Goal of the Internship Toolkit

The professional psychology education and training community has regularly expressed a commitment to quality internship training, and concerns are raised that the imbalance is resulting in students creating their own internships, which are of unknown quality. This highlights the need for resources such as this toolkit to assist in the growth of internship programs and positions that become part of established quality assurance structures in professional psychology.

The internship toolkit is intended to collect resources that can be used to gain institutional and financial support for creating and expanding internship programs. The framework of the toolkit is organized around individual modules, each of which represents a core component related to the structure of an internship program: rationale for developing internships; internship settings and structures; funding; administrative issues; legal and ethical considerations; quality assurance mechanisms; mentoring resources and emergency recovery procedures. Although it is hoped that many will find the entirety of the toolkit useful, each section was designed to be a stand-alone source of information such that the user of the toolkit could readily access the specific information desired.

A Historic Perspective on Internship Training

The first widespread doctoral internships arose out of a need for psychologists to provide services to veterans of World War II. Financial resources from the federal government through the Department of Veterans Affairs were provided for training to develop the needed workforce. Federal support from the National Institute of Mental Health later provided large scale, additional, financial support for internships. However, federal support for internships has declined; consequently the economic structure of internships has dramatically changed. Complicating the reduced support from the government is the reality that many third-party payer systems, including Medicare, will not reimburse for services provided by a psychology trainee.

Thus, as the number of doctoral internship positions has grown, funding for such positions has, of necessity, come from more diverse sources. At the same time, doctoral training in professional psychology has attracted more and more students at a rate that has been greater than the creation of new internship positions. Consequently, as early as the 1970s and continuing most years up until the present there has been an imbalance between the number of students seeking an internship and the number of available positions offered in the APPIC match. Considerable efforts have been devoted to decreasing this imbalance; however, it is difficult to determine what impact these efforts have had. Although both the numbers of available internships and applicants seeking internships continue to increase, growth in the number of applicants exceeds creation of new internships. In the ten-year period from 2002–2012 the number of positions offered in the match grew by 16 percent (438), while the number of applicants increased by 44 percent (1,362). Specifically, 3,073 applicants were registered in 2002 and 2,752 positions were offered. In 2012, there were 4,435 applicants for 3,190 positions, although 426 of these individuals withdrew or did not submit rankings for the match. The results of the 2013 internship match were released on Feb. 22, 2013 and a total of 3,094 applicants were matched. There were 957 (24 percent) individuals who did not match; this is 84 fewer than in the 2012 match. A total of 282 positions were unfilled in phase 1 of the match. The number of internship positions offered in the 2013 match increased by 186 from 2012.

Benefits

To the profession and the public. Internship provides the capstone experience in doctoral training in professional psychology, and psychologists involved in that training have the opportunity to help improve the profession. In addition to providing needed internships for current and future graduate students, an agency that develops an internship can help maintain quality control within the profession by ensuring that psychologists entering the field are competent.

To staff. The addition of an internship program to an existing organization can increase staff diversity in terms of demographic and cultural factors and expertise. This in turn may increase the number of professionals available to treat a specific population. Interns are often energetic and excited about their work and can help staff reconnect with their own passion for the field of psychology. Having interns who can provide clinical services may also free up staff to do research, pursue other interests, or assume other tasks and roles within the agency.

To professional growth and development. Supervising interns keeps staff members on their toes and may lead them to strengthen their own competencies. Enhanced competencies, especially in the area of supervision, may be of benefit to psychologists as they advance within an agency or in their careers.

To service provision. Psychology interns can provide quality services which expand the ability of an agency to serve its clients/patients. Developing an internship program is a cost-effective way of increasing staff and services in this tight economic climate.

To quality. Being a recognized training site within the field is often viewed as a measure of quality of the agency itself and accreditation is frequently linked to grant funding eligibility. This prestige may also lead to an increased ability to attract high quality staff to the agency.

Making the Case for Developing an Internship Program

It is a good idea to first gather information about what will be needed to create a successful, quality internship:

• Internship structure that will best fit your agency.
• Number of interns.
• Staffing to provide training and supervision.
• Office space.
• Technology.
• Financial support.

When looking at the costs of an internship program, look also at the financial benefits (cost­-benefit analysis):

• Number of hours of service provided by interns.
• Cost of service provision by interns per hour versus that of staff.
• Hours of service provided by interns in relation to the hours of training/supervision provided by staff.
• If interns can supervise practicum students at your site, you may also be able to add additional hours of therapy at little cost.

