is necessary to evaluate the perceived personal sacrifices associated with some advocacy efforts. According to Chang, Hays, and Milliken (2009) there are numerous perceived personal costs. For example, they cite burnout, job loss, and harassment from other professionals who may have the belief that client difficulties are not systemically related. Additionally, psychologists are likely to contextualize their chosen advocacy issues as either inappropriate or incongruent with their professional agenda (Chang et al., 2009; Lating et al., 2009). Similarly Benjamin and Course (2002)suggest “psychologists’ aversions to political or social pronouncements have a long history in American psychology, grounded in part in the belief that science and application are separate activities and in the long-standing prejudices held against applied work” (p. 46). In other words, some psychologists experience difficulty aligning their professional identities and values with larger, sociopolitical issues and may fear professional ramifications.

In addition to these perceived challenges, advocacy literature must articulate the personal attributes that influence effective involvement in public policy advocacy. Interestingly, an identified barrier to psychologists’ participation in advocacy relates to the nature of the person drawn to the profession. Psychologists are likely to focus their attention on the interpersonal issues that affect clients rather than considering the larger, systemic issues contributing to pathology (Chang et al., 2009; Lating et al., 2009). In fact, it may be that psychologists view advocacy on an individual-level rather than global-level. For example, fostering development of self-advocacy skills and encouraging clients to be resourceful may be a primary focus rather than becoming an advocate for the clients or the field (Waldmann & Blackwell, 2010). Perhaps this tendency precludes psychologists from identifying or promoting the need for social change.

Despite the helpful studies previously conducted on advocacy, there are distinct limitations to the current state of advocacy research. The literature related directly to advocacy within psychology is underdeveloped. There is an immediate need for research assessing perceived barriers to participation in advocacy via the development of “rigorous assessment tools to evaluate practitioner awareness, knowledge, and skills related to advocacy counseling efforts” (Green, McCollum, & Hays, 2008, p. 26). This study not only moves forward the field of research assessing perceived barriers to psychologists’ involvement in public policy, but it also suggests important implications for guiding enhancement of professional advocacy efforts and directing training programs.

Statement of Problem

Advocacy within the profession of psychology appears to be limited and in its infancy. Strikingly, research shows that other fields engage in high rates of advocacy. This study seeks to understand what the perceived barriers are to advocacy within the field of psychology. Further, it strives to elucidate whether there are differences between those who advocate specifically on behalf of psychological issues versus those who may advocate in other related domains.

Method

Participants were recruited via a mass email sent to the graduate psychology department of a private southeastern university. Those who decided to participate completed an anonymous online survey created with the purpose of understanding barriers to advocacy. The survey contained a total of 18 items that included demographic information, rates of advocacy involvement, and attitudes toward various types of advocacy efforts. Items followed a four-choice response scale measuring frequency of behavior (e.g., “I advocate for issues within my specific field of psychology”: very frequentlysomewhat frequentlyrarelynever), and belief in personal effectiveness (e.g., “I do not believe my participation will generate much of an effect”: very relevantsomewhat relevantsomewhat irrelevantvery irrelevant”). Items were chosen based off of the literature review, which identified several barriers to advocacy within the field of psychology. The portions of the survey that were used for the current analysis can be found in the online-only data supplement.

Participants ranged in age from 18 to 64 years, with most between the ages of 18 and 34. The majority of participants were students (63.5%), with the remaining sample consisting of alumni, staff, and faculty members. Of those who endorsed being a student affiliate, almost 60% were working toward a postgraduate degree (masters or doctorate).

Pearson correlations, a stepwise linear regression, and a principal components analysis were used to examine the data.

Results

Descriptives

Participants included 85 adults from the previously mentioned university. However, only 59 participants completed demographic information. The sample was predominantly composed of females (94.8%). Participants were asked to select their age via different ranges: 20.3% were between the ages of 18–24, 44% were between the ages of 25–34, 11.9% were between the ages of 35–44, 20.3% were between the ages of 45–54, and 3.4% were between the ages of 55–64. The percentages reported were rounded to the nearest tenth; as such, the valid percent equals 99.9%. The sample consisted predominately of students (91.5%) currently working toward a master’s degree (38.6%) or a doctoral degree (38.6%) in psychology or a closely related field. The remainder of the sample consisted of university faculty (3.4%), alumni (3.4%), and clinical staff (1.7%). The self-described political orientations of participants varied among very liberal (20.7%), somewhat liberal (27.6%), moderate (37.9%), somewhat conservative (12.1%), and very conservative (1.7%).

Pearson Correlations

To investigate the influence of barriers to advocacy within psychology, several statistical analyses were conducted on responses to the online survey. Pearson correlations between self-reported relevance of potential barriers and advocacy in psychology are presented in Table 1. Results indicated that those who advocate more frequently tend to believe that the relevant barriers are having a poor past experience (r = −.261, p = .048) and not believing one has enough knowledge to discuss issues competently (r = −.348, p = .007). Meanwhile, feeling as though not being aware of current public policy issues was a relative inhibitor to advocacy was significantly correlated with less advocacy (r = .404, p = .001). Additionally, significant correlations were present between several potential barriers, indicating a considerable degree of consistency among items. pro-43-4-372-tbl1a.gif Pearson Correlation Matrix Among Barriers to Advocacy Efforts and Self-Reported Public Policy Advocacy

Stepwise Linear Regression

Although some barriers to advocacy were individually correlated with advocacy participation, the overlap of variance among items can make it difficult to determine which barriers are most important in predicting advocacy. Thus, a stepwise linear regression was used to determine which predictors (i.e., barriers) work in combination with one another to predict advocacy involvement within one’s specific field of psychology most effectively. The following nine predictor variables were entered into the model: unawareness of public policy issues, lack of belief in the effect one’s participation will have on issues, lack of time, disinterest, belief that one is not persuasive enough, poor past experiences, lack of awareness of opportunities to become involved, belief that there is no need for advocacy, and belief that one does not have enough knowledge to discuss such issues competently.

