Symposium:Div. 17 Special Section -

Health Psychology

“Preparing Students for New Roles in Integrated Health: The Evolving Interface

of Counseling and Health Psychology”

Participants

1. Chair: Brian L. Lewis, Ph.D. – Salem VA Medical Center

2. Donald R. Nicolas, Ph.D. - Ball State University

3. Annette Kluck, Ph.D. & Daniel Stabin, M.A.- Auburn University

4. Sarah Hastings, Ph.D. & Tracy Jay Cohn, Ph.D.- Radford University

5. Mary Ann Hoffman, Ph.D. - University of Maryland

Recent Health Care Developments and their Implications for Training in

Counseling PsychologyDonald R. Nicholas, PhD

Dept. of Counseling PsychologyBall State University

Change is under way and on the way. . . . .

health care reform (ACA) accountability for effective (evidence-based) & cost efficient care change in health

care delivery systems (PCMHs, ACOs) credentialing/privileging to identify highest quality

providers change in education/training health service psychology, competency movement, accreditation

(program, internship, postdoc) and board certification (ABPP) specialty recognition taxonomy of terms

the confusing terminology of change

health service psychologymedical home

PCMHsemphasis

ACAinterprofessional

competenceintegrative caretaxonomyACOsexposureexperiencemajor area of study

Health Service PsychologyHealth Service Psychology

Education Collaborative (HSPEC)Given that professional psychology includes diverse areas of practice

and the mounting concerns about psychology’s role in areformed health care system, HSPEC chose to focus on

preparation of psychologists for the delivery of health careservices and made seven recommendations that constitute

the core of a blueprint for the future.(HSPEC, 2013)

Why the change? --- Health Care Reform

Affordable Care Act (ACA)

• Economist Jonathan Gruber - brief explanation– http://www.youtube.com/watch?v=IF8SiN8Bbh0

Some Implications for Counseling Psychology

Affordable Care = Accountable Care • Accountability in health care– effective (evidence-based) and cost efficient care

• To do so will effect psychologists– settings & forms of practice– processes of credentialing & privileging– education and training

ACA & implications for practice settings

Patient Protection and Affordable Care Act (ACA; Public Law No: 111-148, Mar 23, 2010:),

… will continue to focus on the growing expectation that interprofessional healthcare organizations (that is, patient center healthcare homes & accountable care organizations) will become the nexus of the delivery of efficient, cost effective, and quality healthcare services. (Rozensky, 2014, APA Convention, Hawaii)

Interprofessional health care delivery organizations

• Patient Centered Healthcare (Medical) Home– proposed since 1967 by American Academy of Pediatrics

Accepted 1990s – A model of care in which “patients have a direct relationship

with a provider who coordinates a cooperative team of healthcare professionals, takes collective responsibility for the care provided and arranges opportunities for other qualified professionals as needed… • Interprofessional Collaboration

Interprofessional Collaboration

• “Interprofessionalism involves the development of competencies across disciplines and the application of those shared competencies in an integrated, team based health care system….

• Rozensky & Janicke, 2011

IPEC

Interprofessional Collaborative Practice

• “When multiple health workers from different professional backgrounds work together with patients, families, carers [sic], and communities to deliver the highest quality of care” (WHO, 2010)

Interprofessional team based care

• Care delivered by intentionally created, usually relatively small work groups in health care, who are recognized by others as well as by themselves as having a collective identity and shared responsibility for a patient or group of patients, e.g., rapid response team, palliative care team, primary care team, operating room team (IPEC, 2011).

ACA and Diversity

• IOM identified INSURANCE as key factor for quality of health / health disparities – Uninsured….. – 1 out of 3 Hispanics/ Latinos and American Indians – 1 out of 5 African Americans – 1 out of 8 White Americans

Dr. Garden Grant/ Minority Health 2012

Practice of Health Service Psychology

• In this era of health care reform (ACA), with its focus on accountability, evidence-based and cost-efficient practice, health service psychologists (counseling, clinical, school) will practice in settings where interprofessional collaboration is essential/expected.

