Clinic Profile: UNIVERSITY OF MONTANA
Jennifer S. Robohm, Ph.D.
Tell us about the Clinical Psychology Center
There are 23 faculty in the Psychology Department at the University of Montana, 8 of whom are Clinical faculty and 3 of whom are School/Clinical faculty. (The School/Clinical program is brand-new, and its first doctoral students enrolled this year.) There are approximately 35 clinical students in-house and on internship. The clinical training is broad-based, with specializations possible in Child/Family work and Neuropsychology. Our students attend their initial practicum at the Clinical Psychology Center (CPC) and are required to carry 3-4 cases for a full year. (Many choose to remain at the CPC for a longer period of time.) Most of our students, for both financial and training purposes, also take on one or more clinical assistantships in the community, working at the state prison, the state mental hospital, and a community health center, among other placements.
The CPC is a training, research, and service unit of the Department of Psychology’s doctoral training program in Clinical Psychology. At the CPC, clients are treated by approximately 20 practicum students at any one time, all of whom are closely supervised by licensed psychologists from the clinical faculty and the local community.
Services available at the CPC include individual, couples, and child/family psychotherapy and psychological evaluations. We also provide a range of psychotherapy groups, depending on client need and student interest. During the past few years, we’ve offered DBT skills training, men’s and women’s process groups, a meditation group, a panic disorder treatment group, an LGBT support group, and a chronic pain group.
CPC clients tend to be low- to moderate-income individuals and families who do not have health insurance and who could not otherwise afford treatment. Although housed within the University of Montana, we are a community clinic, and fewer than one third of our clients are students. (The UM has its own Counseling and Psychological Services center, but students are limited to 8 sessions of psychotherapy and then referred on, as necessary.) In a recent break-down of 73 open cases, we found that approximately 10% of our clients were Native American, with an additional 11% being other clients of color.
Do you conduct research in the clinic?
Although I had grand ideas about developing a research program at the CPC, I quickly realized that my first few years would have to be focused on the nuts-and-bolts of clinic operations: policies and procedures, documentation, collections, etc. At some point, I do hope to expand our program evaluation and outcomes research. I’d also like to look more closely at the supervision that we are providing to our students.
What is unique or notable about your clinic?
One component of our clinical program is the Indians into Psychology (InPsych) program, funded by the Indian Health Service. The main objectives of the program are to recruit, fund, and train American Indians in clinical psychology and to have them return to work on reservations with Indian people. The InPsych Program provides up to two scholarships per year to qualified candidates who are accepted into the Clinical Psychology graduate program. In 1999, the APA Directory Survey indicated that of 86,969 APA members, only 366 (0.4%) were American Indian. The University of Montana has bestowed 4 doctorates to InPsych students since the program began, and we have an additional 6 InPsych students enrolled in our Clinical program right now, 4 of whom are currently seeing clients at the CPC. The presence of these students in our program and at our clinic greatly enhances our sensitivity to the needs of our Native American students and clients.
As mentioned earlier, we are also developing a new School/Clinical program which will enable us to greatly expand the services that we provide to children and families, including testing, evaluations, and school-based services. My understanding is that ours is one of only a handful of such programs in the country.
What are the biggest challenges you face?
The mental health system in Montana is in serious trouble, and those individuals without health insurance have very few treatment options. Although the Western Montana Mental Health Center is located in Missoula and serves the Medicaid population, they have a six-month waiting list for new clients. Most psychiatrists in Missoula are not taking new private patients, and many parts of the state have no psychiatric coverage at all. There is a small psychiatric unit in our local hospital, but patients have to be transported elsewhere several hours by ambulance when there isn’t an available bed.
For the CPC, the challenges of providing mental health care in a rural community are many. (Although Missoula is considered a “big” city in Montana with 57,000 residents, we draw clients from up to several hours away.) We are faced with increasingly sick and desperate clients, and back-up services in the community are extremely limited. As the Director of a training clinic, I want my students to have good training experiences, and to work with clients for whom they feel adequately prepared. However, turning potential clients away because they do not meet our training criteria feels terrible, knowing that they really have nowhere else to go.
How do you generate income for your clinic?
We get funding for my half-time line, that of my Administrative Assistant, and that of a half-time graduate assistant through the Psychology Department and the University. For income, we rely on client fees and fees for assessments and services requested by outside agencies (e.g., Disability Determination Services, Vocational Rehabilitation Services). CPC services are provided on a sliding-fee-scale basis, with client fees based upon household income and the number of people living in the home. A recent examination of our active cases revealed that the average CPC fee was $5.50/session, with the modal fee being $3.00. (Needless to say, we are not self-sustaining!) To make up some of the difference, we also sponsor or co-sponsor continuing education workshops in the community, and all profits from those workshops go back into the clinic’s coffers.
How long have you been Director
I’ve been the CPC Director since July 2004, and I work half-time at the University. (I spend the rest of my professional time in private practice.) As I am considered staff (rather than faculty), I am not tenured, and my contract is renewed on an annual basis. I still participate in all clinical faculty meetings, and my feedback is considered in the evaluation of students and their progress.
Prior to my hiring, the clinic was run by a faculty member, on a rotating basis. (The faculty member serving as Director would get a one course buy-out to run the clinic!) Not surprisingly, the clinic is in much better shape, now that there is a designated person whose sole University responsibility it is to attend to clinic programming, policies, and procedures.
What are you looking forward to developing in your program?
During this past year, I have been running a supervision seminar with interested faculty, to enhance the supervision that we are providing at the clinic, and to create a safe forum for collegial feedback and support. (Like many psychologists, most of us have been providing supervision for years without any training.) This summer, I will also be offering a supervision seminar to our advanced students, to provide them with more opportunities for hands-on training in supervision.
Now that the clinic is running more smoothly, I would like to focus more on diversity and social justice issues within our training, programming, and clinic operations. (My work with the ADPTC Diversity Committee has helped me to appreciate some of our blindspots!)
I’m also looking forward to building our continuing education program. This coming week, we are co-sponsoring a workshop on domestic violence with Lundy Bancroft, and over 225 judges, attorneys, guardians ad litem (GALs), and custody evaluators have registered. Several of my students have been involved in the program’s organization, and it’s been a wonderful opportunity for them to see ways in which advocacy by psychologists can have a significant impact on a larger community (indeed, state-wide) level.
What is the most rewarding part of your job?
I like knowing that I am contributing to the professional development of my students, and that we are providing an invaluable service to our community. In my capacity as Director, I really emphasize documentation, record-keeping, fee-setting and collections, risk management, and other non-“sexy” (but nonetheless critical) parts of student training. I like to think that I’m helping to prepare my students for the “real” world after graduate school, as well as helping them to appreciate the complexities of these often-neglected parts of clinical training.
