Health service psychology (HSP) trainees, like so many providers across the nation, faced significant challenges from the outset of the COVID-19 pandemic. But, as described in a new position paper in Clinical Psychological Science, many of those challenges for HSP trainees predate the pandemic — and will endure without systemic intervention.

"Crises like COVID-19 can reveal fault lines and tensions that are more easily obscured in times of relative stability," the authors, a cross-country cohort of twenty-three doctoral psychology residents, write.

The paper, "Systemic challenges in health service psychology internship training: A call to action from trainee stakeholders," covers long-standing issues of concern for HSP residents, such as: the ambiguity in the status of trainees, including essential versus nonessential status; training benchmarks and competencies; training aims; location and locality of trainees; the broad adoption of telehealth during 2020-2021; economic security of trainees; challenges pertaining to diversity, equity, and inclusion; and trainee roles in the decision-making and policy of training. The paper's authors also offer recommendations for systems-level changes that would advance equity and sustainability in HSP training. 

Here's what lead author Roman Palitsky, Ph.D, a postdoctoral research fellow in the Department of Psychiatry and Human Behavior, said about navigating COVID-19 as a trainee, the need for stakeholder equity for residents, and how the greater community has responded to the paper: 

Some of the paper's co-authors began working on this call to action in early 2020; were you already thinking about the challenges in HSP training, and then the pandemic struck, or did the urgency come from the exacerbation of such challenges amid the pandemic? 

I think that at first we just wanted to understand what was happening. We were all right in the middle of internship, so we were trying to understand internship and COVID at the same time. While trying to navigate COVID-related changes we were also trying to understand how to respond as interns, so we started to look into the literature on internship training. The more we delved into the situation though, the more it seemed that the issues we and other interns were facing with COVID pointed back the norms and structures of the clinical internship itself. I think that at this point "COVID as revelation" about the state of things prior to COVID has sort of become its own genre, but at the time it sort of struck us that the challenges COVID revealed for clinical internships may be as significant as the ones that it created.

Of the paper's twenty-four focused recommendations, is there one (or a grouping of recommendations) that stands out as most significant? 

To us the recommendations are all connected, and it may be that the spirit of the recommendations — the need for stakeholder equity for interns — is really the most important piece. I think one of the issues we have to contend with is the artificial separation of these topics into different domains under different purviews, for instance with financial compensation in one category and challenges to diversity in another. In reality the need for accountability, diversity, equity, strong training, responsiveness to the environment, and many other issues we discuss are intimately connected with one another.

Our final set of recommendations, Recommendations for a Trainee Stakeholder Model, focuses on cross-cutting principles underlying inequities in training, and makes suggestions for some solutions. At the heart of many of these recommendations is the need to make the different stakeholders accountable to one another, not just in principle but also in terms of resources and actions.

You and your co-authors detail ways in which programs can support trainees from diverse backgrounds. Do you think your other recommendations could improve diversity, equity, inclusion, and belonging in HSP training programs, as well? 

Absolutely. Again, all of these issues are fundamentally connected. One of the ongoing challenges in our field is to recognize this.

Are any of these recommendations already in place within the Department of Psychiatry and Human Behavior (DPHB)?  

DPHB has been remarkably responsive to COVID and, in many ways, has been exemplary. For example, for the interns who were at Brown, we found that DPHB has already been a strong proponent of competency-based training, which enabled unique training opportunities that were often flexible when they needed to be. Like many sites, Brown has embraced tele-interviews as well, and has been doing a great deal to provide telehealth training for interns as well. DPHB also has a phenomenal Diversity, Equity, Inclusion, and Belonging Committee for the training program. I have been a member for several years, as well as several of the other paper authors. This committee in particular has been exceptional at including and valuing trainees, and has consistently provided trainees with great mentorship experiences at Brown through the Diversity Mentorship program.

How has the greater trainee community responded to your pre-print?

We have been amazed at the response from the greater trainee community, and are gratified that many of our colleagues have shared that this speaks to their own experiences. That said, we have been acutely aware of how many trainees remain unrepresented in our paper. For instance, no trainees who worked in correctional facilities, or in the military, were part of our initial coalition.

There are a few initiatives happening now to bring trainee voices into the conversation. One of our co-authors, Samantha Reznik, has proposed a panel to the Association for Behavioral and Cognitive Therapies conference that focuses on lived experiences from stakeholders in different sectors of HSP training.

The larger hope here is that our call for engaged participation is embraced, that more trainees can join the conversation about training, and that their input is welcomed in a way that can lead to real impacts on training.

The paper is online now in Clinical Psychological Science. Print publication is slated for late-fall.