• How does one become a member of an interprofessional team?

Credentialing and Privileging

• Health care providers do not just walk into an

organized healthcare facility and just see their patients. They must have permission to see patients as members of the professional staff (Stromberg et al., 1988, p 329)

Credentialing

• Defined as the process of obtaining, verifying and assessing the qualifications of a health care practitioner to provide patient care services in or for a health care organization.

• Credentialing of professional staff assures that systems of care only include the highest qualified providers as part of their system of care

Credentialing and Training

• That is, credentialing will require graduation from accredited education and training programs which suggests that providers have met (at least minimal) defined standards of training (Rozensky, 2011).

• increasing expectation of specialty board certification — already routine expectations of hospital-based healthcare providers on the “professional staff” (Rozensky, 2012). – American Board of Professional Psychology (ABPP)

Privileging

• Defined as the process whereby a specific scope and content of patient care services (i.e., clinical privileges) are authorized for a health care practitioner by a health care organization, based on evaluation of the credentials and performance

• practice organizations regularly and routinely require evidence of competence to maintain clinical privileges – re-credentialed every xxx years

Education & Training

• (HSPEC) Blueprint– 7 recommendations

• Multiple competencies– Counseling Psychology– Psychology Practice in Primary Care– Patient Centered Medical Home– Interprofessional/integrative/collaborative care

• APAs Specialties Taxonomy

HSPEC 7 issues addressed:

1: The competencies . . . should be clearly articulated and understood by all . . 2: There should be guidelines for minimal qualifications to enter doctoral programs . . . 3: Psychology needs to articulate and evaluate the competencies for each level in the sequence of education and training . . .4: There needs to be increased focus on competency assessment in health service psychology education and training . . .5: The future of health service psychology rests on the integration of science and practice.6: Psychology needs to establish the standard of self-regulation for education and training in the profession.7: Psychology needs more research relevant to the preparation and roles of health service psychologists and must have . . . workforce analysis.

Multiple Competencies: Resources

– http://www.apa.org/ed/graduate/competency.aspx

• A Practical Guidebook for the Competency Benchmarks (July 2012) New guidebook that provides practical information on implementing a competency-based approach to education and training

• Final Report of the APA Task Force on the Assessment of Competence in Professional Psychology, October 2006

• Revised Competency Benchmarks for Professional Psychology (June 2011) (DOC, 239KB)

Competencies Resources

• Counseling psychology competencies rationale statement. CCPTP website.• Overview of counseling psychology competencies and essential

components. CCPTP website.• Counseling psychology core competencies, essential components,

behavioral anchors and examples. CCPTP website• Competencies for Psychology Practice in Primary Care Report of the

Interorganizational Work Group on Competencies for Primary Care Psychology Practice, APA, March 2013.

What is a specialty? truth in advertising &

the need for a taxonomy• If specialties are becoming essential and

PCMHs and ACOs are going to be credentialing and privileging providers, consistency in terminology is needed.

• The CRSPPP Taxonomy

Commission for the Recognition of Specialties in Professional

psychology (CRSPPP) Taxonomy

13 APA Recognized Specialties in Health Service Psychology

• Behavioral and Cognitive• Clinical Child• Counseling• Clinical Neuropsychology• Clinical Health• Clinical• Forensic

• Family• Psychoanalysis• School• Prof. Geropsychology• Police and Public Safety• Sleep

so what am I getting in my doctoral program?

