The challenges observed in health-service-psychology (HSP) training during COVID-19 revealed systemic and philosophical issues that preexisted the pandemic but became more visible during the global health crisis. In a position article written by 23 trainees across different sites and training specializations, we use lessons learned from COVID-19 as a touchstone for a call to action in HSP training. Historically, trainee voices have been conspicuously absent from literature about clinical training. We describe long-standing dilemmas in HSP training that were exacerbated by the pandemic and will continue to require resolution after the pandemic has subsided. We make recommendations for systems-level changes that would advance equity and sustainability in HSP training. This article advances the conversation about HSP training by including the perspective of trainees as essential stakeholders.

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Prolonged exposure to socioeconomic hardship (SH) is associated with greater delayed reward discounting (DRD), a form of impulsive decision-making that reflects a reduced capacity to delay gratification and a significant correlate of diverse risk behaviors, but the neurobehavioral mechanisms linking SH and DRD are unknown. An emerging hypothesis suggests that cognitive and affective stress associated with poverty may tax neurocognitive functions, such as working memory (WM), and lead to impulsive DRD. Furthermore, research suggests that emotional reactivity (ER) is an important dispositional factor to consider in the link between executive functions and DRD. Thus, we longitudinally examined the indirect effect of SH on impulsive DRD via a network of brain regions associated with WM function in a sample of young adults, and whether that link was moderated by ER. Participants were 119 rural African Americans (aged 19-24 years) assessed behaviorally on four occasions, with fMRI at the last time point. Results showed that, among emerging adults with higher ER, SH severity was predictive of increased DRD via reduced response in brain regions activated during an n-back WM task. These findings reveal both the cognitive and affective mechanisms that underlie the relationship between SH and DRD.

The stressors associated with poverty increase the risks for externalizing psychopathology; however, specific patterns of neurobiology and higher self‐regulation may buffer against these effects. This study leveraged a randomized control trial, aimed at increasing self‐regulation at ~11 years of age. As adults, these same individuals completed functional MRI scanning ( M age = 24.88 years; intervention n = 44; control n = 49). Functional connectivity between the hippocampus and ventromedial prefrontal cortex was examined in relation to the intervention, gains in self‐regulation, and present‐day externalizing symptoms. Increased connectivity between these brain areas was noted in the intervention group compared to controls. Furthermore, individual gains in self‐regulation, instilled by the intervention, statistically explained this brain difference. These results begin to connect neurobiological and psychosocial markers of risk and resiliency.

Child maltreatment is associated with a variety of risk behaviors in young adulthood; however, the underlying cognitive and neural mechanisms of this relation are not well understood. The primary aim of the present study was to examine the direct and indirect effects between maltreatment in childhood and downstream impulsivity via neural activity during a cognitive task. In a sample of emerging adult women from the rural southeastern United States, childhood abuse and neglect were assessed using the childhood trauma questionnaire. Outcome measures of neural activity during a functional magnetic resonance imaging N-back verbal working memory (WM) task and trait impulsivity on the Impulsive Behavior Scale were assessed approximately 1 year later. Results indicate that adults with higher levels of reported childhood maltreatment demonstrate worse behavioral performance and lower neural response during a difficult verbal WM task. Furthermore, neural activity significantly mediated the relation between abuse and neglect in childhood and trait impulsivity. These new findings demonstrate an association between neurocognitive functioning and reported childhood abuse and neglect, and indicate that such changes may underlie the relation between maltreatment and trait-level impulsivity.