Training Trainees to Train: A Model Approach for Doctoral Internships in

Psychology at University Counseling Centers

G. Keilan Rickard, Ph.D.Jenna Mendelson, M.A.Wendy Mathes, Ph.D.

University of North Carolina at GreensboroCounseling Center

ACCTA Conference, San Diego, CA September 2014

Learning Objectives

This program is designed to help you:• Develop strategies to prepare trainees to train

others; • Create low-cost professional development

opportunities for counseling center staff; and• Summarize the literature about ASD in college

students.

Overview

• Why train to train?• How to train to train? The ALTO Model• Example from UNCG• Training exercise

Why Train to Train?

(Rodolfa et al., 2005, p. 350)

Why Train to Train?

• Did you have graduate coursework in learning theory?

• Have you led trainings or didactic seminars?

Introduction to UNCG• UNCG

– Enrollment > 17,000. Students from 40 states and > 70 countries. – Approximately 2,500 freshmen & 1,500 transfer students each fall.– Minority enrollment is about 34 percent.

• UNCG Counseling Center– Housed in Student Health Services building– 11 full-time, licensed staff, two psychiatrists– Offers individual, couples, group counseling, outreach, consultation,

psychiatry, crisis management, & biofeedback– 2013-2014, we saw 1,282 distinct students, or 8.2% of enrolled

students (average # of individual sessions was 4)

Introduction to UNCG• UNCG Counseling Center Training Program

– Small training cohort– UNCG students pursuing master’s in social work, master’s or Ph.D. in

counseling, Ph.D. in clinical psychology– “an advanced placement and is not appropriate for students without

clinical experience” (from Counseling Center website)– Modest stipend in exchange for 20 hours/week– Moving toward APA internship

Trainee Activities• Individual, group, & couples therapy• Urgent and crisis walk ins (no after-hours on call)• Consultation• 2+ outreach activities per semester• Weekly individual supervision, case consultation, psychiatry consultation,

training seminar• SafeZone training • Special Project

Trainee’s Special Project• Supposed to meet a need of the Counseling Center• From the Training Manual:

After assessing the Center’s needs, each trainee collaborates with the appropriate staff to implement a Project. Trainees are

encouraged to think creatively and work independently on this project.

• Examples from previous years:– Increased accessibility for students with disabilities– Improved biofeedback resources – Guided meditation/mindfulness CD

Trainees’ 2014 Special Project• Early spring 2014, trainees met with Training Coordinator• Brainstormed within trainees’ areas of interest and expertise• Decided to research autism spectrum disorder and make our research

translational, relevant to our counseling center and campus

Implications for the Model

• Step One: Assessment of Needs– In the realm of trainee interests/expertise– In collaboration with Counseling Center staff and

other stakeholders

Step One: Assessment of Needs

• Do……meet with multiple employees & stakeholders…strive for best fit between training need and trainer

expertise…consider methods such as observation, surveys, &

questionnaires • Don’t…

…just hear what you expect or want to hear…just listen to the “higher ups”…fix something that ain’t broke…think you have to fix every problem

Trainees’ 2014 Special Project

• Literature Review– Websites for ASD support programs on college

campuses• Spreadsheet• Themes? Gaps?

– Scholarly/scientific literature regarding ASD in college population • Annotated lit review• Themes? Gaps?

– Writings by people with ASD– Client charts

ASD Literature

• From scholarly/scientific literature– Symptoms:• Difficulties with reciprocal social interactions (APA,

2013; Adreon & Durocher, 2007)• Difficulties with communication (APA, 2013; Adreon &

Durocher, 2007)• Restricted/repetitive behaviors & interests (APA, 2013;

Adreon & Durocher, 2007)• Sensitivity or special interest in sensory input (APA,

2013)

ASD Literature

• From scholarly/scientific literature– Prevalence

• On the rise (VanBergeijk et al., 2008)• Approximately 1% of population (American Psychiatric Association,

2013)