• Specialty in Counseling Psychology with a _________________ in _________________– major area of study ----- 2-3 yrs didactics and a dissertation or research project – emphasis ----- at least 4 courses and 2 practica– experience ----- at least 1-2 courses and 1 practicum– exposure ----- at least 1-2 courses

– anything else is a focus– only applicable to the 13 recognized specialties

References

• Rozensky, Ronald H. (2011). The institution of the institutional practice of psychology: Health care reform and psychology's future workforce. American Psychologist, 66(8), 797-808. doi: 10.1037/a0025074

• Rozensky, Ronald H., Celano, Marianne, & Kaslow, Nadine. (2013). Implications of the Affordable Care Act for the practice of family psychology. Couple and Family Psychology: Research and Practice, 2(3), 163-178. doi: 10.1037/cfp0000009

• Rozensky, Ronald H., Grus, Catherine L., Belar, Cynthia D., Nelson, Paul D., & Kohout, Jessica L. (2007). Using workforce analysis to answer questions related to the internship imbalance and career pipeline in professional psychology. Training and Education in Professional Psychology, 1(4), 238-248. doi: 10.1037/1931-3918.1.4.238

• Rozensky, Ronald H., & Janicke, David M. (2012). Commentary: Healthcare reform and psychology's workforce: Preparing for the future of pediatric psychology. Journal of Pediatric Psychology, 37(4), 359-368. doi: 10.1093/jpepsy/jsr111

References

• Interprofessional Education Collaborative Expert Panel. (2011). Core competencies for interprofessional collaborative practice: Report of an expert panel. Washington, D.C.: Interprofessional Education Collaborative.

• American Psychological Association. (2012). Education and training guidelines: A taxonomy for education and training in professional psychology health service specialties. Retrieved from http://www.apa.org/ed/graduate/specialize/taxonomy.pdf

• Rodolfa, Emil, Bent, Russ, Eisman, Elena, Nelson, Paul, Rehm, Lynn, & Ritchie, Pierre. (2005). A Cube Model for Competency Development: Implications for Psychology Educators and Regulators. Professional Psychology: Research and Practice, 36(4), 347-354.

• Rozensky, Ronald H. (2012). Health care reform: Preparing the psychology workforce. Journal of Clinical Psychology in Medical Settings, 19(1), 5-11. doi: 10.1007/s10880-011-9287-7

References

• Beacham, Abbie O., Kinman, Carissa, Harris, Josette G., & Masters, Kevin S. (2012). The patient-centered medical home: Unprecedented workforce growth potential for professional psychology. Professional Psychology: Research and Practice, 43(1), 17-23. doi: 10.1037/a0025320

• Hatcher, Robert L., Fouad, Nadya A., Campbell, Linda F., McCutcheon, Stephen R., Grus, Catherine L., & Leahy, Kerry L. (2013). Competency-based education for professional psychology: Moving from concept to practice. Training and Education in Professional Psychology, 7(4), 225-234. doi: 10.1037/a0033765

• Nash, Justin M., Khatri, Parinda, Cubic, Barbara A., & Baird, Macaran A. (2013). Essential competencies for psychologists in patient centered medical homes. Professional Psychology: Research and Practice, 44(5), 331-342. doi: 10.1037/a0033106

• Nicholas, Donald R., & Stern, Marilyn. (2011). Counseling psychology in clinical health psychology: The impact of specialty perspective. Professional Psychology: Research and Practice, 42(4), 331-337. doi: 10.1037/a0024197

• Schaffer, Jack B., Rodolfa, Emil R., Hatcher, Robert L., & Fouad, Nadya A. (2013). Professional psychology competency initiatives: Reflections, contrasts, and recommendations for the next steps. Training and Education in Professional Psychology, 7(2), 92-98. doi: 10.1037/a0032038

Health Psychology in Counseling Psychology

Academic Training Programs:

What Are Faculty and Trainees Doing?Annette S. Kluck, Ph.D.

Daniel Stabin, M.A.Auburn University

Counseling Health Psychology

Recent push in APA focuses on Health Service Psychologists– APA recognizes that Counseling Psychologists can contribute

to health services beyond mental health (APA, 1996, 2011)– APA’s public definition of counseling psychologists lists

among the problems we treat: helping people adapt to physical disabilities, diseases, or injury (APA, 2013)

– Division 17 definition includes attention paid to health-related concerns (SCP, 2014)

What Happens in Our Programs?