After conducting a stepwise linear regression analysis, it can be concluded that the overall model significantly predicts public policy advocacy, F(1, 54) = 17.270, p < .001 (A statistical table summarizing the results is available in the online-only data supplement). Results of the stepwise linear regression procedure indicated that the only significant barrier present, after considering overlap of variance among variables, was awareness of public policy issues (r = .492, R2 = .242).

Principal Components Analysis

To investigate the constructs behind lack of advocacy within psychology, a principal components analysis (PCA) with varimax rotation was conducted. The results of these analyses are available in the online-only data supplement. Using Kaiser’s eigenvalue-greater-than-one-rule, three components were extracted from the 10 barriers. Items loaded onto each component were considered if they had a correlation (i.e., loading) of at least .4 with a given component. Given these criteria, the first component yielded could be named “disinterest,” the second component could be named “uncertainty,” and the third component could be named “unawareness.”

The three components accounted for 60% of the total variance after performing a PCA. The first component contributed 28% of the variance, the second component contributed 21%, and the third component contributed 11%. These three factors were reproduced on the Extraction Sums of Squared Loadings, indicating that only these factors had eigenvalues that were greater than or equal to one.

The first component included not having an interest in participating, not believing there is a need for advocacy, not believing that participation will generate an effect, having a poor past experience, and not wanting to give out information (termed “disinterest”). The second component included not having enough knowledge and not feeling persuasive enough (termed “uncertainty”). Finally, the third component included lack of awareness of public advocacy issues as well as opportunities to advocate (termed “unawareness”).

The results of the PCA taken in tandem with the results of the correlation and regression analysis indicate that there are three distinct components regarding barriers to advocacy (disinterest, uncertainty, and unawareness); however, the influence of several barriers (e.g., poor past experience, lack of knowledge) are subsumed under the impact of unawareness of public policy issues.

Discussion

Results indicate that those who advocate do so regardless of whether the issue lies within or outside of their specific field. More simply, those who advocate, advocate. This finding may be indicative of unique personal characteristics of those who are involved in advocacy efforts. Relative to other health professions, those drawn to professional psychology may be more interested in individual issues rather than larger sociopolitical concerns (Lating et al., 2009). In other words, psychologists may more readily advocate for individuals but advocate less for larger platforms. This advocacy pattern may be further influenced by the tendency for public policy issues to be presented in polarized views, in contrast to the tendency for psychologists to view things in shades of gray.

Results further revealed that several barriers were independently correlated with psychologists’ participation in advocacy; however, a substantial overlap of variance was also indicated. Considering poor past experiences with advocacy as a barrier was, ironically, associated with greater participation in advocacy. This suggests that negative past experiences do not deter people from advocating in the future. It is also likely that those who advocate are more apt to have negative (as well as potentially positive) experiences than those who do not advocate.

The overall regression model with nine predictor variables entered in was deemed statistically significant. The only significant barrier, however, was awareness of public policy issues. In other words, much of the predictive influence of the assessed barriers to advocacy was actually subsumed under the barrier of feeling unaware of public policy issues for which to advocate. For example, not believing one has enough knowledge to discuss issues competently inhibits public policy advocacy, but not over and above the influence of not being aware of public policy advocacy issues in the first place. These results suggest that lack of awareness of advocacy issues strongly inhibits involvement in psychology advocacy. In fact, the impact of some other speculated barriers might actually be better accounted for by this lack of awareness. For instance, psychologists or psychology students may feel as though they lack adequate knowledge to discuss public policy issues simply because they are in the dark about what the issues are.

Furthermore, areas previously assumed to be relevant barriers to advocacy, (e.g., unawareness of opportunities to become involved, lack of time) appear less important than expected. Instead of emphasizing awareness of avenues for advocacy or suggesting time-efficient opportunities, interventions should be aimed primarily at improving education with regard to current, relevant public policy concerns. Lating et al. (2009) indicated that 60% of psychology programs do not offer specific advocacy training. However, the authors note that 88% cover advocacy issues in class. This suggests that improvements in education are slowly developing and perhaps will someday result in full-fledged advocacy training as an integral part of psychology programs.

Although lack of awareness was found to be the most meaningful barrier, moderate semipartial correlations (i.e., correlations after considering the impact of other investigated barriers) suggest future studies are needed to establish the roles of variables to assess interest in participating in as well as the belief in a need for public policy advocacy. In the current study, these variables failed to meet statistical significance as predictors of advocacy; however, increased sample size in future replications may provide the power necessary to yield a significant result.

After performing a PCA, three components emerged. The three components accounted for 60% of the total variance. The first component contributed 28% of the variance (not having an interest in participating, not believing there is a need for advocacy, not believing that participation will generate an effect, having a poor past experience, and not wanting to give out information). The second component contributed 21% (not having enough knowledge and not feeling persuasive enough), and the third component contributed 11% (lack of awareness of public advocacy issues as well as opportunities to advocate).