– Trends• Compared with other “disability groups,” ASD diagnosis is more

common with upper-middle SES and less common with lower SES (Wei et al., 2013)

• People with ASD are less likely than other “disability groups” (except ID and multiple disabilities) to enter post-secondary education (Wei et al., 2013)

• Correlation between ASD and STEM fields (Wei et al., 2013)

ASD Literature

• From scholarly/scientific literature– Common problems students with ASD face:• Voice sometimes perceived as odd (Alpern & Zager,

2007)• Campuses are designed for neurotypical students

(Beardon, 2011)• Students with ASD may foresee academic challenges

but not foresee challenges in other domains (Camarena & Sarigiani, 2009)• Friendships are shorter in duration compared to those

of neurotypical students (Jobe & White, 2007)

ASD Literature

• From scholarly/scientific literature– Common problems students with ASD face:• Sudden reduction in parental involvement and support

(Brown et al., 2012)• Lack of preparation for self-advocacy (Brown et al.,

2012)• Higher number of symptoms correlates with higher

rates of dissatisfaction with college (White et al., 2011)

ASD Support Programs on College Campuses

• Can cost upwards of $5,000 per semester• Efficacy is underresearched (Hart et al., 2010)• Common program components include:

– Independent Living Skills: Supported apartment living (meal prep/grocery shopping, laundry, cleaning, budgeting/managing money).

– Academic: Study skills, time management, tutoring, check-ins with instructors. and advising.

– Social Skills: Relationship development, communal living, conflict management, and friendships/dating.

– Health/Wellness: Exercise & recreation, healthy lifestyle choices, mental health & meds mgmt, stress mgmt, and sensory integration.

– Careers/Employment: Internships, mentors, interviewing skills, and career exploration.

(adapted from Brown et al., 2012)

ASD Support Programs on College Campuses

• Evidence of efficacy for a program that introduces students to campus resources (Andrews et al., 2012)

• Counseling Centers often identified as key resource for students with ASD

ASD Perspectives

• Largely absent from the conversation• Advice for clinicians from a person with autism

(Christmas, 2011):– Wear nametags in case the patient has difficulty

recognizing faces.– “Try not to use irony, sarcasm or figures of speech. This

will only confuse the patient with AS and you will not make progress” (p. 33).

– “Remember that strategies you take to ameliorate symptoms in a person with AS may simultaneously help other patients, too” (p. 34).

ASD Perspectives (from Beardon et al., 2009)

• “Positive” stereotypes:– Pressure to be a genius– Narrow interests can mean unusually in-depth

knowledge • Impairment vs. Strengths-based language• Bullying is common• Dating & sex

Client Charts

• Common themes• Comorbidity• Counselor expertise?

Implications for the Model

• Step Two: Literature Review– Expand definition of “literature”– Compile findings into central document(s)– Allow themes/gaps to drive research questions

and directions

Step Two: Literature Review

• Do……look in alternative “literatures”…remain organized & meticulous…go where the questions lead you

• Don’t……let “received wisdom” go unchallenged…silo information away from the team…get frustrated with rabbit holes

Trainees’ 2014 Special Project

• Development and Delivery of the Training– Setting = Weekly Case Consult meeting– Audience = Senior Staff (licensed counselors,

social workers, and psychologists)– Goal = Increase awareness and knowledge of ASD;

make our knowledge pertinent to clinical practice– Method = Collaborative/conversational

Trainees’ 2014 Special Project

• Power dynamics• Conversational• Informative• Audience as expert (subverting the usual

trainer-audience hierarchy)

Implications for the Model

• Step Three: Training– Consider audience, setting, goal, delivery, etc.– Promote learning that’s clear & practical

Step Three: Training

• Do……imagine yourself as an audience member…set yourself up to succeed (preparation)…have fun

• Don’t……worry about teaching all the things…downplay your expertise…bluff

Trainees’ 2014 Special Project

• Now what?– Feedback from senior staff

• Informal conversations evincing learning goals met• Encouragement to continue with the project

