The purpose of this article is to explore structural competency as a framework for training in counseling psychology. Structural competency as a guiding paradigm can be an important component of counseling practice that is informed by an understanding of the effects of oppression and structural-level disparities on the psychological well-being of marginalized groups and individuals. We outline a set of training principles that can inform the development of socially responsive curricula in counseling psychology programs. These principles are derived from the need for an emancipatory, liberatory stance among newly trained practitioners and from the need for counseling psychologists to engage in anti-oppression advocacy. We argue that part of this advocacy must involve partnering with clients to counteract the over-reliance on de-contextualized treatments that ignore the role that individual and collective agency can play in bringing about positive psychological change.

In this article, we describe ethical tensions we have faced in the context of our work as intervention scientists, where we aim to promote social justice and change systems that impact girls involved in the juvenile legal system. These ethical tensions are, at their core, about resisting collusion with systems of control while simultaneously collaborating with them. Over the course of designing and implementing a randomized controlled trial (RCT) of an ecological advocacy intervention for girls, called ROSES, ethical paradoxes crystalized and prompted us to engage in critical reflection and action toward the aim of moving away from conducting research on legal-system-involved girls and moving toward a more democratic, participatory process of inquiry with girls. Our experience revealed two intertwined paradoxes that ultimately served generative purposes. First, in collaborating with legal system stakeholders, we observed a single story of girls' pathology narrated for girls, without girls, and ultimately internalized by girls. Second, in reflecting critically on the ethical implications of our study design, it became clear that the design was grounded in a medical model of inquiry although the intervention we sought to evaluate was based, in part, on resistance to the medical model. We describe emergent ethical tensions and the solutions we sought, which center on creating counternarratives and counterspaces that leverage, extend, and disrupt our existing RCT. We detail these solutions, focusing on how we restructured our research team to enhance structural competence, shifted the subject of inquiry to include the systems in which youth are embedded, and created new opportunities for former research participants to become co-researchers through formal roles on an advisory board.

Although recent years have seen an increase in attention paid to social justice concerns by psychologists, challenges remain in fulfilling the promise of psychology as a discipline that can meaningfully undertake social action. These challenges arise largely due to some persistent contradictions between the typical goals of psychological practice and the tenets of social change. These contradictions include (a) the emphasis of psychological practice on individual and small group change versus the need for social justice endeavors to tackle widespread inequality and oppression; (b) the greater likelihood of psychologists to advocate for clients by helping them to navigate existing systems versus advocating by challenging and dismantling these systems; and (c) aligning ourselves as practitioners, educators, and scientists within oppressive structures versus acknowledging the ways that we uphold, perpetuate, and benefit from such structures. In this article, we argue that the structural competency paradigm can provide a guiding framework for training and practice in psychology that aims to reconcile these tensions. We use the illustrative case of a low-income, minority client struggling with mental health problems, disabilities, and housing instability to demonstrate the complexities of the challenges confronting social justice−minded practitioners and to explore how a structurally competent stance can inform efforts to achieve social change while retaining psychology’s investment in positive person-level transformation.

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Background Despite an established taxonomy of implementation strategies, minimal guidance exists for how to select and tailor strategies to specific practices and contexts. We employed a replicable method to obtain stakeholder perceptions of the most feasible and important implementation strategies to increase mental health providers’ use of measurement-based care (MBC) in schools. MBC is the routine use of patient-reported progress measures throughout treatment to inform patient-centered, data-driven treatment adjustments. Methods A national sample of 52 school mental health providers and researchers completed two rounds of modified Delphi surveys to rate the relevance, importance, and feasibility of 33 implementation strategies identified for school settings. Strategies were reduced and definitions refined using a multimethod approach. Final importance and feasibility ratings were plotted on “go-zone” graphs and compared across providers and researchers to identify top-rated strategies. Results The initial 33 strategies were rated as “relevant” or “relevant with changes” to MBC in schools. Importance and feasibility ratings were high overall for both survey rounds; on a scale of 1 to 5, importance ratings (3.61–4.48) were higher than feasibility ratings (2.55–4.06) on average. Survey 1 responses resulted in a reduced, refined set of 21 strategies, and six were rated most important and feasible on Survey 2: (1) assess for readiness and identify barriers and facilitators; (2) identify and prepare champions; (3) develop a usable implementation plan; (4) offer a provider-informed menu of free, brief measures; (5) develop and provide access to training materials; and (6) make implementation easier by removing burdensome documentation tasks. Provider and researcher ratings were not significantly different, with a few exceptions: providers reported higher feasibility and importance of removing burdensome paperwork than researchers, providers reported higher feasibility of train-the trainer approaches than researchers, and researchers reported higher importance of monitoring fidelity than providers. Conclusions The education sector is the most common setting for child and adolescent mental health service delivery in the USA. Effective MBC implementation in schools has the potential to elevate the quality of care received by many children, adolescents, and their families. This empirically derived, targeted list of six implementation strategies offers potential efficiencies for future testing of MBC implementation in schools.