As many know, an article in the Chronicle of Higher Education on May 27, 2008 (Available here), marked the public unveiling of the development of a new accreditation system for clinical science, the Psychological Clinical Science Accreditation System (PCSAS). Not surprisingly, more questions were raised than were answered by the Chronicle article. This article attempts to provide background and answer some of those questions.
First, who are the players and what are the goals of the new accreditation system? PCSAS is an independent organization that originated within and has been guided in its formation by the Academy of Psychological Clinical Science — please note, not by the Association of Psychological Science (APS) — more about that later. The Academy is an alliance of 49 clinical science graduate programs and nine clinical science internships whose mission is to strengthen training in psychological clinical science (see psychclinicalscience.org for more information about the Academy, its mission, members, and officers).
I won’t belabor the “whys” of PCSAS. A monograph in preparation for publication in Psychological Science in the Public Interest, authored by Tim Baker, Dick McFall, and Varda Shoham, will provide a glimpse into the future directions of clinical psychology and describe the rationale for change in training and accreditation. What I want to point out here is that the relationship between clinical science programs and the Committee on Accreditation (CoA) has waxed and waned over the years. As a result of substantial strain between them in the 1990s, an accreditation summit in 1992 to consider alternatives was cosponsored by APS, the National Institute of Mental Health (NIMH), and the Council of Graduate Departments of Psychology (COGDOP). In parallel, reforms in accreditation were proposed in 1995 from within CoA and negotiations among the American Psychological Association (APA), COGDOP, the Council of University Directors of Clinical Psychology (CUDCP) and others. Among the central principles in the 1995 accreditation reform was the idea that programs would be evaluated according to their own stated training models and that trainee expertise did not need to be demonstrated through a checklist of courses — for more about this history, see Bootzin, R.R. (2007). Psychological clinical science: Why and how we got to where we are. In T.A. Treat, R.R. Bootzin, & T.B. Baker (Eds.), Advances in Psychological Clinical Science: Integrative Perspectives in Honor of Richard M. McFall (pp 3-28). New York: Psychology Press.
Initially the reforms worked well and the accreditation war seemed to be moving into a long truce. But, over the decade following the 1995 agreement, CoA accreditation gradually became more prescriptive and more burdensome to clinical science programs. In 2004, the Academy and NIMH brought together leading clinical scientists and NIMH program staff for a joint-conference about new directions for training psychological clinical scientists. Tom Insel, director of NIMH, expressed the frustration shared at other National Institute of Health (NIH) institutes that although NIH had funded the development of many treatments that received empirical support, they were not widely available to those who needed them.
In 2005, another attempt at reform and restructuring of CoA was made. But the restructuring that occurred as a result of an accreditation summit in Snowbird, Utah, did not change the basic direction of accreditation nor reduce the steadily increasing accreditation burden for clinical science programs.
Why not? First, the basic structure and goals of accreditation are fundamentally the same as they were when accreditation of clinical psychology programs was instituted in the late 1940s, 60 years ago. The science of clinical psychology, however, has not been static during that time. Today, we are conducting psychological science differently than we did in the mid-twentieth century. This includes increased focus on translational research and collaborations, disciplinary and interdisciplinary. We have new tools, such as neural imaging, behavioral genetics, computational modeling, and graphical data analysis. Our old models of training will not do. We need new models to develop the expertise of the next generation of clinical scientists who will advance knowledge about assessment, treatment, dissemination, and other applications of clinical science.
Many of us are skeptical that a single set of requirements for all programs and for all individuals within a program is the best way to approach the task. PCSAS is starting anew.
Different clinical science programs may come up with different solutions to the challenges that face us for training graduate students to advance, apply, and disseminate knowledge about psychological clinical science. We want a system that will encourage innovation in training, coupled with evidence about outcomes. We have the opportunity to reconsider how best to train clinical scientists for the challenges of the twenty-first century. What could be more important or exciting?