The three components identified by the PCA (disinterest, uncertainty, and unawareness) as barriers to advocacy corroborate the findings of previous advocacy research (Myers & Sweeney, 2004; Gronholt, 2009). The first component, termed “disinterest,” included not having an interest in participating, not believing there is a need for advocacy, not believing that participation will generate an effect, having a poor past experience, and not wanting to give out information. Though this is a complex and multifaceted component, results remain consistent with previous research suggesting that advocacy is not a priority among many psychologists due to a general lack of interest (Myers & Sweeney, 2004). More explicitly, the authors found that 28% of clinicians did not view advocacy as a priority. Furthermore, 27% of clinicians reported that they did not have any interest in advocating (Myers & Sweeney, 2004). Other studies have used the lack of “motivational spark” as a synonym for the disinterest in participating experienced by professionals (London, 2010).

The second component, termed “uncertainty,” included items such as not having enough knowledge and not feeling persuasive enough. The lack of knowledge identified by our participants is likely related to a lack of training in advocacy. Myers and Sweeney (2004) established that 41% of their sample found a lack of training to be a significant barrier in advocacy work. When psychology programs fail to emphasize advocacy, students are likely to graduate without the confidence and tools necessary to advocate effectively. According to London (2010), a lack of confidence impacts motivation and the manner in which psychologists conceptualize problems and the need for change.

Finally, the third component, termed “unawareness,” included lack of awareness of public advocacy issues as well as opportunities to advocate. Again, our results corroborate the findings of Myers and Sweeney (2004) that suggest a lack of awareness of advocacy issues is a significant barrier to participation in advocacy.

There are several limitations inherent in the design of the current study. For one, the sample was drawn from one university in the southeastern region of the United States. There may be issues with generalizability to the population of the United States as a whole. Additionally, the small sample size (N= 86) may further reduce applicability to the general population of professional psychologists. As such, the results should be interpreted within the context of existing within an exploratory framework. Further research is needed to examine characteristics in more diverse samples. Furthermore, the survey used was exploratory at best. Future studies ought to expand on the current template to include questions with greater variability in responses, as well as to include additional items or perceived barriers.

Participation in advocacy within the profession of psychology is essential because public policy drives professional functioning. The future of the field and of the people served by psychologists depends on advocacy efforts. Consequently, a careful consideration of the interaction among the three components identified in our study can provide valuable insight into improving advocacy within psychology. First, advocacy must become a valued asset to the field. As previous research has indicated, nearly half of psychologists admit that advocacy is not a priority (Kindsfater, 2008). Before the other barriers to advocacy can be addressed, psychologists need to perceive advocacy as an integral part of their profession. Once advocacy is valued, the lack of preparation and awareness can be addressed through graduate training programs and continuing education courses. Ideally, the increased valuation of advocacy, combined with the necessary tools and avenues to pursue it, will ignite motivation for psychologists to take their roles as advocates seriously.

Implications

Advocacy is a major component of psychology and mental health awareness. Although no significant trait or construct differences were found between participants who advocate within or outside their own field, this study did illustrate the essential need for advocacy training. This finding is crucial because it illustrates that lack of motivation or unwillingness to advocate is not primarily responsible for preventing advocacy; rather it is a deficiency in understanding or simply being aware of relevant issues. This lack of knowledge implies that the psychological community should seek to enlighten individual members not only about advocacy procedures, how they work, and the vast benefits that can emerge, but also about specific issues. Psychology students and professional practitioners are typically unaware of how much their individual contributions can actually help. People may not spend time or money advocating if they do not believe any results will emerge from their efforts. Hence, steps should be taken to highlight positive advocacy experiences and successful policy changes.

If professional psychologists actively supported relevant issues regarding mental health, the field of psychology would advance at a faster rate. To initiate this, implementing advocacy education in continuing education classes, mandatory seminars, and yearly conferences would compel psychologists to hear the relevant issues at hand. Professional psychologists may be overwhelmed with a heavy workload and not have time to individually research and participate in public policy advocacy. However, when made aware of significant concerns related to mental health, by nature, professional psychologists will be unable to ignore them.

As for spreading the importance of advocacy among professional facilities outside of the psychological field, companies can provide in-house training to employees to increase comfort and familiarity with the advocacy process. Because there are numerous areas in which individuals are interested, education can be provided according to the relevance of each specific institution. People in general are more likely to support issues that have meaning to them. Tailoring advocacy education in this manner may not only attract a greater amount of people but may also make the understanding of advocacy more simplistic.

Furthermore, there is a lack of awareness among society about which issues are most pertinent to be advocated for. It is therefore critical to provide timely information pertaining to relevant public policy issues for which the public can advocate. Creating public advocacy groups can also help disseminate information and increase opportunities for positive experiences. Increasing layman’s confidence in advocacy can be accomplished by providing training opportunities via open workshops to create collaborative advocacy endeavors.

The findings presented in this study carry valuable implications for efforts aimed at enhancing participation in advocacy. Lating et al. (2009) suggest that the continued separation of professional and educational agendas in the training of psychologists may contribute to the profession’s deficient involvement in advocacy. Specifically, psychology is the only major health profession to maintain an academic training model despite the creation of professional training programs. The lack of advocacy training appears to contribute to the development and maintenance of barriers such as lack of awareness of and lack of perceived competence in discussing public policy issues.