Next, determine what resources you already have and what additional resources are easily accessible:

• Licensed psychologists on staff qualified to supervise.
• Other mental health professionals on staff that could serve in roles other than that of primary supervisor (e.g., seminar facilitator, group supervisor, seminar presenter).
• Nearby space that can be used or reconfigured or offices of part-time staff that can be utilized/shared.
• Salary of a staff member who may be resigning or retiring (to be redirected for stipends rather than staff replacement if adequate staffing already exists).
• Interests and expertise of staff to be incorporated into program.
• Professionals in the community that would be willing to present one or more seminars.
• Available grants to fund internship development and/or pursuit of accreditation.

Outline the benefits of developing an internship program:

• Contribution to the profession by filling a need for internships, training the next generation of psychologists, and creating a qualified workforce.
• Enhanced staff diversity and expertise.
• Potential to free up current staff to take on new roles/tasks in agency.
• Professional growth and enhanced competence of staff.
• Increased service provision.
• Prestige of agency and increased ability to attract quality staff.
• Influx of new ideas.

Enlist the aid of staff members who are in favor of developing an internship to assist in gathering and presenting this information to administrators.

Then What

Developing an internship program may seem like a daunting task, but once in place it can be easily updated and improved as needed. Sites wishing to develop internships have access to assistance and resources from many sources — professional organizations, doctoral programs and other internship programs. Additionally, they can collaborate with potential partners to form a consortium internship, which may allow a site to pool their resources (funding, space, supervision and training) to form one collective, larger program. The remainder of this toolkit contains an abundance of useful information regarding the ways an internship can be structured, potential costs and sources of funding, legal and administrative issues, quality assurance, mentoring resources and additional tips for handling potential problems that might arise. We hope you will find developing an internship program to be an exciting and rewarding endeavor.

Structures

In structures we consider:

1. Duration and hours of training.
2. Types of affiliation between the organized internship program and an academic institution or institutions.
3. Types of internship governance.
4. General administrative structure.

Structural and administrative components must allow for depth, breadth and intensity of training appropriate for the internship level of training — more advanced than practicum and less specialized than postdoctoral training.

Duration and Hours of Training

• Full time. The one-year full-time internship is the principal model in doctoral training. The majority of internships in the U.S. and Canada are full time, requiring at least 40 hours per week training for no less than 10 months (for school psychology internships) and no more than 12 months duration. In the full-time internship, students pursue clinical training either in the same geographic region or at a distance from their doctoral program. The pragmatic advantages for students and programs are clear: The student for whom the internship is a capstone of doctoral training and education, completed in a year, can proceed to graduate and to postdoctoral training and licensure. For the internship program and students, the full-time model may be most cost-effective and efficient.
• Part time (Half time). The half-time internship has worked well as a training structure in some regions of the country and for specific programs and students. The half-time program is often set within a regional community of students, doctoral programs and psychological service sites. Most of these internships have developed through extensive cooperation between educational institutions and local training sites. For some doctoral programs, the half-time internship is integral to a PsyD degree that integrates the internship with academic work (see “doctoral program integrated training” governance model). Although it may be possible to establish half-time internships within traditional full-time internship settings, this would create additional administrative challenges.

Affiliation Between Doctoral Programs and Internships

• Non-affiliated independent training structure. Internships that function as part of an independent institutional setting. In this more traditional form of internship, described as “capstone model,” no course work, seminars or other training services are regularly provided by graduate program faculty. However, a graduate program may have been instrumental in developing the internship and may be used as a resource (see Mangione, VandeCreek, et al., 2006).
• Exclusively affiliated. Internships only admit students from a specific doctoral program. Historically referred to as “captive” or “fully affiliated,” graduate programs operate these internships for the benefit of their students. Students may or may not participate in the internship. These internships share a common decision-making structure at a higher level of authority within the doctoral program (Mangione, VandeCreek, et al., 2006).
• Partially affiliated. Similar to exclusively affiliated, a partially affiliated internship arranges to hold some positions for students from an affiliated doctoral program, while leaving the remaining positions open to all applicants.

Governance: Internship Placement in relationship to Academic Programs

• Capstone model. A non-affiliated independent training structure. Doctoral programs subscribing to this model view the internship as a culminating experience that serves to integrate practicum training and academic preparation (Cornish et al., 2005). Coursework is not taken concurrently. Students are required to complete coursework prior to commencing internship. Interns typically complete internships that are not affiliated with their academic program. The majority of psychology programs endorse the capstone model (Ducheny, in Kenkel & Peterson, 2009, p. 211).
• Doctoral program integrated training model. This model is characterized by the requirement that students take coursework in their graduate program concurrent with internship training (Mangione, VandeCreek, et al, 2006). Internship is integral to final years of the graduate curriculum and is typically half time. These programs are fewer in number and are reviewed on a case by case basis by APPIC. This program structure has been controversial in terms of whether internship training can truly be integrated with academic requirements, especially as APPIC membership criteria require that the training is “post-practicum and pre-doctoral.” Distinguishing between practicum and internship training is particularly important for programs using an integrated training structure.
• Allied/shared governance. In addition to level of affiliation, integrated internships may have some form of shared governance with a doctoral program or allied training structure. The internship sites may be centrally or administratively coordinated by the doctoral program.

