So, it’s that time that every psychologist in California looks forward to every couple of years, that time when one enjoys the distinct pleasure of paying the California Board of Psychology its annual fee of several hundred dollars ($445 this year) to…. Well, I’m not sure what they do for me every two years. But I need to do it or they don’t let me keep my license.
As a sidenote, there are only a few states (a half dozen or so, if this list is accurate) that don’t require psychologists to attend a requisite number of Continuing Education (CE) courses every year, and these are apparently Colorado, Connecticutt, Hawaii, Illinois, Michigan, New Jersey, and New York. I can imagine the reaction of many mental health consumers out there – “I will stay away from those states, they just let psychologists sit around and collect their fees and not update their skills at all!”
I’m more than sympathetic to that sentiment – any psychologist who simply gets their doctorate and doesn’t make any effort to read relevant literature, stay current, learn new techniques, etc., will eventually find themselves selling a highly inferior and arguably even dangerous product to the public (whether this is a danger that requires government force to correct for is another matter).
In California, psychologists are required to earn 36 hours of CEs every two years (70 percent of which can be earned online). These courses must be accredited by the American Psychological Association, or APA – like most other states, California’s psychologist licensing standards (in terms of ethical standards) are borrowed heavily from the APA’s Ethical Guidelines, and generally, California marches to the APAs tune, for good or ill.
So one of the positives of having a CE requirement like in California, of course, is that psychologists are then required to seek out learning experiences on a regular basis (for fear of losing their ability to practice). Hopefully, these learning experiences are relevant and useful for the psychologist in practice, and make them a better practitioner in the end.
Let’s take a look at what I’ve amassed over the past two years:
1) “The Role of Clinical Supervision in Facilitating Compassion for Self and Others” (daylong live course)
2) “Sleep in the Veteran Population” (daylong, live)
3) “Risk Management: Medical eRisk Considerations for Online Communication” (online)
4) “Ethical Principles of Psychologists and Code of Conduct” (online)
5) “Legal and Ethical Issues Related to Clinical Decision Support Systems” (online)
6) “Suicide Risk Management Training for Clinicians” (online)
7) “Cognitive Processing Therapy (CPT) Enhancement Course” (online)
8) “An Introduction to Telehealth in VA” (online)
9) “Mental Health Assessment and Interventions With Older Veterans” (daylong, live)
10) “14th Annual Updates on Dementia: Translating Research into Practice.” (daylong, live)
A few things to note about this list. Number one on the list is a required course I needed to take in order to retain my right to supervise students. Was it a particularly practical course? I honestly don’t remember much of it, but I do remember getting generally warm fuzzies at the end of it (it focused a lot on self-care and self-reflection as a tool for improving one’s supervisory capacity), but I’m not sure it necessarily made me a better supervisor. Frankly, I think getting personal therapy has made me a better supervisor more than anything (along with getting CEs specifically in geropsychology related coursework – more on that later).
The second item on the list was worthy of note – in this case, I don’t precisely recall learning anything earth-shattering from this course (it reviewed common issues related to sleep in veterans, such as optimizing adherence to C-PAP treatment in veteran populations, common sleep issues in polytrauma patients, etc.) but it was particularly useful for me given the preponderance of sleep-related issues that seem to impact my population. Although not directly related to Geropsychology, it was a valuable course for me to take, it definitely helped me to stay current in some things I need to stay current with on a day-to-day basis.
Now, let’s focus on the rest of the list. Aside from the last two items on the list (which were generally outstanding presentations on the state-of-the-art in assessment and interventions for dementia patients and older adults with psychiatric issues), let’s be honest: the rest of these CEs listed here were “filler” courses. Sure, all psychologists need to know basic risk management techniques for managing suicidality, and need to be familiar with the APA’s Ethical Guidelines (I would say I was familiar with both just fine before I took those courses). And sure, telehealth is interesting, certainly a fine subject -and I must say, I completely forgot about what “clinical decision support systems” was even about. Finally, I will not be using cognitive processing therapy in my work with veterans (this was a good online course in that it netted me 2.5 hours of CEs – most of these were 1 or 1.5 hours in length), mainly because I haven’t had supervised training in it – but I now have earned CEs in it. In short, what do most of these classes really have to do with my job? I’ll be bluntly honest – aside from the class on sleep and the two geropsychology courses, I took all of my other CEs to fulfill my 36 hour requirement with the government. I would have taken CEs on aging-related or geriatrics issues if I could. They just weren’t available.
