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Final
Report of the Blue Ribbon Panel
Professional Education Task Force of the California Psychological Association and the California School of Professional Psychology-Los Angeles
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Preface
This Report constitutes the deliberations and recommendations of the Blue Ribbon Panel of the Professional Education Task Force, a joint effort undertaken by the California Psychological Assocation (CPA) and the California School of Professional Psychology, Los Angeles Campus (CSPP-LA).
The Blue Ribbon Panel (see Exhibit I) consisted of an extraordinary group of nationally recognized health professionals and scientists with expertise in medicine, psychiatry, nursing, pharmacy, the neurosciences, psychology, public policy, as well as gender and multicultural factors relevant to psychopharmacology. We are deeply indebted to the Panel members for volunteering their expertise, time and energy to make this project a success.
We also wish to acknowledge the dedication and assistance of our colleagues in the Professional Education Task Force (see exhibit 2) who have supported us tirelessly throughout the project.
Finally, on behalf of CPA and CSPP, we wish to give special thanks to the Committee for the Advancement of Professional Practice (CAPP) of the American Psychological Association for providing both the financial and professional support that made this effort possible.
Esteban L. Olmedo, Ph.D.
Charles Faltz, Ph.D.
Los Angeles, California
January, 1995
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Exhibit 1
Blue Ribbon Panel
Ronald E. Fox, Ph.D.-Senior Advisor and Convener
Ph.D., Clinical Psychology, University of North Carolina, Chapel Hill, North Carolina, 1962. Currently President, American Psychological Association and CEO of Piedmont Care, Chapel Hill, North Carolina
Michael J. Bader, D.M.H.
D.M.H., University of California, San Francisco, 1980. Currently Assistant Clinical Professor of Psychiatry, University of California, San Francisco.
Ronald S. Gabriel, M.D., F.A.A.N., F.A.A.P.
M.D., Boston University, 1963. Currently Clinical Professor, Neurology and Pediatrics, UCLA School of Medicine.
Jean A. Hamilton, M.D.
M.D., University of Texas Medical School, San Antonio, 1977, Currently Professor, Department of Psychology: Social & Health Sciences and Women's Studies, Duke Univeristy.
Colonel Gregory B. Laskow, Ph.D.
Ph.D., Counseling Psychology, Texas Tech University, Lubbock, Texas, 1972. Currently Chief, Department of Psychology, and Director, Clinical Psychology Internship Program and Psychopharmacology Demonstration Project, Walter Reed Army Medical Center, Washington, D.C.
Benjamin Robert Margolis, Pharm.D., J.D.
Pharm.D., University of Southern California School of Pharmacy, 1969; J.D., Southwestern University School of Law, Los Angeles, California, 1985. Currently Judge Pro Tern, Municipal Court, Los Angeles Judicial District and Adjunct Assistant Professor of Pharmacy Practice at the University of Southern California, Los Angeles, California.
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Joseph Steven Pachman, M.D., Ph.D., M.P.H.
Ph.D., Clinical Psychology, University of North Texas, Denton Texas, 1978; M.D. University of Connecticut School Of Medicine, Farmington, Connecticut, 1990; M.P.H., Yale University School of Medicine, 1993. Currently Medical Director, LPI, Stamford, Connecticut,
Lieutenant Commander John L. Sexton, Ph.D.
Ph.D., Clinical Psychology, California School of Professional Psychology, San Diego, California, 1983. Currently Psychopharmacology Fellow, Walter Reed Army Medical Center, Washington, D.C., participating in congressionally directed Prescription Privilege Demonstration Project at Walter Reed Army Medical Center.
Leonard A. Zlmwdt M.D.
M.D., Meharry Medical College, 1960. Currently Associate Dean, Hospital Programs, Charles R. Drew University of Medicine and Science, bs Angeles, California.
Patricia Ryan Wahl, R,N. Ph.D., F.A.A.N.
M.S.N., Adult Psychiatric Nursing, 1958; Ph.D., Social Psychology, University
of Cincinnati, Cincinnati, Ohio, 1985. Currently, Director, School of Nursing,
San Diego State University, San Diego, California.
Jocelyn T. Whiten, Ph.D.
Ph.D., Department of Neurosciences, University of California, Los Angeles, School Of Medicine, 1974. Currently Founder/Director, Addiction Research & Prevention Center, Drew University of Science and Medicine, Martin Luther King, Jr., Drew Medical Center, Los Angeles, California.
