2024 President Elect’s Column 59 (4)
Stewart E. Cooper, Ph.D., ABPP
October 24, 2024
APA’s Population Health Model and Psychology Becoming a Multi-Tiered Profession: The Emerging Opportunity for the Society for the Advancement of Psychotherapy
The Society for the Advancement of Psychotherapy (SAP) is a leading organization dedicated to the enhancement of psychotherapy practice, research, and education. Our mission is to promote mental health and well-being by supporting the professional development of psychotherapists and advancing the science of psychotherapy. Aligned with our mission, the fourth of my four 2025 Presidential Initiatives is for SAP to function as the authoritative voice in advancing psychotherapy science, practice, education, and application. There are two major movements occurring with the American Psychological Association (APA) whose confluence with produce an opportunity (and need) from Division 29. The first of the two is APA’s significant buy in to advocating for and using a population health approach. The second is APA’s efforts to becoming a multi-tiered profession. Having a contextual understanding of both of these is helpful for understanding the emerging opportunity for SAP.
Background on APA’s Population Health Model:
“In most countries, physical and mental health frameworks are built around a traditional medical model which focuses on acute care for individuals. This provider-intensive approach contributes to treatment gaps resulting from an imbalance between need for services and availability of those services (Carbonell et al., 2020). A population health approach can help relieve treatment gaps and address population health needs.” (APA, 2024). The document can be viewed at https://www.apa.org/international/networks/global-psychology-alliance/population-health.
“Population health focuses on improving the health, health equity, safety, and well-being of entire populations, including individuals within those populations. This approach involves a multidisciplinary science base from psychology, sociology, cultural anthropology, medicine, economics, education, and other disciplines. Population health aims to address the cultural, economic, systemic, historical, environmental, relational, and occupational contexts that influence health status, well-being, and functioning across the lifespan. Its ultimate goal is to foster equitable human flourishing” (APA, 2024). Adopted from Psychology’s Role in Advancing Population Health (PDF, 150KB). This synthesis document is available in several other languages.
The Global Psychological Alliance, of which APA is a major partner, is the author of a concise synthesis article entitled “How does psychology fit within a population health framework?” The article contrasts the population health model with the traditional individual health approach and makes a strong case for the need for transformation. The piece also presents other helpful concepts and recommendations. This synopsis of the public health approach is available at https://www.apa.org/international/networks/global-psychology-alliance/population-health-statement.pdf).
Background on APA’s efforts to becoming a multi-tiered profession:
APA has been considering the role of individuals with master’s degrees in the psychology profession for over 75 years. However, up until the last few years relatively little attention has been paid toward this issue. In fact, there has been significant opposition toward considering any level of training besides the doctoral degree, despite there being a number of states with master’s trained health services providers. Today, 20 states either have or will have some type of license for master’s in psychology trained individuals. Note that the titles and scope of practice of this group of master’s psychology trained providers has and does vary greatly, something which both APA and ASPPB want to remedy. Note also that school psychology masters and Ed.S. trained professionals who worked in school settings are already accepted within APA as exceptions to the doctoral restriction.
In December of 2013, the Board of Professional Affairs (BPA) and Committee for the Advancement of Professional Practice (CAPP) Master’s Workgroup produced a position paper on this topic. A decision was made to table further action or discussion at that time.* The topic was revisited a few years later. Since that time “APA has had numerous work groups, task forces, and convenings about clinical, counseling, and school psychology – collectively known as health service psychology or HSP. In the last 5 to 6 years, general agreement has been reached on understanding the profession as multi-tiered – i.e., there is value in a unified vision that includes individuals with doctoral and master’s degrees. In 2018, the APA Council of Representatives voted to accredit master’s degree programs in health service psychology. Since then, many APA governance groups, including the Board of Educational Affairs (BEA) and BPA have been considering what it means for psychology to become muti-tiered. BPA and BEA are in the process of developing two proposals that will be brought before the APA Council of Representatives in February 2025” (email, APA Board of Professional Affairs, 2024).
The following is a summary of APA deliberations and actions related to recognition of master’s level HSPs and is taken directly from the initial draft of the Competency Framework for Master and Doctoral Degree Education and Training in Health Service Psychology developed by BPA.
● 2017: APA Council of Representatives voted to consider options for master’s degree training and/or practice acknowledging current issues and developments had risen to a level that necessitated action.
● 2018: APA Council voted to proceed with accreditation of master’s degree programs in HSP.
● 2018: BEA Blueprint Taskforce produced a report, accepted by the Council, outlining APA accreditation plan for master’s degree programs in HSP.
● 2019: The APA’s Board of Educational Affairs (BEA) and Board of Professional Affairs (BPA) jointly formed a task force to delineate competencies for students completing master’s degree programs in Health Service Psychology and to distinguish from individuals completing doctoral degree programs.
● 2019: APA CoA began work to establish standards for accreditation of master’s degree HSP programs.
● 2020: APA’s Board of Directors and Council of Representatives held focused conversations on the future of psychology practice and education.
● 2021: Master’s Competencies Task Force recommended that BEA and BPA establish a separate task force to update existing APA approved Education guidelines on doctoral degree competencies which was hoped would facilitate completion of master’s degree competencies.
● 2021: BEA and BPA jointly formed Task Forces to update the master’s and doctoral degree competencies with the expectation that doing so would then help delineate the differences between HSP competencies for doctoral degree and master’s degree students.
● 2021: APA convened an Assembly on the Value/Distinctiveness of the Doctoral Degree in Health Service Psychology.
● 2021: BPA formed a work group to recommend an appropriate master’s scope of practice and title in HSP to inform upcoming updates to the APA Model Licensure Act.
● 2023: BPA received report from 2021 Master’s Title and Scope Work Group.
● 2024: BEA and BPA considered the work of the Doctoral HSP Competencies Task Force.
● 2024: BPA formed APA Model Licensure Act (MLA) Work Group to begin revising and updating MLA.
The Emerging Opportunity for the Society for the Advancement of Psychotherapy:
APA’s endorsement and embracing of a population health approach along with its moving toward a multi-tiered profession will provide significant opportunity for and need from the SAP. Even today, there are thousands of graduates from master’s in HSP psychology-related programs each year compared to a far smaller number of doctoral level graduates. Psychotherapy will be the central skill not only for doctoral level HSP providers but also for master’s level and, at a basic level, to bachelor’s level and peer mental health support providers. A Presidential Task Force is focused on master’s and doctoral HSP competencies, titling, and scope of practice has been formed and is active. They (Andres Perez-Rojas, Libby Williams, and James Lichtenberg) submitted a comment for SAP on the Competency Framework for Master and Doctoral Degree Education and Training in Health Service Psychology developed by BPA.
I welcome your input and ideas regarding this opportunity, i.e., what emphasis would like to see SAP take on, what support should be provided to the new members we will likely get, what advocacy positions should we take, what roles are you interested in, providing input to the Presidential workgroup, etc. Your voice is important and I value hearing from you. Please email me at stewart.cooper@valpo.edu
President-Elect,
Stewart Cooper