This should translate to the practice of health psychology activities among counseling psychology students and the faculty that train themExisting research documents general trends of an interest in counseling psychology among students and facultyThere appear to be a subset of counseling psychology division members who also hold membership in the health psychology division (Nicholas & Stern, 2011)Core areas of competence for counseling health psychologists can be identified (Nicholas & Stern, 2011)We sought to examine how this relates to the future of the field and current program activity

Survey of Programs

Based on study by Raque-Bogdan, Torrey, Lewis, & Borges (2012), we can generally assume the following about Counseling Psychology programs

Less than a fifth of programs were particularly known for subspecialty in health psychology or primary careOver half have no formal specialty track/concentration/minorIn most programs that lack formal training, it would be somewhat difficult to impossible to offer formal coursework in health psychologyTraining directors indicated that there is some interest in health psychology among studentsMajority of programs with students interested in health psychology have one or no faculty members with expertise

Faculty Job Openings

Reviewed classified ads from the Monitor on Psychology from May 2011 to March 2014– Imperfect data source

• Not all programs advertise in the magazine• Same job advertised across multiple issues• Programs do not always list everything they are

considering or wanting• Programs may not list the exact number of positions• Program alignment is no always clear in ads

Faculty Job Openings

Who is in the data?– We included new programs known to be seeking

accreditation and participation in CCPTP– We did not include ads that suggested the

position was for another program in the department

– We included ads for positions in departments with counseling psychology programs• Department head positions• Open lines to contribute to any program

Faculty Job Openings

Who are we trying to hire in APA-accredited programs– 39 advertised positions– 8 explicitly mentioned interest in filling position with

someone with health psychology focus – 10 of the 39 were for admin (head/dean) slots– Translates to 20.5% of positions– Relative to current proportion of faculty with health

psychology expertise, there is a trend to advertise for health psychology expertise among non-administrative faculty lines

Counseling Psychology Faculty Grants

Examined grants held by counseling psychology faculty reported in the Insider’s guide to graduate programs in clinical and counseling psychology: 2012/2013 edition (Norcross & Sayette, 2013)– A source that can be used for recruiting– Applicants may review to find faculty research interests

and programs that match what they desire– Training directors were given opportunity to update the

data to reflect current program activity

Counseling Psychology Faculty Grants

– 51 total grants at 28 counseling psychology programs– 26 grants listed as explicitly focused on health– 8 others might have a health focus – 16 of the 28 programs had a least 1 grant explicitly linked

to health psychology– Based on proportion of faculty with health psych expertise

(Raque-Bogdan et al., 2012), significantly greater portion of grants have health psych focus (p < .001)

Counseling Psychology Student Interests

Based on existing research (Raque-Bogdan et al., 2012), – Most programs have at least some students who are at

least somewhat interested in health psychology– Over half of programs have at least some opportunity

for practicum training in a health psychology setting– A minority of graduates go on to a health psychology

position after completion of their degree

Internship Activities

We know that there were 407 counseling psychology doctoral students who matched during phases 1 and 2 to APPIC sites. Not all are from APA-accredited programs– Contacted only training directors of APA accredited

counseling psychology programs– 377 from PhD– 40 from PsyD– 45 respondents (11% response rate)

Internship Activities

What settings are they training in for their primary setting?