Efforts to increase psychologists’ participation in public policy advocacy must begin early on and be integrated throughout their curricula. Pertinent public policy issues fit well into courses on ethics, diversity, assessment, and even intervention. Similarly, discussion about and training in the advocacy role may be reinforced through clinical training and supervision. In addition to incorporated teaching lessons, specific coursework in public policy advocacy might aid students in developing skills used to advocate, while increasing comfort, enhancing familiarity, and expanding knowledge of current issues.

References

American Psychological Association. (2010a). Ethical principles of psychologists and code of conduct (2002, Amended June 1, 2010). Retrieved from http://www.apa.org.proxy-library.ashford.edu/ethics/code/index.aspx

American Psychological Association. (2010b). Public description of clinical psychology. Retrieved from [http://www.apa.org.proxy-library.ashford.edu/Ed./graduate/specialize/clinical.aspx]

Barnett, J. E. (2004). On being a psychologist and how to save our profession. Independent Practitioner24, 45–46.

Benjamin, L. T., Jr., & Crouse, E. M. (2002). The American Psychological Association’s response to Brown v. Board of Education: The case of Kenneth B. Clark. American Psychologist57, 38–50. doi:10.1037/0003-066X.57.1.38

Burney, J. P., Celeste, B. L., Johnson, J. D., Klein, N. C., Nordal, K. C., & Portnoy, S. M. (2009). Mentoring professional psychologists: Programs for career development, advocacy, and diversity. Professional Psychology: Research and Practice40, 292–298. doi:10.1037/a0015029

Chang, C. Y., Hays, D. G., & Milliken, T. F. (2009). Addressing social justice issues in supervision: A call for client and professional advocacy. The Clinical Supervisor28, 20–35. doi:10.1080/07325220902855144

Council of Specialties in Professional Psychology. (2009). CoSPP bylaws. Retrieved from http://cospp.org/bylaws

DeLeon, P. H., Loftis, C. W., Ball, V., & Sullivan, M. J. (2006). Navigating politics, policy, and procedure: A firsthand perspective of advocacy on behalf of the profession. Professional Psychology: Research and Practice37, 146–153. doi:10.1037/0735-7028.37.2.146

Fox, R. E. (2008). Advocacy: The key to the survival and growth of professional psychology. Professional Psychology: Research and Practice39, 633–637. doi:10.1037/0735-7028.39.6.633

Green, E. J., McCollum, V. C., & Hays, D. G. (2008). Teaching advocacy counseling within a social justice framework: Implications for school counselors and educators. Journal for Social Action in Counseling and Psychology1, 14–30.

Gronholt, J. M. (2009). An exploration of the differences in psychology faculty and graduate students’ participation in mental health legislation and barriers to advocacy. Dissertation Abstracts International: Section B. Sciences and Engineering70, 2.

Kindsfater, H. C. (2008). Factors related to psychologists’ participation in professional advocacy(Unpublished dissertation). The University of South Dakota: South Dakota.

Kiselica, M. S., & Robinson, M. (2001). Bringing advocacy counseling to life: The history, issues, and human dramas of social justice work in counseling. Journal of Counseling & Development79, 387–397. doi:10.1002/j.1556-6676.2001.tb01985.x

Lating, J. M., Barnett, J. E., & Horowitz, M. (2009). Increasing advocacy awareness within professional psychology training programs: The 2005 National Council of Schools and Programs of Professional Psychology Self-Study. Training and Education in Professional Psychology3, 106–110. doi:10.1037/a0013662

London, M. (2010). Understanding social advocacy: An integrative model of motivation, strategy, and persistence in support of corporate social responsibility and social entrepreneurship. Journal of Management Development29, 224–245.

Myers, J. E., & Sweeney, T. J. (2004). Advocacy for the counseling profession: Results of a national survey. Journal of Counseling & Development82, 466–471. doi:10.1002/j.1556-6678.2004.tb00335.x

Pfeiffer, S. M. (2007). Political giving by health professions. Advance: Newsletter of the Association for the Advancement of Psychology, 12.

Ratts, M., D’Andrea, M., & Arredondo, P. (2004). Social justice counseling: “Fifth force” in field. Counseling Today, 28–30.

Ratts, M., & Hutchins, A. M. (2009). ACA advocacy competencies: A social justice advocacy at the client/student level. Journal of Counseling & Development87, 269–275. doi:10.1002/j.1556-6678.2009.tb00106.x

Toporek, R. L., Gerstein, L., Fouad, N., Roysircar, G., & Israel, T. (2006). Handbook for social justice in counseling psychology: Leadership, vision, and action. Thousand Oaks, CA: Sage Publications.

Trusty, J., & Brown, D. (2005). Advocacy competencies for professional school counselors. Professional School Counseling8, 259–265.

Waldmann, A. K., & Blackwell, T. L. (2010). Advocacy and accessibility standards in the new Code of Professional Ethics for rehabilitation counselors. Rehabilitation Counseling Bulletin53, 243–248. doi:10.1177/0034355210368866

Submitted: December 20, 2011 Revised: May 7, 2012 Accepted: May 9, 2012

 

This publication is protected by US and international copyright laws and its content may not be copied without the copyright holders express written permission except for the print or download capabilities of the retrieval software used for access. This content is intended solely for the use of the individual user. Source: Professional Psychology: Research and Practice. Vol. 43. (4), Aug, 2012 pp. 372-378) Accession Number: 2012-17525-001 Digital Object Identifier: 10.1037/a0029161

Tools

· Google Drive

· Add to folder

· Print

· E-mail

· Save

· Cite

· Export

· Create Note

· Permalink

· Share

 

powered by EBSCOhost

© 2018 EBSCO Industries, Inc. All rights reserved.