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Roster of Task Force Members
Co-Chairs
Charles A. Faltz, Ph.D,
Chief, Forensic Mental Health Services, Mental Health Division, San
Mateo County, California.
Esteban L. Olmedo, Ph.D.
Vice-Chancellor for Academic Affairs, CaIifomia School of Professional Psychology, Los Angeles, California.
Members
Toni M. Bernay, Ph.D.
The Leadership Equation Institute, Los Angeles, California.
Helene West Feldman, Ph.D.
Assistant Clinical Professor, University of California at Los Angeles, School of Medicine, Department of Psychology and Biobehavioral Sciences.
Bonita Hammell, Ph.D.
Senior Clincial Psychologist, Forensic Evaluation Unit, CMI, San Diego, California.
Sandra Harris, Ph.D.
Clinical Psychologist, California State University, Northridge, California.
Jaylene Kent, Ph.D.
Chief of Behavioral Medicine, Kaiser-Permanente Medical Group, Santa Teresa Hospital, San Jose, California.
Elsie Velasco Go Lu, Ph.D.
Deputy Director, Department of Mental Health, Los Angeles, California.
Lisa M. Porche-Burke, Ph.D.
Chancellor, California School of Professional Psychology, Los Angeles, California.
Alison E. Stanley, Ph.D.
Staff Psychologist, Fairview Developmental Center, California Department of Developmental Services,
Megan Sallaway, Ph.D.
Pacific Psychological Associates, El Segundo, California.
Dawn Martin, Ph.D.
Martin & Associates Inc., Santa Ana, California.
Observer
Lillian R. Friedland, Ph.D.
Friedland Psychological Associates, Inc., Los Angeles, California.
CPA Consultants
Peggy Dudder
Michael Haley, Ph.D.
Carl London
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Introduction
In the Spring of 1993 the California Psychological Association (CPA) and the California School of Professional Psychology, Los Angeles Campus (CSPP-LA) began holding discussions regarding the possibility of pursuing prescription privileges for psychologists in California. As a result of these initial discussions, it became clear that there were fundamental issues underlying prescription privileges'that revolved around education and training.
To pursue the matter, CPA and CSPP established a
Professional Education Task Force co-chaired by Charles Faltz Ph.D. (CPA)
and Esteban Olmedo, Ph.D. (CSPP-LA). A primary goaI of the Task Force is
to develop recommendations for a biobehavioral curriculum that would F
doctorally trained psychologists to prescribe medication relevant to their
practice. The curriculum recommendations would be made generally available
to educational institutions and public policy makers concerned with health
reform. The Task Force has met monthly over the last 1 and 1/2 years. A
roster of Task Force members is provided in Exhibit 2 in the Preface.
1
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Blue Ribbon Panel
One of the initial actions of the Professional Education Task Force was to obtain funding from the Committee for the Advanccmcnt of Professional Practice (GAPP) of the American Psychological Association (APA) to establish a Blue Ribbon Panel of distinguished health care professional and scientists with the following charge:
1. To review various curricula used to train various groups to prescribe medications relevant to the practice of psychoIogy.
2. To incorporate gender and cultural sensitivity as integral policy components of psychopharmacology training.
3. On the basis of (1) and (2) above, to draft recommended education atul training requirements that wouId efficiently prepare psychologists to prescribe medications.
In early 1994 nominations for the Blue Ribbon Panel were sought by the Professional . Education Task Force from the national community of health care professionals. The Task Force was searching for a diverse panel with a depth and breath of expertise in medicine, psychiatry, nursing, pharmacy, the neurosciences, professional psychology, public policy, as well as gender and multicultural factors relevant to psychopharmacology.
After extensive consideration of many outstanding
nominees, the Blue Ribbon Panel was appointed (see Exhibit 1 in the Preface),
and a meeting was convened. which took place on May
27-28, 1994 at the W&tin Hotel, Los Angeles International Airport.
The Blue Ribbon Panel was provided with extensive background materials regarding the education and training of health professionals who currently prescribe medications as well as various curricula which have been proposed for the training of psychologists.These background
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materials may be found in the Appendix. As can be seen in Appendix A there is a wide range of training requirements for prescribing health care professionals, as well as for existing and proposed curricula for the training of psychologists to prescribe.The latter range from 360 to 660 contact hours of didactic academic instruction.