• 69.2% at college counseling centers• 2.8% at jail/prison/correctional facilities • 8.1% at medical hospital/centers• 2.8% at medical schools• 22.2% at VAs

Internship Activities

Activities while on internship For comparison purposes• 100% have had experience thus far providing individual therapy • 100% have or will have experience providing brief therapy• 78% have or will have experience providing assessment• 95.1% have or will have experience providing group therapy• 78% have or will have experience providing long-term therapy• 82.1% have or will have experience providing supervision• 86.8% have or will have experience with serious mental illness• 100% have had experience with anxiety, PTSD/trauma, and mood disorders• 65.8% have or will have vocational/career experience• 94.9% have or will have multicultural therapy experience• 30.8% have had experience with the modality of health psychology

Internship Activities

Activities while on internship Within areas of health psychology• 22% have or will have primary care experience• 28.9% have or will have integrative health care experience• 27.0% have or will have experience with integrative health care within a

specialty• 5.1% have had oncology experience• 15.4% have or will have HIV/AIDS experience• 33.3% have or will have pain management experience• 34.2% have or will have chronic/terminal illness experience• 51.5% have or will have eating disorder/weight management experience• 23.7% have or will have neuropsychology experience with adults

Internship Activities

Identity evidenced by membership of pre-doctoral interns– Comparing to the Nicholas & Stern (2011) data for professionals

– Members by division• 63.2% are 17• 2.9% are 12• 5.7% are 22• 11.1% are 38• 2.9% are 40• All respondents who indicated membership in 38 also indicated

membership in 17

So where are we?

Appears to be an interest in faculty with health psychology expertise when new lines are advertised in the Monitor on PsychologyWhen counseling psychology faculty get grants, they tend to get grants in an area of health psychology About 1/3rd of counseling psychology students obtain experience in the modality of health psychology while on internshipSupports need to provide students with training even if they are unlikely to go onto health psychology careers because internships involve work in health psychology specialties

References

• American Psychological Association [APA]. (2011). Model act for state licensure of psychologists. American Psychologist, 66, 214-226.

• American Psychological Association [APA]. (2013). Public description of counseling psychology. Retrieved September 20, 2013 from http://www.apa.org/ed/graduate/specialize/counseling.aspx

• American Psychological Association [APA]. (1996). Recognition of health service providers.Approved Council Resolution. C.(17). Retrieved February 6, 2014 from http://www.apa.org/about/policy/chapter-10.aspx#recognition-service

• Nicholas, D. R., & Stern, M. (2011). Counseling psychology in clinical health psychology: The impact of specialty perspective. Professional Psychology: Research & Practice, 42, 331-337.

• Raque-Bogdan, T., L., Torrey, C. L., Lewis, B. L., & Borges, N. J. (2012). Counseling health psychology: Assessing health psychology training within counseling psychology doctoral programs. The Counseling Psychologist, 41, 428-452.

• Society for Counseling Psychology [SCP}. (2014). What is counseling psychology? Retrieved March 10, 2014 from http://www.div17.org/about/what-is-counseling-psychology/

Integrated Care TrainingNew River Valley Free ClinicA Collaboration Between Radford

University and the NRV Free Clinics Christiansburg and Giles, VASarah Hastings, Ph.D. & Tracy Jay Cohn, Ph.D.

RU Doctoral Program History

• First admissions in 2008• Accredited in 2012• Graduated 2 cohorts• Emphases

Clinic History

• 33 year old clinic• Established as Free Clinic

– Consists of two clinics in medically underserved areas• HPSA Scores are developed for use by the National Health Service Corps in determining priorities for

assignment of clinicians. Scores range from 1 to 25 for primary care and mental health, 1 to 26 for dental.

– Montgomery Co, VA: Medical = 18/10– Mental Health = 19/15

– The mission of the Free Clinic of the New River Valley/Community Health Center: is to provide affordable and high quality medical, dental, behavioral and preventive health services to people of all ages and circumstances, regardless of ability to pay or insurance status.