Where are we in this process? On January 14, 2006, the Academy executive committee (EC) plus the three past presidents were brought together in Tucson by Varda Shoham, the then president, to discuss the possibility of an independent accreditation system. After extensive discussion, the Academy EC voted to develop such a system. Supporting documents were prepared; the possibility of an accreditation system was discussed by program representatives at the Academy business meeting in May; and a formal vote of the membership, concluded on October 15, 2006, overwhelming endorsed developing an independent accreditation system. Over the next year, the mission statement and guidelines were revised in response to suggestions from program representatives. Exploratory meetings were held with a number of potential stakeholders.
The bylaws of PCSAS call for the Academy EC to appoint the nine-person Board of Directors. By the end of November, the Board was appointed and on December 26, 2007, PCSAS was incorporated. The first telephone conference call of the Board was on February 6, 2008, and the first in-person meeting was held on May 21, 2008. At the May meeting, Dick McFall was designated as Executive Director; he was appointed officially on July 21, 2008.
The PCSAS leadership includes Dick McFall, Indiana University, Executive Director, and the Board members: Dick Bootzin, University of Arizona, President of the Board and clinical faculty member; Tim Baker, University of Wisconsin, clinical faculty member; Bob Levenson, University of California, Berkeley, Secretary and clinical faculty member; Beth Meyerowitz, University of Southern California, clinical faculty member; Bob Simons, University of Delaware, clinical faculty member; Mahzarin Banaji, Harvard University, nonclinical faculty member; Joseph Steinmetz, Dean, Arts and Sciences, University of Kansas, current or former department chair member; Myles Brand, Executive Director, NCAA, public member (Editor’s Note: Myles Brand resigned recently due to health problems and the process for identifying a replacement has begun); and Rebecca Levin Silton, University of Illinois, student member.
So what is APS’s role in all of this? APS and Alan Kraut, as executive director, have been remarkably supportive of the Academy and in helping to solve issues affecting psychological clinical science. There would be no Academy without APS — certainly not one that has its current influence in funding and training agencies. The Academy is an affiliate of APS. Affiliate status is not an indication of “ownership.” For example, SSCP is an affiliate of APS even at the same time that it is part of Division 12 of APA.
APS has had a long standing interest in accreditation as indicated by its co-sponsorship of the 1992 accreditation summit. At every step along the way in the development of the Academy’s accreditation system, APS has been interested and its Board has voted to help support PCSAS. Thus, just as APS helped the Academy develop, APS is committed to helping PCSAS succeed.
The next steps, which already are underway, involve establishing a review committee, developing review criteria to reflect the PCSAS guidelines, putting in place revenue streams for current expenses and to sustain PCSAS for the long-term, developing liaisons with interested organizations including a host of federal funding and regulatory agencies who have been showing support in initial meetings, and working to overcome some of the challenges facing any new accreditation system. One of the key goals over the next year will be gaining recognition from either the Council of Higher Education Accreditation (CHEA) or the U.S. Department of Education, a process that also has begun. Other issues include working with the Veterans Administration and state licensing boards and making ourselves known to interested parties in Congress.
At this beginning point, the accreditation system is focusing on psychological clinical science doctoral programs. Consideration of whether or not internships will also be accredited is being deferred until after the system for doctoral programs is established. Some readers interpreted a statement in the Chronicle to indicate that PCSAS also may consider accrediting masters level programs. This is definitely a misinterpretation. The focus of PCSAS is on psychological clinical science doctoral training and nothing else.
Despite the close ties between the PCSAS and the Academy, PCSAS will be an independent accrediting system. The Academy, under the direction of its current president, Tim Strauman (Duke University) has made a strong commitment to the success of PCSAS. Even so, not all Academy programs may elect to apply for accreditation, and non-Academy programs are eligible to apply. During the transition period, as PCSAS establishes itself, dual accreditation between PCSAS and the CoA or the Canadian Psychological Association (CPA) is likely.
There are many challenges that face us. We can use your help if we are to be successful in achieving something truly historic. Do not hesitate to email me at Bootzin@u.arizona.edu if you would like to help.
This article originally appeared in the Fall 2008 issue of Clincal Science, the Newsletter of the Society for the Science of Clinical Psychology (SSCP).