The Role of Trauma Core Competencies in Shaping Clinical Psychology Graduate School Education and Training

Why are the New Haven Trauma Core Competencies important for graduate students, trainees, and psychologists? Applying a standardized set of knowledge, skills, and attitudes at all stages of professional development has the potential to improve education and training, advance standards of care, support use of evidence-based or informed practices in clinical settings, enhance delivery of care, and improve patient outcomes. Consistency in the content and quality of teaching and training programs contributes to a common shared language, defines expectations for optimal work performance, and ensures uniform quality of patient care across clinical settings.As the field of trauma psychology continues to advance, developing adequately prepared graduate students for internship training is a concern for students, faculty, universities, clinical supervisors, internship sites, and accrediting organizations.

This article describes how the New Haven Core Competencies were used to develop the Ph.D. Clinical Psychology Trauma Area of Emphasis program at Palo Alto University (PAU). It provides an overview of how the five areas of focus: 1) scientific knowledge about trauma, 2) psychosocial trauma-related assessment, 3) trauma-focused psychosocial intervention, 4) trauma-informed professionalism, and 5) trauma-informed relational and systems (Cook & Newman, 2014) were used to guide program development.

Justification for developing a Trauma Area of Emphasis was driven by student demand for advanced studies and training in this area along the growing number of internship programs offering rotations in trauma psychology. A recent search of the Association of Psychology Postdoctoral and Internship Centers (APPIC) directory using key terms to identify programs that had posted descriptions that included the word “trauma” produced 161 matches (16%) of the 1005 available internship sites. It is reasonable to anticipate that the number of trauma focused internship training opportunities will continue to grow in the years to come. To ensure that PAU clinical psychology students were well prepared for internship and possessed a solid foundation of knowledge, skills, and attitudes, administration supported the implementation of competency-based educational programming. A faculty member with research, clinical, and program development experience was hired to serve as the Director of the Trauma Area of Emphasis. The director was tasked with developing curricula and identifying training opportunities that underpin each core competency, selecting assessments to obtain a valid and reliable evaluation formeasuring learning outcomes, mentoring students, guiding dissertation research, and serving as the faculty advisor for the campus trauma club.Below is a description of various activities and endeavors at PAU that are aligned with each of the New Haven Trauma Core Competencies.

Scientific Knowledge about Trauma

Scientific knowledge of trauma is obtained from coursework and from participating as a member of one of the seven trauma-focused research labs at PAU. Trauma-focused research labs allow students to work closely with faculty in designing projects that demonstrate their ability to critically review, analyze, and expand the existing scientific literature on trauma and resilience. Lab participation supports the development of student dissertation research through collaborative and independent research endeavors that include becoming knowledgeable about human subjects protection and IRB procedures, data collection methods, data management and analysis, and publication of manuscripts in peer-reviewed journals. Examples of topics recently addressed by several of the trauma-focused research labs at PAU include fostering resilience after traumatic events, use of trauma interventions and treatments, the intersection of trauma and personality, the effects of interpersonal trauma, mindfulness and disasters, and the use of substances after traumatic events. Lab research projects are conducted locally and globally. A specific example of a local lab activity is the Early Intervention Clinic(EIC) at PAU. In this lab, students are trained and then supervised using an evidenced-based treatment with people who have experienced a trauma within the past two years. Anonymized, aggregate clinical data is available for use by the EIClab students for scientific presentations, manuscripts, and dissertations. Lab students are able to apply their knowledge in a real world setting, receive feedback on refining their clinical skills, gain experience in running a clinical trial, work with an institutional review board, and contribute to a program of research. Participation in a research lab help students nurture their scientific-mindedness and establish a foundation for their professional identity. An example of a recent collaborative international project completed by students and faculty representing two labs, Risk and Resilience Research Laband the Culture, Community, and Global Mental Health Lab, examined the effectiveness of post-trauma interventions in Central African Republic. With funding from USAID, through a grant to Catholic Relief Services, the study was designed to provide data on the psychological impact of trauma healing and peace education programs. Collaboration between labs offers PAU students extensive opportunities for professional growth by offering training and mentorship from more than one research mentor.

Comprehensive Assessment of Trauma

The second core competency, psychosocial trauma-focused assessment, addresses the importance of being able to appropriately assess and diagnose trauma-related mental health issues, note the impact that the trauma has had on the individual’s capabilities, and specify the person’s unique contextual factors (Cook & Newman, 2014). In part, PAU graduate students strive to meet this competency through specialized trauma-focused assessment courses. The Assessment of Traumacourse at PAU highlights the many ways trauma can affect functioning and provides a comprehensive overview of the screeners, assessments, and batteries that can be used for detection, evaluation, diagnosis, and for guiding treatment. PAU offers adult, child, adolescent, and family assessment courses.

Graduate students who take these courses are taught how to administer trauma-specific assessments and to demonstrate their ability to administer these assessments through experiential assignments. In addition, the trauma-focused assessment course at PAU is also designed to acquaint students with ethical issues and cultural considerations that should influence selection and administration of assessment measures by clinical interview, self-report, and informant report. In a clinical training setting, graduate students learn how to assess their clients for trauma exposure and apply their knowledge of trauma to their client’s case conceptualization and treatment plan. Specific training in this area provides graduate students with an understanding of and familiarity with trauma-specific assessment protocols in preparation for internship.

