National responsibilities to improve training for psychological services for children, youth, and families in the 1990s.

Abstract

The purposes of this chapter are to provide a framework for the rest of this book, to present the rationale for including certain issues, and to indicate what issues will remain unfinished, to be addressed in the future. National responsibilities will be described in three domains:The National Institute of Mental Health (NIMH) and other federal agencies, The American Psychological Association (APA) and related organizations, and State and local governments, collectively, and related organizations.After describing the scope of children's psychological problems and service needs, I shall present the state and local governments' complex and changing responsibilities for services to all seriously mentally ill adults and children. Next I shall describe NIMH's support of clinical training for children's services and recommend changes that may simultaneously help to bridge the gap between the public service system and academic training programs, and to improve both clinical training and public services for the seriously mentally ill. Finally, in anticipation of many of the following chapters, I shall discuss the critical evolution of certain key issues in training for children's services, concluding with a model for training to assure adequate breadth and depth of training in the preparation of an individual clinician. The ScoDe o f Psv . choloaical Problems and Service Needs pf Children. Youth. and Families It is generally known and accepted that children, youth, and their families have enormous unserved and underserved psychological problems. From the 1969 Joint Commission on the Mental Health of Children (Joint Commission, 1969), to the 1978 President's Commission on Mental Health, to the 1986 US.Congress, Office of Technology Assessment (OTA) report, many reports have amplified the same theme: Many of the 65 million children and youth under age 18 (from 5% to 15%) have serious emotional disorders, which impair their present functioning and future potential. Just a small proportion of these children (probably from 10% to 15%) are currently receiving adequate treatment, services, or both. Although the general problem is clear, the specific data to document exactly the what, the who, and the why of the problem, are frustratingly absent. We do not have accurate data about children's psychological problems and needs. The President's Commission on Mental Health summarized the problem as follows:Because diagnostic criteria vary so widely, different surveys of general populations show that the overall prevalence of persistent, handicapping mental health problems among children aged three to fifteen ranges from 5 to 15 percent. These conditions include emotional disorders, the so-called conduct disorders, and impairments or delays in psychological development. (President's Commission on Mental Health, 1978, p. 8) Mental health diagnostic codes used with adults are usually not appropriate for children; DSM-Ill and DSM-Ill-R have failed to improve this situation (Garmezy, 1978).

Overcoming Barriers to Increase the Contribution of Clinical Psychologists to Work With Persons With Severe Mental Illness.

“…Clinical psychology training programs, at least in the United States, are not usually geared toward preparing and encouraging students to pursue careers that involve working with people with SMI. Evidence from surveys of graduate programs and internship programs indicates that very few offer a subspecialty in psychiatric rehabilitation, provide updated courses relevant to working with people with SMI, or have faculty members who specialize in this area and can influence the training or curriculum (Hoge, Stayner, & Davidson, 2000; Johnson, 1992; Millet & Schwebel, 1994; Wohlford, 1994). At the time of Millet and Schwebel's 1991 survey of APA-accredited clinical psychology training programs, it was found that roughly half of the programs graduated no students with a specialty in the treatment of people with SMI in the previous five years.…”

“…At the time of Millet and Schwebel's 1991 survey of APA-accredited clinical psychology training programs, it was found that roughly half of the programs graduated no students with a specialty in the treatment of people with SMI in the previous five years. Program directors who participated in this survey complained about the lack of faculty with specialization in this field and made comments like “few psychologists really want to work in this area.” As Wohlford (1994) noted, a substantial proportion of program directors even indicated that they would discourage students from pursuing a career in this area. Even without overt discouragement, it has been noted (Johnson, 1992) that most clinicians tend to serve clients for whom the methods with which they are familiar are appropriate, rather than adapting new practices needed to treat other populations.…”

Clinical child psychology: A practice specialty serving children, adolescents, and their families.

“…Historically and consistently, the significant mental health needs of infants, children, adolescents, and their families have not been adequately met (Masi & Cooper, 2006). Many years ago, Wohlford (1990) suggested that perhaps only 10% to 15% of children/adolescents with psychological disorders receive adequate treatment for these conditions. The situation has not significantly improved as Kataoka, Zhang, and Wells (2002) suggest that only 20% to 30% of youth who have a recognized psychological disorder receive any kind of specialized mental health care.…”

Psychologists' role in a family-centered approach to practice, training, and research with young children.

“…In a conference sponsored by the National Institute of Mental Health (NIMH) in 1988, Training in Clinical Psychology: Improving Services for Children and Adolescents With Severe Mental Disorders (Wohlford & Magrab, 1988) a number of these concerns were addressed. The need for more child-focused content in course work and practicum experiences and the importance of developmental and family issues were noted.…”