– In Fall of 2013, the Free Clinic received funding to become a Federally Qualified Health Center

Models of Care

Models of Care

Models of Care

Practicum Positions

• Two positions in rural Giles County clinic• Two positions in Christiansburg clinic• One behavioral health position, Christiansburg

Involved Staff and Faculty

Clinic Staff: Brittany Hall, M.S., Integrated Treatment Care Coordinator

RU Faculty: Valerie Leake, Ph.D., Associate Professor, RU,

Practicum CoordinatorTracy J. Cohn, Ph.D., Associate Professor, RU, Clinic

Board Member

Referral Procedure New patient or patient returning for PC appointment (who has not been screened using QPD

[Quick Psycho Diagnostics panel] in past 6 months) enters building. Patient checks in at front desk. Patient waits until called to exam room by nurse.

Patient called to exam room: Nurse records vitals, blood pressure, current medications, and reason for visit. Nurse administers QPD panel (assisting as necessary). QPD is scored by nursing staff and report is added to medical record under mental health tab.

QPD Positive Result: Care Coordinator is notified. Care Coordinator, on-site

behavioral health volunteer or advanced student enters the exam room before or after PCP/NP, depending on patient and practitioner flow, to see patient.

Brief, psychoeducational-based intervention is conducted; follow-up appointment is made for a thorough BH intake.

QPD Negative Result: Patient resumes traditional medical

appointment. Re-Screen for behavioral health concerns

at next PC appointment within 6 months. If patient presents with BH concern, follow

procedure for positive result.

Referral ProcedureBH Condition Severity is Assessed: Patient returns for 50-minute appointment with Psych NP or Care

Coordinator. Psych NP or Care Coordinator conducts BH assessment; determines if

patient has sufficient BH and PC issues to refer to Collaborative Care Team.

If patient is NOT appropriate for Collaborative Care Team: BH provider

sees patient as necessary or PsyNP sees patient only during medical appointments for brief, psycho-educational interventions.

If BH condition worsens (as indicated on subsequent QPD or via patient report), severity is re-assessed.

If patient IS appropriate for Collaborative Care Team: PCP or BH provider or Psych NP informs Care Coordinator, who arranges for case

to be reviewed by Team, and sets date. Team reviews case as a group, and Integrated Treatment Plan is

developed/approved. Patient is assigned a BH counselor (if patient does not already have one) and

referred to other specialists as necessary. Patient or patient case is seen/reviewed by Consulting Psychiatrist, as appropriate. Care Coordinator reviews plan at least monthly, or as health and/or circumstances

change. Care Coordinator communicates with patient and facilitates patient attending all

BH and PC appointments, which are coordinated to the extent possible. Patient may “graduate” from Team care as determined by Team or patient. Patient may re-enter Team care if BH conditions worsens.

Outcome Measures

• QPD– Overview of QPD– Psychometrics– Alternatives

• Administration protocol• Time A “Intake”• As close to the marked time but not before:

– Time B: After 1 month but not before– Time C: After 3 months but not before – Time D: After 6 months but not before– Time E: After 12 months but not before – Time FinalX: the exit assessment.

• Existing clients who were already receiving IC (BH and PC) were administered the QPD and this became their Time A.

Challenges/Future Directions

• Supervision• Funding• Space• Distance• Benefits to clinic• Benefits to students• Looking ahead

Developing a Health Psychology Research Focus in Counseling Psychology Programs

Mary Ann Hoffman, Ph.D. University of Maryland hoffmanm@umd.edu

What is Clinical/Counseling Health Psychology?

• Interdisciplinary field including clinical, counseling, social and developmental psychologists.

• A significant minority of these psychologists trained as counseling psychologists (Nicholas & Stern, 2011)

• Yet my review of key journals in Counseling Psychology show little scholarship on health-related topics (2003-2013, about 20 articles in TCP and a handful in JCP)

• Case needs to be made that mind-body interface is an important and timely research topic.

Why Should We Care about Clinical Health Psychology?

• Research interests of applicants often foreshadow timely topics.

• An increasing number of students are interested in the mind-body interface; and,

• In utilizing positive psychology variables to intervene in health-related concerns (1/4 of applicants at UMD)

• Attention to health and wellness fits well with our field’s focus on hygieology versus pathology

Developing a Research Emphasis in Health Counseling Psychology

• facilitating scholarship by identifying health topics that fit counseling psychology core values;

• mentoring our students in health psychology research by bridging our interests; and,

• increasing visibility of clinical health research in key counseling psychology journals.