Advocacy: The Key to the Survival and Growth of Professional Psychology

Contents

1. Psychology as Health Care Profession

2. Prescription Privileges

3. Provider Restraints

4. Health Care System in Disarray

5. Diverse Patients, Diverse Providers

6. Looking Ahead

7. References

Listen

By: Ronald E. Fox The Consulting Group of HRC

Biographical Information for Authors: Ronald E. Fox received his PhD in clinical psychology from the University of North Carolina in Chapel Hill. He is executive director of The Consulting Group, a division of HRC (a multidiscipline practice in Chapel Hill, Durham, and Raleigh, North Carolina), and a clinical professor at the University of North Carolina. His areas of professional interest include professional education, practice standards, advocacy, and professional development. He is a past president of the American Psychological Association (APA) and a member of the APA Council of Representatives. Dr. Fox may be contacted by e-mail at  drronfox@nc.rr.com

The very survival of psychology as a profession may well depend on the development and implementation of a successful advocacy program. Without it, psychology is destined to remain a minor player in the nation’s heath care market. Unfortunately, psychology is poorly positioned to conduct the comprehensive, coordinated, and expensive effort that is needed.

Despite their many political successes over the past several decades, psychologists remain reluctant participants in the advocacy process ( DeLeon, Loftis, Ball, & Sullivan, 2006 ). For the present purpose, advocacy is defined as the use of political influence to advance the profession through such means as political giving, legislative lobbying, and other active participation in the political decision-making process. Psychologists’ level of giving for advocacy has not increased with their growth in numbers and remains far below that of comparable health care professions ( Pfeiffer, 2007 ). The need is manifest, the potential rewards are there for the taking, but the will to act often lies dormant.

Successfully addressing each and every one of the issues discussed in this special section of the journal are cases in point. Establishing psychology as a primary health care profession already has required a great deal of advocacy effort and even more will be needed in the future ( Wright, 2001 ). The same is true for prescriptive authority (RxP) legislation and the management of its impact on both society and the profession. Managed care and the evidence-based practice movements have brought major opportunities and threats to psychology that will require strong political advocacy to establish appropriate boundary conditions for cost and accountability measures whose unintended consequences can be disastrous. The increasing diversity of patients requires expanded skills and training for practitioners and the creation of better access to services.

Political action will be necessary to put in place the policy changes and funding opportunities needed. The future of our profession can be bright. The road to it runs directly through the social and political arenas. A brief review of some of the history and background of these issues will help clarify why the need for major advocacy mechanisms is so critical to the future development of the profession of psychology.

Psychology as Health Care Profession

Several presidents of the American Psychological Association (APA) have created initiatives to help establish psychology as a health profession (e.g., Jack Wiggins, Pat DeLeon, Norine Johnson, Ron Levant), which is very good and necessary. But much remains to be done. In order to make psychology a true health care profession providing services that are both accessible to the general public and affordable, those services will need to be reimbursable in the same manner as other health care. This requires the inclusion of psychological care in the myriad health and rehabilitation services reimbursed by public and private carriers.

Early advocacy efforts to gain recognition and reimbursement were first initiated in the 1970s by a group of activist practitioners known as the “Dirty Dozen” ( Fox, 2001 ). This group also founded psychology’s first advocacy organization outside of APA, the Council for the Advancement of the Psychological Professions and Services, or CAPPS (not to be confused with CAPP, or the Committee for the Advancement of Professional Practice, the oversight group for the APA Practice Directorate, which was established much later). These psychologist advocates also successfully pressured APA to establish a Committee on Health Insurance (COHI) and ultimately an advocacy program within APA itself, thus recognizing the legitimacy of such efforts by psychologists.

The numerous successes brought about by these early pioneers, which remain impressive over 40 years later ( Fox, 2001 ), include passage of the first “freedom of choice” legislation, ultimately enacted in numerous states, requiring insurance carriers doing business in a state to reimburse for the services of psychologists if they reimburse other providers for mental health care; convincing a major carrier for federal employees’ comprehensive health plan to cover psychological services; a class-action lawsuit forcing the U.S. Civil Service Commission to recognize psychologists as independent and reimbursable providers in their contracts; pressuring the Civilian Health and Medical Plan for the Uniformed Services (CHAMPUS) to reimburse psychologists for both outpatient and inpatient services (subsequent legislation extended the same access to beneficiaries of deceased veterans) ( Wiggins, 2001 ); passage of the 1975 Vocational Rehabilitation Act, placing mental health on a par with physical health and granting parity to psychologists for reimbursement; and the establishment of psychology’s first full-fledged doctoral program explicitly devoted to training practitioners, the California School of Professional Psychology ( Cummings, 2001 ). Many similar schools, which were subsequently established in other states, award the Doctor of Psychology (PsyD) degree. In 1976, Cummings convened the first meeting of what was to become the National Council of Schools of Professional Psychology (NCSPP), which 20 years later became the first national training council to identify “advocacy training” as a core professional value for the professional graduate curriculum.