Recommended Training Requirements
Following an intensive review of existing and recommended curricuIa to prepare psychologists to prescribe, the Blue Ribbon Panel agreed. that the following three principles would guide the development of its recommendations:
1. Education and training requirements should be designed to prepare psychologists to prescribe in a manner consistent with the highest standards of psyohology as a health care profession.
2. Education and training requirements should provide for the effective and efficient preparation of psychologists to prescribe; that is, psychologists interested in prescribing medications should have the opportunity to meet the requirements within a context that accommodates the needs and realities of their professional p r acti ce s.
3. The recommendations of the Panel should take the form of broad substantive guidelines rather than a detailed curriculum.The latter should be left for development by educational institutions who will provide the relevant training programs.
On the basis of the forgoing the Blue Ribbon Panel recommends the following guidelines:
The coursework leading to a prescribing proficiency is designed to be completed at the postdoctorl level by licensed clinical psychologists. Although it is recognized that individuaI programs will vary in their determination of the prerequisites to prepare an individual applicant for a particular course of study, the following guidelines assume that
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psychologists entering the program will have an appropriate knowledge base adequately grounded in the biobehavioral sciences. This knowledge base may have been acquired at the undergraduate, graduate, or postdoctoral levels. The following guidelines also assume that training programs would develop at set of competencies that trainees would be expected to master at the completion of each course.
Prerequisites:
1. Doctoral Degree in Psychology as evidenced by:
a. PhD or PsyD in Clinical Psychology or
b. Currently listed in the National Register of Health Service Providers
in Psychology
or
2. Doctor of Mental Health
AND
3. Currently licensed psychologist in California.
Didactic Curriculum:
395 - 570 Contact Hours as follows:
*260 - 435 contact hours over a six month period of academic instruction
*Up to 135 contact hours of didactic-laboratory training combined with the Practicum
Practicum:
18 months
*May include additional didactic
*Includes a minimum of 2 hours-week of appropriate supervision by a
qualified practitioner
*Minimum of 100 patients seen for management of medication with a balance
as to diagnostic mix, gender, ethnicity and age.
*Morbidity conferences held periodically
*Inpatient and outpatient placements
*Evaluation of critical thinking
The recommended guidelines for contact hours are shown in Exhibit 3.
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EXHIBIT 3
Topic
Contact Hours
Totals
Neuroanatomy 25-45
Neurophysiology 25-45
Neurobiochemistry 20-30
Subtotal 70-120
PHARMACOLOGY/PSYCHOPHARMACOLOGY
Pharmacology 30-30
Clinical Pharmacology 30-45
Psychopharmacology 45-60
Developmental Psychopharmacology 10-15
Chemical Dependency, Chronic Pain Management 15-45
Subtotal 130*1%
PATHOPHYSIOLOGY
Includes anatomy, organ systems, drug reactions,
drug interactions, well vs. not well organism, and sociocultural
90-120
90-120
aspects of physiology
INTRODUCTION TO PHSYCIAL ASSESSMENT & LABORATORY
Covers familiarity with physical exams, medical charts, MRI's, etc.
30-45
30-45*
PHARMACOTHERAPEUTICS
Professional ethical & legal issues 15-15
Psychotherapy/pharmacology interactions 15-15
Interactive computer technology 15-15
Pharmacoepidermiology 30-45
Subtotal 75-90*
TOTAL CONTACT HOURS
395-570
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The unanimous opinion of the Blue Ribbon Panel was that the major learning experience for prescribing is the supervised practicum.In addition, the Panel felt that some of the didactic materials (e.g,, pharmacotherapeutics, physical assessment) could be incorporated in the context of the practicum setting(s).
It was also the view of the Blue Ribbon Panel that given that this is a proposed curriculum to train psychologists it ought to emphasize the role of psychology -in the study and practice of pharmacotherapy. Specifically, it ought to emphasize the importance of teaching social factors in psychopharmacology including psychosocial, sociocultural, therapeutic-relational and ethnocultural and gender sensitivity issues.Although these considerations ought to permeate the entire curriculum (e.g., sociocuItural aspects of physiology), they are particularly relevant under the major heading of Pharmacotherapeutics” in Exhibit 3.
