by Elaine S. LeVine, Ph.D. and Luis Vazquez, Ph.D.
With prescribing psychology laws in action in Louisiana and New Mexico and a number of additional states with enabling legislation underway, increasing numbers of psychologists across the country are interested in obtaining training in psychopharmacology. Many hope to prescribe and will want to follow their state laws regarding specific training requirements, while others seek training in order to broaden their skills in both practice and research. Given this increasing interest in training in psychopharmacology, it is fortunate that psychologists have a number of training programs located throughout the country from which to choose.
The extant programs (which are discussed in detail on the APA Division 55 website) are all based on the document, "Recommended postdoctoral training in psychopharmacology for prescription privileges," accepted by the APA Council in 1996; yet offer this coursework through different teaching modalities and somewhat different conceptual frameworks. Each of the programs offers some unique characteristics that will make it most appropriate for given psychologists. In this article, we discuss the general nature as well as some of the distinctive characteristics of the New Mexico program, which is a collaborative effort of the Southwestern Institute for the Advancement of Psychotherapy and New Mexico State University, what we refer to as the "SIAP program."
When the New Mexico RxP Task Force began to plan a strategy for passing a prescriptive authority law, it was the consensus of the group that the New Mexico legislature and citizens would respond most positively if it were demonstrated that there was within the state a means for educating psychologists to be competent prescribers. Faculty and administrators at New Mexico State University were far-sighted in recognizing that a postdoctoral program in psychopharmacology could address the great need of the underserved mentally ill in New Mexico. An arrangement was established between the private institute, the Southwestern Institute for the Advancement of Psychotherapy and the APA accredited counseling psychology program at New Mexico State University so that trainees could obtain postdoctoral, professional development credit at New Mexico State University for participation in the SIAP postdoctoral program and complete a certificate in psychopharmacology for psychologists. In its infancy, the Prescribing Psychologists' Register allowed the SIAP/NMSU Collaborative to use some of its written materials to develop coursework. With this initial help, the SIAP/NMSU Collaborative was able to develop its own board and curriculum and, thus, operate independent of any other program. The program is now in its third iteration, having graduated 12 trainees in 2001, and 22 trainees in 2004. Twenty-four trainees of the third iteration have completed about 120 hours of the 450 hours of the program. The New Mexico psychologists participating in the program reside in all corners of the state (from Gallup to Crown Point, Santa Fe, and Farmington, down to the southern corners of Alamogordo, Las Cruces, and Hobbs). Interestingly, the SIAP/NMSU program is also attracting trainees from other states (Colorado, California, Arizona, Kansas, and Florida) who feel that they learn best in the structure and format this program provides.
The emphasis of the SIAP/NMSU curriculum is for psychologists to integrate the knowledge base and skills needed to create a best practice of medical psychology so that prescribing psychologists not only prescribe psychotropic medication, but also provide quality care from the biopsychosocial perspective. The curriculum of the SIAP/NMSU Collaborative is taught live at various sites in New Mexico every four to six weeks over a period of two years. The curriculum is divided into five primary units.
1) Overview of major topics in psychopharmacology.
2) In-depth study of pathophysiology and physical assessment.
3) Broad-based course in pharmacology.
4) Specialized coursework in substance abuse.
5) Intensive study regarding the treatment of special groups and examination of ethical and legal issues.
We believe that the second unit in pathophysiology and physical assessment is a rather unique aspect of the SIAP/NMSU program. The faculty for this unit of ten, two-day courses is the medical staff and medical residents of the Family Practice Residency Program in Las Cruces, New Mexico. Classes meet in the Family Practice Clinic so that trainees have direct experience conducting physical exams. Taught through a problem-based learning approach, each course for this unit focuses on a particular organ system. Trainees learn the disease states, laboratory assessment, and physical assessment techniques associated with each system. At the end of this unit, the Trainees must demonstrate competency in conducting physical exams as well as facility in analyzing case studies, determining hypotheses about disease states, recommending appropriate laboratory tests, and outlining physical assessment and history findings that would confirm the diagnoses. We believe this unit provides an excellent basis and foundation for our psychologists to enter primary healthcare as medical psychologists.
The New Mexico Prescribing Psychologist Law requires two practica, and these are integrated into the SIAP/NMSU curricula. An eighty-hour practica is to be completed with a primary care physician. This practica is completed in conjunction with the second unit of pathophysiology and physical assessment, so that the trainees have direct experience working with physicians in primary healthcare settings. Many of the trainees have completed these 80 hour practica in their home communities. The Family Practice Residency Program in Las Cruces has been able to provide this experience for a number of the trainees residing in the southern part of the state. The experience of the 80 hour practica in the Family Practice Residency Program has been unique and quite rewarding for all involved. Under medical staff supervision, a medical resident and trainee work side by side to evaluate, diagnose and treat patients.
One medical staff shared with us a story of which we are most proud. The supervisor stated that she was watching the medical resident and trainee through a one-way mirror as they conducted a medical history and exam with a new patient. The medical resident was very quiet during the whole examination. When the resident and psychologist left the room, the supervisor asked the resident why he made so few comments during the entire examination. The resident responded, "The doctor was doing such a good job that I didn't think I should interrupt him." What is exciting about the practicum is that these professionals are developing ways of communicating with one another from an interdisciplinary approach regarding patient care. The participating trainees are located throughout the state. Many of the residents will be located throughout the state upon the completion of their programs. Thus, the 80 hour practica is establishing the groundwork for intensive interdisciplinary care that, hopefully, will continue after the trainees complete their training.
Upon completion of the 450 hours of academic coursework, SIAP/NMSU trainees must complete a practicum treating 100 patients from this biopsychosocial model. The practicum is required to be supervised by a physician experienced in the administration of psychotropics. Securing practicum sites to meet the requirements for the training program for psychologists has been challenging at times, even though prescriptive authority is the law in New Mexico. It has been somewhat easier to develop sites in the rural areas with a large underserved population. However, once a practicum site has accepted the trainee, supervisors involved seem very pleased with the performance of the trainees. What they soon discover is that, while these psychologists are 'in training' about psychotropics, they bring many needed skills to the facilities that they serve. The medical personnel that they work with quickly begin to rely upon the psychologists' expertise in diagnosis and communication with patients. In fact, in several hospital settings, our trainees have been asked to provide staffing to their medical colleagues regarding the treatment of various mental health conditions.
Through our continued experiences with each new class, SIAP is developing systems and forms that facilitate effective delivery of mental health care from a biopsychosocial/interdisciplinary perspective.
Please feel free to visit our website, http://www.siaprxp.com, for more information, including the handbook about the program and the practicum manual.
Elaine S. LeVine, Ph.D., is a Conditional Prescribing Psychologist in New Mexico and the Director of the Southwestern Institute for the Advancement of Psychotherapy and an Affiliate Associate Professor at New Mexico State University. Dr. Levine has been a Registrant since 1979.
Luis Vazquez, Ph.D. (not pictured), is Professor and Department Head, Department of Counseling and Educational Psychology, New Mexico State University.