Providing Trauma-Focused Intervention

The third core competency, trauma-focused psychosocial intervention, highlights the need to address trauma-exposed individuals’ global well-being through evidence-based psychosocial interventions (Cook & Newman, 2014). For PAU graduate students, working towards this competency includes completing coursework that is required for the Trauma Area of Emphasis. The courses are sequential and begin with Foundations of Trauma, followed by Assessment of Trauma and Treatment of Trauma. Topics covered within these courses include the multifaceted presentations of trauma, considerations when assessing and treating trauma, and use of validated assessments and evidence-based treatments. These courses encourage class discussions as a way to foster consideration of client characteristics, comorbidities, culture, level of resiliency, available resources, and recovery environment. This approach allows for students to generate appropriate case conceptualizations and identify appropriate treatments for use with clients from diverse cultural backgrounds. To ensure that PAU graduate students are meeting optimal standards of quality and performance, the Trauma Area of Emphasis uses a structured approach that begins with attainment of knowledge from foundational coursework that is later applied in supervised clinical settings.

Coursework and clinical training is augmented by Trauma Grand Round lectures that are organized by a student-run organization, the Association of Traumatic Stress Studies. Trauma Grand Rounds are offered quarterly and focus on trauma-specific assessment, intervention, cutting-edge research, and professional development. Recent speakers include the deputy director for dissemination and training at the National Center for PTSD and Stanford faculty who are national experts in telemental health. Examples of topics addressed include using technology to augment existing trauma-specific treatments, identifying risk factors for childbirth-related trauma, and evidence-based care for veterans with PTSD. In addition to learning from leading experts in trauma, students have an opportunity to make professional connections, familiarize themselves with the process of earning CEUs, and become appreciative of the importance of staying up-to-date with the scientific literature at all stages in their respective careers. PAU incorporates the New Haven Core Competency of trauma-focused psychosocial intervention by creating tailored course work experiences and allowing for unique opportunities to interact with professionals with expertise in some facet of trauma research, clinical care, or program development. This individualized training curriculum allows PAU graduate students to acquire the knowledge, skills, and attitudes necessary to appropriately implement psychosocial interventions for trauma-related disorders.

Trauma-Informed Professionalism

The fourth core competency, trauma-informed professionalism, encompasses professional values and ethics, integrity, cultural humility, and ability to work effectively with traumatized populations, other professionals, and staff members (Cook & Newman, 2014). In this area graduate students work towards achieving competency by learning the APA code of ethics and then demonstrating their understanding of the ethical codes when conducting research, engaging with clients, interacting with other students and faculty, and when receiving feedback during supervision. PAU graduate students have opportunities to engage professionally through their research labs, leadership roles in student and professional organizations, and during their supervised clinical experiences. The Gronowski Center is a PAU outpatient psychology training clinic where graduate students are audio and video recorded providing therapy to their clients. Clinical supervisors review recordings and provide individual and group feedback that focuses on the development of the students’ skills and professional clinical identity. Quarterly reviews document the progress of each student’s ethical decision-making skills, ability to receive and incorporate feedback into the sessions, and skills in treating clients, including those who have experienced trauma. This competency also addresses the extent to which graduate students are able to identify ways that their client’s cultural beliefs and practices shape the expression of their trauma symptoms and influences their engagement in treatment. Students also have the option to consult with other supervisors to enhance their cultural competence. As graduate students progress through their doctoral training this competency evolves from meeting required benchmarks that indicate acquisition of knowledge and fundamental skills to the integration of ethics and cultural competence. This integration comprises a foundation component of their professional and ethical identities as early career psychologists.

Engaging With Trauma-Informed Systems

The final core competency, trauma-informed relational and systems, addresses an ability to effectively and conscientiously engage with traumatized individuals, groups, and/or communities (Cook & Newman, 2014). Evidence of making progress towards this competency is demonstrated when graduate students are able to articulate their knowledge of the debilitating effects of trauma and demonstrate their ability to respond appropriately to their clients’ experiences. Graduate students also incorporate this competency into all facets of their clinical work. One example is consulting with other professionals regarding trauma-informed treatment modalities that promote resilience, recovery, and healing. Understanding this competency also means that graduate students are able to acknowledge and demonstrate an awareness of intergenerational and cultural factors that may contribute to a trauma’s impact and address the ways that these factors could be treated. As a growing body of research continues to reveal trauma’s wide-reaching and enduring effects, the need for specialized training becomes increasingly important. PAU’s Foundations of Trauma Psychologycourse was so popular this year that an additional section needed to be added to the schedule. Graduate students from other areas of emphasis including forensics, mindfulness and meditation, and neuropsychology enrolled in the Foundations of Trauma course as a step towards applying trauma-informed care approaches into their respective areas of specialization.

By using the New Haven Core Competencies to develop PAU’s doctoral program trauma courses, graduate students are well prepared for internship. Specifically, graduate students are able to demonstrate specific abilities and meet minimal quality and performance standards, rather than relying solely on the accrual of hours and completion of coursework as a representation of readiness for the next stage in their training. The New Haven Core Competencies help supervisors and academic mentors identify the educational and experiential standards doctoral level students studying trauma should aim for as they become increasingly more independent. While successful completion of doctoral courses that are aligned with the New Haven Core Competencies is only one component of the educational and clinical training necessary to become a competent psychologist, these important competencies provide a template for lifelong learning and training.