The recommended training component could be two years if the 18 months of practicum are taken subsequent to six months of academic training; however, the panel acknowledged that some of the didactic and practicum training could be taken concurrently. A six month estimate for completing the initial 260 - 435 contact hours of didactic curriculum permits a model for post-doctoral fellows to subsidize their training with compensation for cIinical work and still allow for 10 - 17 contact hours of training per week during evenings and/or weekends.
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The above guidelines are designed to lead to the awarding of a certificate of proficiency for doctoral level clinical psychologists. The Blue Ribbon Panel's recommendations may be adapted as an area of subspecialty proficiency in post-doctoral or, in the future, prc-doctoral programs in clinical psychology. The adaptation would involve the development of specific training requirements and curricula that would-be provided by training institutions that would satisfy a proficiency standard recognized by professional bodies that would approve the proficiency. Total, training time for the proposed doctorally trained prrscribing psychologist would be, after undergraduate college/university graduation, on average, seven (7) to nine (9) years, depending on whether the prescribing curriculum was completed at the doctoral or post-doctoral level.
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APPENDIX A
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REFERENCES
1. American Psychological Association, (1992). Report ad hoc task force on psychopharmacology of the American Psychological Association.
2. Balster, R.L. (1990, Spring). Predoctoral psychopharmacology training for clinical/counseling psychologists, Psychopharmacology Newsletter 23 (1). Division 28. American Psychological Association.
3. Uniformed Services University of the Health Sciences (USUHS) & Department of Psychology, Walter Reed Army Medical Center (WRAMC) (1994), WRAMC psychopharmacology demonstration project, USUHS didactic curriculum for 1994-1995. Department of Defense.
4. Fox, R.B., Schwelliz, F.D. & Barclay, A.G. (1992). A proposed curriculum for psychopharmacology training for professional psychologists. Professional Psychology: Research and Practice, 23 (3), 216-219.
5. Wallerstein, R.S. (Ed.). (1991). An experiment in mental health professional education. Lanham, MD: university Press.
6. University of Southern California. (1/21/94). Doctor of dental surgery course requirements (Class of 1977). Los Angeles, CA: USC.
7. Association of American Medical Colleges (1993). Curriculum directory 1993 March 22. Washington, AAMC.
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APPENDIX B
PROGRAM PREREQUISITES
(where available)
Curriculum #1 APA Task Force, Level 3 Training
A psychopharmacology track should recruit students with a strong background in the biological sciences. Some background in anatomy, physiology and chemistry would be necessary to take the graduate-level courses that make up the proposed curriculum.
Biology- Minimum of 12-15 semester hours including general biology, cellular and human genetics, Vertebrate anatomy, and mammalian physiology.
Molecular biology recommended.
Chemistry- Minimum of 9-12 semester hours including 2 semesters general chemistry; one semester organic chemistry.
Mathematics- College level algebra would be a minimum.
Pharmacology and/or substance abuse (desirable).
Curriculum #2 Balster
Biology- Minimum 12 semester hours including general biology, vertebrate anatomy, and mammalian physiology.
Chemistry-Two semesters of general chemistry and at least one semester of organic chemistry.
Mathematics- College level algebra would be a minimum.
Pharmacology and/or substance abuse (desirable).
Curriculum #4 Fox, Schwelliz, and Barclay
Biology- Minimum 12-15 hours including general biology, vertebrate anatomy, mammalian physiology, and human genetics.
Lab work desirable;Social concerns to biology encouraged.
Cell or molecular biology needed.
Chemistry-Minimum 9-12 semester hours. General chemistry and organic chemistry required.
Curriculum #7 UCLA School of Medicine
Physics (with lab) - 1 year
Chemistry (with lab) - 1 year, must include inorganic chemistry, quantitative analysis, and organic chemistry.
Biology - 2 years.
College mathematics - 1 year, must include algebra; introductory calculus highly recommended.
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APPENDIX C
PRACTICAL EXPERIENCE
(where available)
Curriculum #1 APA Task Force, Level 3 Training
Some period of supervised practice also would be needed for safe and effective clinical use of: medications.
Curriculum #2 Balster
Some period of supervised practice would also be needed for safe and effective use of medications.
Curriculum #3 DoD
One year.
Curriculum #5 DMH
Three years.
Curriculum #7 UCLA School of Medicine
Two year clerkship foIlowed by internship and residency.
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