Identifying Health Topics Aligned with Counseling Psychology

Facilitate more research by identifying way Counseling Psychology can uniquely contribute. Examples:

• Strengths-based approaches to healthy adaptation and coping. • Understudied variables that intersect with health and well-being: self-

compassion, forgiveness, positive coping, gratitude, meaning-making and benefit-finding

• Interface between health and work, work identity, and income• Role of cultural variables in health outcomes (e.g., disparities, gender,

race, ethnicity, and housing insecurity)

Examples of Health-Related Projects at the University of Maryland

• Prostate cancer study- social support and social networks; quality of life

• Expressive writing for chronic pain: role of self-compassion and self-efficacy in pain perception

• Breast cancer in young women: effect on career and career identity and meaning

A Qualitative Analysis of Psychosocial Support in Online Prostate Cancer Forum

(Furhmann, Ross & Hoffman)

• Prostate cancer affects 1 in 6 men; most survive but with QOL issues • What role do online support forums play in survivorship?• We categorized content and intent of the 100 “most viewed” and “most

responded to” posts on prostate cancer forum Healing Well• Most observed content categories: ED Treatments, Urinary Incontinence,

Quality of Sexual Life, Cancer Treatment Options.• Most observed intent categories: Seeking Info. Based on Experience, • Offering Support/Reassurance, Seeking support/reassurance. • Online support forums fill medical void by offering reassurance and

normalization from others going through similar experience

Effectiveness of a Positive Writing Intervention for Chronic Pain

(Ziemer & Hoffman)

• Chronic pain is widespread, affects QOL, and is often not treated effectively with biomedical approaches

• Would a brief expressive writing intervention using either a self-compassion or self-efficacy prompt be effective?

• 93 randomly assigned participants - met criteria for chronic pain• Ss in both conditions reported sig. less pain and less depression• Ss in self-compassion condition reported less intrusive pain • Ss in both conditions reported greater self-compassion• Those who wrote using more positive adjectives reported less pain,

less intrusive pain, less pain catastrophizing

The Work Life and Career Development of Young Working Women who are Breast Cancer

Survivors (Raque-Bogdan & Hoffman)

• Cancer at a younger age has more significant and enduring psychosocial effects than cancer at older ages

• Does breast cancer during early adulthood impede career development and commitment?

• Women’s career trajectories have traditionally been understudied in the career literature as have careers of persons with chronic disease

• Results: Early cancer diagnosis intensified most women’s need for purpose in life and led them to re-appraise meaning in their work

• Need for financial security and medical insurance prevented re-appraised sense of life meaning the focus of their career

• Or, from redirecting their career paths to one that better expressed their re-appraised life meaning.

Mentoring Student Research:

• Finding a “bridge” between interests of advisor/advisee • Examples: You may know about career development but not about effect

of health challenges on career• You may know about expressive writing but not that it’s a great way to

study health issues such as chronic pain, caregiver experiences, and cancer survivorship

• You may know about social networks but not their role in seeking health support and receiving health services

• Advisee/Advisor projects• Student initiated research teams

Your Research Helps in Seeking a Career In Health Counseling Psychology

• Research, extern, and intern experiences create a foundation for a career in clinical health psychology

• These experiences are becoming more important than designation of program as clinical or counseling psychology

• Your research demonstrates your passion, commitment and skills• Student who studied chronic pain interned at VA and is interviewing at

research centers, NIMH, etc. • Student who studied QOL in persons w/ autoimmune disorders works in

behavioral medicine setting and teaches health psychology• Student who studied and did externship re/ disordered eating offered post doc

opportunities at both ED clinics and Counseling Centers

So Many Interesting Topics! So Little Time!