The single largest employer and trainer of clinical psychologists, the US Department of Veterans Affairs (VA), has announced that students and graduates of programs accredited by the Psychological Clinical Science Accreditation System (PCSAS) are eligible for internships and employment in the Veterans Health Administration.
This action paves the way for the delivery of more empirically validated psychological treatments to the nation’s military veterans. It also has enormous implications for the training and licensure of clinical psychologists in the US and, by extension, other nations. And it sets a model for how other mental health disciplines might train students.
PCSAS’s mission is to promote science-based training and to introduce a new culture of scientific clinical psychology. It emerged amid concerns that clinical training programs too often emphasize hours spent practicing old and unproven therapies in a one-size-fits-all, outdated system to the detriment of time spent both gaining a thorough knowledge of the latest clinical methods and providing the research training that will create new knowledge aimed at improving public health.
Before PCSAS launched, the American Psychological Association (APA) Commission on Accreditation (CoA) was the only accrediting body for clinical psychology training programs. As PCSAS President (and APS Past President) Robert W. Levenson has described it, APA accreditation has served as “a major gatekeeper” in determining who can be licensed to provide mental health services.
The new VA regulations give PCSAS the same standing as CoA. Incoming PCSAS Executive Director Alan G. Kraut described VA recognition as “a quantum leap” for the organization.
“But it means even more for the mental health of our nation’s veterans,” said Kraut, who is APS Executive Director emeritus. “It means the VA has locked in that our vets will get the most scientifically based mental health treatments we have, and that the next generation of effective treatments will be discovered and developed with VA support.”
PCSAS’s “significant attention to the implementation of interventions …is consistent with the VA’s clinical directions and strengthens [the] VA’s care for Veterans,” said Jeffrey Burk, National Mental Health Director, Psychosocial Rehabilitation and Recovery Services at the VA and the person most responsible for overseeing this policy change.
“In addition, PCSAS’s emphasis on research is consistent with VA’s research mission, and the inclusion of PCSAS accreditation might improve VA’s ability to hire psychologist researchers,” Burk said.
PCSAS President Levenson described the VA action as a win-win.
“PCSAS programs benefit greatly from the superb training and career opportunities the VA centers provide,” he said. “The VA system and the veterans they serve benefit from ready access to the newest, most cutting edge clinical science and a pool of talented clinical scientists. PCSAS looks forward to continuing to build and strengthen this relationship with the VA in the coming years.”
APS and Accreditation
The drive for a new accreditation system dates back to the earliest days of APS when an evaluation of policies and programs affecting graduate education in psychology raised concerns about the increasing emphasis in accreditation on practitioner interests over scientific principles. Many APS leaders argued that education and training standards were shifting away from the Boulder model, the name given to the scientist-practitioner model established at a 1949 APA conference in Boulder, Colorado.
“There was a sense then among APS leaders that accreditation requirements had changed in ways that were eroding the scientific basis of professional training and were having a negative impact on graduate training more broadly, and on the quality of mental health care,” APS Executive Director Sarah Brookhart explained.
Over the next two decades, clinical psychological scientists increasingly voiced concerns about the CoA accrediting a burgeoning number of programs under too general a set of rules, warning that those training programs lacked sufficient scientific foundations.
“As the same standards and procedures for accreditation have been extended to accommodate newer, more professionally oriented training programs, many feel that the scientist-practitioner model is being undermined by the very system of quality control that was originally designed to promote it,” wrote APS Past President Marilynn Brewer (then Chair of the APS Graduate Education Committee), in a 1992 article for the Observer.
That year, APS organized the Summit on the Future of Accreditation to address the impact of accreditation on the scientific basis of psychology. The Summit was co-sponsored by the Council of Graduate Departments of Psychology (COGDOP) and the National institute of Mental Health (NIMH).
At that summit, Stanley Schneider, then Associate Director of Training at NIMH, described accreditation as a “barrier to innovation” in psychology and pointed out 50 years of deteriorating ties and isolation between the research and practice sides of education in psychology.
Three years later, APS gave its support to the founding of the Academy of Psychological Clinical Science (APCS), a North American alliance of scientifically oriented doctoral and internship training programs in clinical and health psychology. APCS, with backing from APS, created PCSAS as an independent entity that since 2009 has accredited 30 of the top clinical programs in the United States (as ranked by US News and World Report) and Canada.
VA’s recognition of PCSAS will benefit the entire field of psychological science and beyond, Brookhart said, because it underscores the importance of science in doctoral training as well as advancing the clinical science model.
“APS has been a strong supporter of the development of PCSAS and we will continue to partner with PCSAS in promoting science-based accreditation of graduate education,” she said.
With APS’s help, PCSAS has generated recognition from the Council of Higher Education Accreditation, Congress, and the National Institutes of Health. But PCSAS picked up particularly big momentum in 2014, when Delaware and Illinois passed laws that made graduates of those programs eligible for state professional licensure. Similar legislation aimed at establishing parity for PCSAS programs is underway in several other states.
“Perhaps no milestone is more telling, however, than PCSAS’s recognition by the VA,” said APS Fellow Richard McFall, who is set to retire as the system’s founding Executive Director and is widely considered as the leading advocate for training in evidence-based clinical psychology. “This reflects the VA’s confidence that PCSAS programs provide high-quality training that prepares all graduates to be competent scientists, capable of advancing our understanding and treatment of mental and behavioral health problems, and also to be first-rate clinicians, capable of delivering effective, science-based health care services to veterans.”