More recent APA advocacy successes include the modification of Social Security administrative law to allow psychologists to qualify as “medical examiners,” thus legitimizing a major role of psychologists in preventing or ameliorating the disabling effects of physical illness and injury ( Wiggins, 2001 ). In 2002, advocacy led to the creation of the Graduate Psychology Education Program within the Bureau of Health Professions of the U.S. Department of Health and Human Services as the first and only federal program dedicated solely to the education and training of psychologists ( Wiggins, 2001 ). In recent years, the APA Practice Web page ( www.apapractice.org ) has announced congressional approval for the Department of Defense Graduate Psychology Education Program to address the behavioral health care needs of service members and their families; the creation of new treatment codes for psychological assessments and neuropsychological testing; and approval for payment of neurobehavioral examinations, which is an acknowledgement of the advanced training and skills of psychologists, to mention only a few examples.

As gratifying as these successes may be, much more remains to be done. Psychological care is almost unique in its ability to help patients retain, enhance, or gain their functionality throughout the health care spectrum: prevention, detection, diagnosis, treatment, and rehabilitation. To capitalize on this potential, psychology must institute a variety of efforts to cement, expand, and protect new markets. Funds for training, demonstration projects, and new treatment centers will be required in both the public and private sectors. Extensive education efforts will be needed to inform the public about the effectiveness of psychological care. Treatment and diagnostic codes must be revised, federal and state agencies must be changed, new laws enacted, and so on. Addressing such an agenda will require social and political advocacy, political giving, and coordinated public information programs far beyond the scope and magnitude of all of our past efforts put together. Without them, the health care market, which is changing rapidly, may well pass the psychology profession by.

Prescription Privileges

Prescriptive authority for psychologists has come to be viewed by many practitioners as the major vehicle for securing the profession’s role as a major health care profession. See  Fox (2003a  2006 ) for a brief review of the history of RxP efforts by psychologists. The lifting of the U.S. Food and Drug Administration’s ban on direct marketing of drugs to the public in the 1990s increased the public demand while accelerating the push for prescriptive authority by several other health professions and increasing the pressure on psychology to do the same.

APA’s Committee for the Advancement of Professional Practice (CAPP) has assumed the challenge at the national level to coordinate and assist state efforts to secure the right of appropriately trained licensed psychologists to prescribe. Impressive and persistent grass roots efforts with the assistance of grants and information sharing and education from CAPP helped advocacy efforts that successfully passed enabling legislation in New Mexico, Louisiana, and Guam. Ongoing, well-organized initiatives to pass similar legislation in a dozen other states were underway by 2007. In 1996, APA’s Council of Representatives adopted a model curriculum for RxP training as well as model licensing laws to encompass the new practice parameters. Most of the points made earlier regarding the need for advocacy in establishing psychology as a health profession obviously apply here as well.

Provider Restraints

The rapid rise in health care costs over the past half-century has taken a tremendous toll on the nation’s fiscal resources and placed U.S. businesses in an increasingly unfavorable competitive position in world markets due to the ever higher costs of employee health plans. Unable to agree on the basic changes needed in the health care system as a whole, insurers and the government have used various efforts to control costs without addressing the underlying problems in the health care system as a whole.

The most prominent, and perhaps most widespread, cost-control strategy has been the “managed care” systems devised by insurance carriers and sold to employers for their company health care plans. Through such means as reducing benefits, tightening procedures, lowering provider reimbursement, requiring second opinions, and transferring approval of claims from the providers to insurance company employees (who may or may not be health care providers), carriers succeeded in holding down and sometimes lowering health care costs in the short term. But the demand for services, the increasing availability of new and expensive procedures, and the press for ever higher profit margins for the carriers have tempered the initial claims of success, leaving patients with more barriers to care, providers with less compensation, markedly higher administration costs, and a health care system that is easily the most expensive of any nation on Earth without evidence that it is also the best. In fact, the United States now ranks last among industrialized nations on most measures of good health care (e.g., infant life expectancy;  Commonwealth Fund Commission on a High Performance Health System, 2006 ).

Managed care, higher co-pays, and provider restrictions and accountability may be useful tools to control costs when used appropriately and judiciously, but they often have been misused and abused to the detriment of patients, providers, and society. APA, along with other professional groups, patient advocates, and some states, has brought successful lawsuits to force some managed care firms to cease various egregious practices. But the fact of the matter remains that the nation’s health care system is broken and in need of a major overhaul, rather than the piecemeal tactics discussed here.

Health Care System in Disarray

A recent report by The  Commonwealth Fund Commission on a High Performance Health System, 2006 ) documents the fact that the United States ranks near the bottom on numerous health indices when compared with other wealthy nations in everything except cost. We pay far more for care and get less in return. We rank last on all measures of equity. Below-average income workers are much less likely to see a physician when sick and are more likely not to get a recommended test, treatment, or follow-up care; not to fill a prescription; and not to see a dentist when needed because of the cost.

Our wealthy citizens do not fare much better, despite seeking care early and showing better follow-through with treatment recommendations. The United States and Canada rank lowest on prompt accessibility of appointments with physicians, but Canada achieves the same rank at less than half the cost! According to the report, the U.S. system is so poorly organized that much of what would be good care is negated despite the huge amounts of money poured into health care. The U.S. health care system is technologically and organizationally backwards.