Administrative Structure

Independent. Defined above as a “non-affiliated independent training structure,” these internships function within an independent institutional setting. While students train at internships that are distinct from their academic program, the internship and doctoral program work together in a collaborative manner given that the internship is a requirement of the degree in professional psychology.

Consortium. A consortium is comprised of multiple independently administered entities that have established a formal agreement to share resources to conduct a well-rounded, comprehensive and unified training program (APA Guidelines and Principles for Accreditation (G&P) (PDF, 151KB) — all domains, but particularly B, C and F). Consortia are possible in the integrated, allied and capstone configurations. Consortia hold several advantages for internship development, notably fiduciary and shared resources. Sites that do not meet accreditation standards alone can be part of an APA-accredited internship. A consortial partner (member entity) of an accredited consortium may not publicize itself as independently accredited unless it also has independently applied for and received accreditation.

Settings

The G&P stipulate that the training institution has “among its primary functions the provision of service to a population of recipients sufficient in number and variability to provide interns with adequate experiential exposure to meet its training purposes, goals, and objectives” (G&P, B. Domain A).

There are no formal definitions for site types and settings. Sites are categorized by programs to best describe their institution, training emphasis, services and populations served. Many sites fit into multiple categories. In an overview of internship structures, Stedman et al. (2005) note that traditional internship training prepares students for the delivery of individual psychotherapy to adult outpatients, followed by work with child, adolescent, low-income, and seriously mentally ill patient populations, group therapy and brief therapy, and to conduct assessments with some or all of those patient populations. Less traditional and newer categories in listings for internship training include HIV/AIDS, administration, public policy/advocacy, primary care, eating disorders, sex offenders, feminist therapy, etc. Therefore, examples listed in Addendum A are not comprehensive, but illustrate major categories of internship settings.

Funding for internship training programs includes consideration of staffing (including training/supervision), office space, technology (computers, phones, recording equipment) and financial support (travel, support services, salaries, benefits). Traditional sources of funding for internship programs and intern stipends include department and agency operational budgets, revenue from service positions, grants, VA training fund, and others. In order to seek funding for internship programs and positions, consider investigating new or innovative sources of funding in addition to advocating for increased funding from traditional services. Most support for internship training has been provided by the agency offering the training program, but some non-traditional funding ideas might involve funding the intern regardless of the location or setting in which the training takes place.

Operational Budget Funds

• Fee for service.
• Contracts.
• Cost offsets.

Grants

Sources for grants include:

• Graduate Psychology Education (GPE).
• Graduate Medical Education (GME).
• Mental and Behavioral Health Education and Training.
• APA.
• Garrett Lee Smith Memorial Act of 2004.
• Department of Labor.
• Private foundation grants.

Scholarships and Supports

• Federal work study.
• State psychological associations.
• Donations from alumni and other donors.
• National Health Service Corps.
• Public Health Science Scholarship Program.

Cost-Benefit Analysis

In seeking funding to support an internship training program, it will be helpful to develop a cost-benefit analysis. Jane Levin, in her cost-benefit analysis of the University of Minnesota Counseling and Consultation Center internship program, reports that there are four models of evaluating cost and benefit:

• Cost versus revenue model (Weiskopf & Newman, 1982). This model, which was developed for a community mental health center, compares revenues generated by interns with costs of the internship training program. It is only applicable to settings where fees are collected for services.
• Fees per contact model (Rosenberg et al., 1985). This model proposes a graph whereby the “yearly cost per intern” is plotted against the “fees per contact.” The goal is to determine how many contacts an intern must have per week to offset the cost of his/her training. This model is also only applicable to fee-generating settings.
• Replacement cost model (Loucks et al., 1980). This model assesses how much it would cost if services provided by interns were delivered by senior staff, minus the cost of the training program. This model is applicable to all internship programs, whether or not the center is fee-for-service.
• Combined model (Schauble et al., 1989). This model proposes a complex mathematical formula to determine cost per service hour for interns versus cost per service hour for senior staff replacement of interns. It is most applicable to programs where there is great variability in costs and numbers of trainees from year to year.

The information below is borrowed from a range of training related sources including, but not limited to APPIC (Association of Psychology Postdoctoral and Internship Centers), APA’s CoA (American Psychological Association Commission on Accreditation), CPA (Canadian Psychological Association) and CCTC (Council of Chairs of Training Councils).

Institutional

Training programs are typically sponsored by an institution or agency whose primary functions include providing services to clientele of sufficient number and variability to meet training goals and objectives. A program may consist of, or be located under, a single administrative entity (institution, agency, school, department, etc.) or may take the form of a consortium. A consortium is comprised of multiple independently administered entities, which have, in writing, formally agreed to pool resources to conduct a training or education program. 