I know what most of you are thinking. This is just where Dr. Lane is being a grumpy, cynical provider. It’s good that I keep abreast of these things, even if they don’t necessarily relate to my day-to-day duties as a Geropsychologist primarily working in long-term-care psychology. So, it’s all good, right?
Here’s where I protest. I didn’t get into this field in order to just become a psychotherapist and learn a few assessment tools and then stop right there. Clinical psychologists with a Doctor of Philosophy (PhD degree) are scientist-practitioners by trade. Whether or not they are primarily researchers, they identify with the idea that truly competent practitioners are ones who maintain a firm footing in current science, utilize the hypothetico-deductive method (hypothesis testing) in the way they frame clinical questions, and have a strong basis in current scientific thinking when they practice their craft (whether it be testing, consultation, or psychotherapy). I take that very seriously.
I also take my identify as a Geropsychologist very seriously. I typically find myself browsing Google Scholar at least once or twice a week to search out interesting basic research papers, clinical guidelines, or what have you. When I run into a difficult patient issue, I often find myself going back into the literature to make sure I remain firmly grounded in current understanding. My recent obsession was with fronto-temporal dementia (FTD), as I seemed to have a couple of patients recently with this issue that I wanted to make sure I understood properly (see this recent article for a discussion). Of course, none of this tends to reward me with any CEs.
One of my biggest grouses are that there just aren’t that many CE courses out there being offered for psychologists on geriatrics-related issues. A very brief, unscientific Google search for “geropsychology CE courses” yields a couple of interesting links: first, the APA’s own online listing of approved CE courses lists a number of topic areas and a total of just over three hundred (303) online CE courses one can take to fulfill the requirements of one’s respective state. All told, there are only 14 courses offered in “Geriatrics” (4.6% of the total). Topic areas with more courses in them include “Professional Resources for Practice,” “Psychotherapy,” “Health Psychology,” “Ethics in Psychology,” “Clinical Psychology,” and “Death, Grief, and Suicidology.”
Now, I have nothing against psychologists learning about any of these topic areas, and in fact (particularly as regards health psychology and the topic area of death and dying) many of these areas overlap with Geropsychology in terms of focus. However, let’s be frank – the population of older adults in the United States will continue to explode over the coming years, as I continually find myself saying. The “demographic tsunami” is right on top of us. And the well-documented shortage of Geropsychologists, or even general practitioners (in psychology or medicine) well trained in aging-related issues doesn’t look as if it will be getting better any time soon at this rate.
What does this matter to me? Well, perhaps not much. I consider myself much better trained in geriatrics than a sweeping majority of psychologists and mental health practitioners out there (although don’t look to me to do sandbox play therapy with your three year old – I have enough trouble raising my own children to worry about treating yours). So what if it’s harder to find quality CE courses in geropsychology for someone like me? Again, maybe it doesn’t matter much. On the other hand, I don’t think it bodes well for our (rapidly aging) future when aging-related issues don’t seem particularly well-valued. For my money, geropsychology should be the hottest topic area in CE provision out there, given the numbers.
There should be a “gold rush” on for providers to get trained in the latest and best methods for working with older adults – because by the numbers, every clinical practitioner will likely find themselves with older adult clients regularly at their doors in the near future – even those who ostensibly work with child populations (ever heard of kinship caregivers? I have).
If such a “gold rush” were ever to occur, there is at least one organization that stands to benefit. I’d like to introduce you to a relatively early-mover in the area of providing CEs for mental health providers in geriatrics: Concept Healthcare, Inc. Founded by Joe Casciani, Ph.D., the principal founder of the nursing home consulting firm, VeriCare, Concept Health bills itself as a company devoted to providing quality training to providers in mental health care services for older adults (although to be fair, I note they also manage a long-term-care psychology group practice as well). While this firm definitely looks promising and knowing Dr. Casciani, they likely offer quality products and services – I note that I do not have access to any of their products as a VA employee (although I could, theoretically, pay for some of their classes myself).
Soapbox rant over. Hopefully I’ll return to more interesting clinical issues in the next week or so.