Other countries are further along in using information technology and a team approach to manage chronic conditions and coordinate care. In countries such as Germany, New Zealand, and the United Kingdom, modern information systems enable a physician to better identify and more efficiently treat and monitor chronic care patients. Physicians also are able to print out lists of the medications that all physicians have prescribed for a patient. In the United States, primary care physicians and specialists are typically poorly informed or not up to date on what other health providers are doing due to a lack of mutually accessible medical records. Records are not computerized in the United States, forcing physicians to rely on written records in a computer age. According to the report, the U.S. Department of Health and Human Services estimates that as much as 30% of U.S. health care spending (about $300 billion) is inappropriate, redundant, or unnecessary, and the U.S. Institute of Medicine estimates that 98,000 people die each year from medical errors—both of which would be significantly reduced with a nationwide, integrated, computerized patient information system.

The only area in which the United States was not ranked last was in preventive health care, although it still trailed Canada and Australia. The bottom line is that despite spending nearly $2 trillion annually, the United States consistently underperforms on most dimensions of performance related to other countries ( Commonwealth Fund Commission on a High Performance Health System, 2006 ).

The point of this rather lengthy discussion of the current state of U.S. health care is that most informed observers now seem to agree that the United States needs a new, integrated national health care system and that fundamental changes are likely. As all the forces and influence groups marshal their resources to debate the relative merits of government-based health insurance versus some form of public and private insurance, psychology must be an active participant. The profession cannot afford to watch from the sidelines as a new system is put into place and then spend the next several decades trying to modify what has been done to allow our participation as happened when Medicare was first established. Psychology must move boldly to be included from the start in whatever new system is developed if we truly intend to be a major health care profession. It will require organized advocacy on a national scale to make it happen, but it can be done.

Diverse Patients, Diverse Providers

The increasing diversity of the U.S. population requires no documentation and must be taken into account in future advocacy plans of the profession. In terms of a national strategy, it will be necessary to address the broad challenges that the changing composition of the population presents: appropriate access to services, recruitment of more minority students, and enhanced training for all providers.

Major public education efforts designed to reach specific cultural and ethnic populations will be needed to promote better, more responsible psychological care; to provide information on where and how to secure help; to reduce resistances; and to encourage psychologically healthy prevention measures. Like any other public health program, the cost of such efforts will far exceed the resources of a single profession. Public funds and support must be a significant part of the mix, but they are unlikely to be put in place unless psychologists themselves take the lead in advocating for them.

It is hard to disagree with the idea that a greater diversity of psychology practitioners will be required to meet the needs for services in the future. Some progress has been made as the results of previous advocacy efforts at both the state and federal levels to increase the number of minority psychologists through targeted scholarships and training programs. Though laudable, it seems unlikely that we will be able to train enough ethnic minority practitioners, and even if it were possible, it will be decades before enough students are recruited and trained to meet current demands. Therefore, it is clear that many current practitioners must gain the knowledge and skills required to work effectively with a diverse patient base. Obviously, major funding will be required for retooling current practitioners to deal with both current and immediate future realities. In addition, a quantum leap in funding for scholarships and demonstration projects for services targeted to minority clients will be essential.

The social need for a diverse profession with programs for a diverse population and the potential benefits to society as a whole are obvious. Once again, it is not conceivable that the commitment of the financial and human resources required will ever be put in place without the strong advocacy and leadership of the profession.

Looking Ahead

Up to now, psychology as a profession has done far too little advocacy to achieve its aim of being a major health, or even mental health, profession. Few psychologists actually participate in any form of advocacy, let alone political giving. Unfortunately, we have the poor results to show for our lack of effort ( Barnett, 2003 ).

A look at political giving as one indicator or our advocacy record provides a good measure of where we stand and how far we have to go. During the 2005 and 2006 biennium, psychology ranked 12th among 15 health care provider groups in contributions and 10th in average contribution per member per year ( Pfeiffer, 2002 ).

Of course, several professions that contribute far more total dollars than psychology also have far more members (i.e., physicians, nurses, social workers, dentists, and audiologists). The rankings according to contributions per member per year are more revealing about where we stand. At a giving rate of $5.58 per member per year, psychology ranks 10th. Podiatrists, nurse anesthetists, and optometrists rank 1st, 2nd, and 3rd, respectively, in average contributions per member and give more total contributions than psychologists despite the fact that their professions have far fewer members than psychology. Podiatry has 11,000 members, optometry 23,000, and nurse anesthetists 29,500 compared with psychology’s 40,000 special assessment payers ( Pfeiffer, 2002 ). Despite relatively small numbers, podiatrists’ total contributions were almost twice as much as psychologists and six times as much per member per year. Optometrists contributed more than twice the total contributions of psychology and more than three times as much per member per year. Nurse anesthetists, with fewer than 30,000, gave three times as much overall as psychologists and almost four times as much per member per year. Clearly, our profession has a long way to go.  Barnett (2004)  makes the case about as directly and simply as it can be made:

We work so diligently to obtain our degrees and become licensed and then risk it all when we don’t become active advocates. How else can we ensure the viability of the profession we work so hard to join?…To entrust our profession’s and our personal future to others seems foolhardy when we consider the competing needs and agendas of many of those groups…[which] are working hard to advance their own agendas… .[I]n Pennsylvania alone there are 550 lobbyists actively representing 1550 organizations. (p. 45)

In order to create the large-scale, orchestrated, and effective advocacy effort that is needed, psychology must do the following and more:

1. Develop a comprehensive database that lists all licensed psychologists in the United States, including a way to identify those who are members of APA and/or a state association. This will take time and money, but it is critical that the profession be able to quickly and easily contact and mobilize its practice base.