Role of Training Director (TD)

The program has a designated director or leader who is a psychologist, appropriately credentialed (i.e., licensed, registered or certified) to practice psychology in the jurisdiction in which the program is located, who is primarily responsible for directing the training program and has administrative authority commensurate with those responsibilities. The program director’s credentials and expertise should be consistent with the program’s mission and goals. 

Role of Supervisor

The program has formally designated intern training supervisors who: 

• Function as an integral part of the program and have primary responsibility for service delivery.
• Are sufficient in number to accomplish the program’s goals.
• Are doctoral level psychologists whose background, training and credentials are appropriate to the program’s training goals.
• Have appropriate training and expertise in clinical supervision.
• Actively participate in program planning, implementation and evaluation.
• Serve as professional role models consistent with the program’s training goals and objectives.

There is no formally agreed upon criteria for who can supervise. However, the core two hours of individual supervision must be provided by a doctoral psychologist licensed in the jurisdiction of the internship program. In addition, as noted above, supervisors’ background and training must be appropriate to the setting and services provided and have competency in clinical supervision.

Basic Internship Components

• Hours of supervision.
• Didactics (lecture or interactive instruction that is not supervision).
• Evaluation of trainees, the program ad overall program self-assessment.
• Selection.
• Research.

There are a number of legal issues facing training programs, with several resources available through the APPIC website. In addition, APPIC provides informal problem consultation (IPC) when training directors, graduate program directors or psychology trainees would like assistance in exploring options and possible solutions to a variety of issues and concerns.

Users may find the following resources helpful in addressing legal issues in training:

• Guidance for communication between graduate programs and internship programs (PDF, 39KB).
• Guidance on interview issues and privacy concerns (PDF, 42KB).
• Record keeping.
• Internship evaluation forms.
• Grievance and due process guidelines (see criterion #12).
• Due process documents.
• Problem consultation.
• Managing problem students (PDF, 74KB).
• “Conscious clause” information.
• FERPA: Family Educational Rights and Privacy Act.

All parties relevant to internship training — trainers, trainees and consumers including the general public — are concerned with the quality of psychology internships. Any proposed internship has two basic requirements: 

1. It provides quality services to the public.
2. It provides quality training to its interns.

Embedded in these requirements are assumptions that all services and training are ethical, that training experiences lead trainees toward completion of their doctoral degree requirements and licensure as psychologists, and that internship sites strive to meet the highest professional standards, including American Psychological Association (APA) or Canadian Psychological Association (CPA) accreditation. In fact, the APA Council of Representatives voted in July 2013, to adopt the resolution on accreditation for programs that prepare psychologists to provide health services, affirming,

Internal Quality Assurance

All training programs are encouraged to undergo ongoing internal self-assessment to monitor continuously their own growth and development. That includes comparing the program to local, regional, state/provincial and national standards. Important steps to internal quality control include:

• Competency benchmarks.
• Follow-through.

External Quality Assurance

One critical first step in external quality assurance is making certain that any internship experience prepares the intern for eventual licensure as a psychologist. As licensure requirements vary by jurisdiction (state, province and territory), it behooves the internship to consider a broader geographic area than just the jurisdiction in which it is located, as it will likely draw interns who will become licensed in other jurisdictions.

There are a number of organizations, memberships and accreditations that can aid in quality assurance for internship training, and even provide mentorship in the accreditation process:

• Licensure.
• Association of Psychology Postdoctoral and Internship Centers (APPIC).
• National Register of Health Service Psychologists (PDF, 249KB).
• Association of Counseling Center Training Agencies (ACCTA).
• California Psychology Internship Council (CAPIC).
• APA Commission on Accreditation (CoA).
• Canadian Psychological Association Accreditation (CPA).

For psychologists who are considering starting an internship — or who are further into the process of developing an internship or trying to improve or expand an already existing internship — some of the most important help available is through speaking directly with other psychologists who are already involved with internship training. Several established organizations such as APPIC, APA and ACCTA have both formal and informal programs established to help with the internship process, and many graduate programs and training organizations stand ready to consult with potential internship directors.

Mentoring Resources

• Association of Psychology Postdoctoral and Internship Centers (APPIC).
• American Psychological Association (APA).
• Association of Counseling Center Training Agencies (ACCTA).
• Local internship or training resources.
• Doctoral programs.
• Education and training literature.

Emergency Recovery Procedures or What To Do if….

While most of the organizations listed above under mentoring could also be helpful in a serious glitch or a major crisis, APPIC is your best resource for this, especially since many of these kinds of issues involve the viability of the internship itself. Please see Problem Consultation at the APPIC website. APPIC's email lists also offers informal problem solving with other APPIC members.