2. Adopt some of the lessons and methods used by successful political groups. For example, an accurate, current information base should be developed regarding the most critical professional issues for segmented portions of psychologists so that targeted messages can be crafted that speak directly to their concerns when requesting advocacy help. Psychology practice is highly diverse. The important issues are not necessarily the same for full-time and part-time providers, or for those who work in independent settings compared with those who work in institutions, or for government service workers compared with those who work in university settings, and so forth. Psychologists are not all the same. Messages that speak most directly to the specific concerns of each segment must be developed. Targeted messages have worked so well for some conservatives that they have been able to gain control of the Republican party and win both state and national elections with a membership that is an actual minority in their own party.

3. Increase psychologists’ participation in political advocacy. This will not be easy as the usual and inexpensive techniques for doing so have been tried to little avail. Only 2%–3 % of practitioners provide the total of psychology’s political contributions at the national level ( Fox, 2003b ). It is time to look to other methods for increasing participation such as more extensive and expensive personal contacts through telephone banks, frequent contacts by local colleagues, and more frequent and targeted mailings. Creating the ability to do such things on a national or even state level takes resources, organization, technical expertise, and dedicated workers. Increasing the rate of participation is the key to our success. “If all special assessment payers gave just $45 per year, just 87 cents a week, psychology could raise $1.8 million per year,…second in size only to medicine among all health care professions” ( Fox, 2003b , p. 3).

4. It is essential that the profession of psychology train and mentor our present generation of undergraduate and graduate students and create in them a culture of advocacy involvement in the profession in order to help create the next generation of psychology advocates. This involves working with educators, clinical supervisors, and others to integrate a focus on advocacy involvement as part of the professional identity of those entering the profession. We must demonstrate the importance of advocacy to students, personally involve them in our ongoing advocacy efforts, and mentor them to help preserve the viability of the future of our profession.

These goals are achievable. They do not involve methods, techniques, resources, or sacrifices beyond our ken, but they do require psychologists to shuck their complacency and act. The future of the profession and the livelihoods of its members are at stake. More important, society needs a vigorous psychology profession in the forefront of the national health care delivery system. The social need is there; psychologists have but to lead the way. But nothing will happen unless they do so. The good news and the bad news are both the same: the outcome is up to the profession.

References

Barnett, J. E. (2003). Saving our profession one psychologist at a time. The Maryland Psychologist48, 20.

Barnett, J. E. (2004). On being a psychologist and how to save our profession. The Independent Practitioner24, 45–46.

Commonwealth Fund Commission on a High Performance Health System. (2006, September). Why not the best? Results from a national scorecard on U.S. health system performance (Vol. 34). New York: Author.

Cummings, N. A. (2001). The rise of the professional school movement: Empowerment of the clinician in education and training. In R. H.Wright and N. A.Cummings (Eds.), The practice of psychology: The battle for professionalism (pp. 70–103). Phoenix, AZ: Zeig, Tucker, & Theisen.

DeLeon, P. H., Loftis, C. W., Ball, V., & Sullivan, M. J. (2006). Navigating politics, policy and procedure: A firsthand perspective of advocacy on behalf of the profession. Professional Psychology: Research and Practice37, 146–153.

Fox, R. E. (2001). Impact of the Dirty Dozen and increased practitioner professionalism on the American Psychological Association. In R. H.Wright and N. A.Cummings (Eds.), The practice of psychology: The battle for professionalism (pp. 104–115). Phoenix, AZ: Zeig, Tucker, & Theisen.

Fox, R. E. (2003a). Early efforts by psychologists to obtain prescriptive authority. In M. T.Sammons, R. F.Levant, & R. U.Paige (Eds.), Prescriptive authority for psychologists: A history and guide (pp. 33–45). Washington, DC: American Psychological Association.

Fox, R. E. (2003b, Summer) From the Desk of the Chair: The cold hard facts. Advance: Newsletter of the Association for the Advancement of Psychology, p. 3.

Fox, R. E. (2006). Training for prescriptive authority for psychologists. In T.Vaughn (Ed.), Psychology licensure and certification: What students need to know (pp. 155–164). Washington, DC: American Psychological Association.

Pfeiffer, S. (2002, Spring). Comparison of health care professions political giving performance. Advance: Newsletter of the Association for the Advancement of Psychology, p. 6.

Pfeiffer, S. M. (2007, Spring). Political giving by health professions. Advance: Newsletter of the Association for the Advancement of Psychology, p. 12.

Wiggins, J. G. (2001). A history of the reimbursement of psychological services: The education of one psychologist in the real world. In R. H.Wright and N. A.Cummings (Eds.), The practice of psychology: The battle for professionalism (pp. 215–250). Phoenix, AZ: Zeig, Tucker, & Theisen.

Wright, R. H. (2001). The rise of professionalism within American psychology and how it came to be: A brief history of the Dirty Dozen. In R. H.Wright and N. A.Cummings (Eds.), The practice of psychology: The battle for professionalism (pp. 1–69). Phoenix, AZ: Zeig, Tucker, & Theisen.

Submitted: October 4, 2007 Revised: January 17, 2008 Accepted: February 14, 2008

Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)