– Self-reflection• Pats on back• Coulda, woulda, shouldas

– Next steps• Revise • Research• Repurpose

Implications for the Model

• Step Four: Outcomes Assessment– Formal? Informal?– Assessment drives future trainings/projects

Step Four: Outcomes Assessment

• Do……create specific, measurable outcomes…invite open-ended comments…use the outcomes to improve future

trainings• Don’t…

…forget/neglect to gather outcomes…discount qualitative and informal measures…be discouraged by poor outcomes

Training to Train: The ALTO Model

AssessmentLiteratureTrainingOutcomes

Training Exercise

• 5 Minutes• Small Group Work• Report Back

ReferencesAdreon, D., & Durocher, J. S. (2007). Evaluating the college transition needs of individuals with high-functioning autism spectrum disorders. Intervention in school and clinic, 42(5), 271-279.

Alpern, C., & Zager, D. (2007). Addressing communication needs of young adults with autism in a college-based inclusion program. Education and training in developmental disabilities, 42(4), 428-436.

American Psychiatric Association (2013). DSM-5. Washington, DC: American Psychiatric Publishing.

Andrews, J, Clark, R., & Thomas, L. (Eds.). (2012). Compendium of effective practice in higher education retention and success. Birmingham & HEA, York: Aston University Press.

Beardon, L., Martin, N., & Woolsey, I. (2009). What do students with Asperger syndrome or high-functioning autism want at college and university? (in their own words). Good autism practice, 10(2), 35-43.

Brown, J. T., Wolf, L. E., King, L., & Bork, G. R. K. (2012). The parent’s guide to college for students on the autism spectrum. Shawnee Mission, Kansas: AAPC Publishing.

Camarena, P. M., & Sarigiani, P. A. (2009). Postsecondary educational aspirations of high-functioning adolescents with autism spectrum disorders and their parents. Focus on autism and other developmental disabilities, 24(2), 115-128.

Christmas, J. (2011). Mental health services and me: What worked, and what didn’t. In L. Beardon and D. Worton (Eds.), Aspies on mental health: Speaking for ourselves (17-35). London and Philadelphia: Jessica Kingsley Publishers.

Hart, D., Grigal, M., & Weir, C. (2010). Expanding the paradigm: Postsecondary education options of individuals with autism spectrum disorder and intellectual disabilities. Focus on autism and other developmental disabilities, 25(3), 134–150.

Jobe, L. E., & White, S. W. (2007). Loneliness, social relationships, and a broader autism phenotype in college students. Personality and individual differences, 42, 1479-1489.

Noe, R. A. (2010). Employee training and development (5th ed.). New York: McGraw-Hill/Irwin.

Rodolfa, E., Bent, R., Eisman, E., Nelson, P., Rehm, L., & Ritchie, P. (2005). A Cube Model for Competency Development: Implications for Psychology Educators and Regulators. Professional Psychology: Research and Practice, 36(4), 347-354.

VanBergeijk, E., Klin, A., & Volkmar, F. (2008). Supporting more able students on the autism spectrum: College and beyond. Journal of autism and

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Wei, X., Yu, J. W., Shattuck, P., McCracken, M., & Blackorby, J. (2013). Science, technology, engineering, and mathematics (STEM): Participation among college students with an autism spectrum disorder. Journal of autism and developmental disorders, 43, 1539-1546.

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Further Reading on ASDArscott, W. (2013). Students with learning and developmental disabilities in post secondary education. In M. Kompf & P. M. Denicolo (Eds.), Critical issues in

higher education (pp. 115-125). Rotterdam: Sense Publishers.Ashby, C. E., & Causton-Theoharis, J. (2012). “Moving quietly through the door of opportunity”: Perspectives of college students who type to communicate.

Equity & excellence in education, 45(2), 261-282.Autism Self Advocacy Network (2013). Empowering leadership: A systems change guide for autistic college students and those with other disabilities.

Washington, DC: Autism Self Advocacy Network.Beardon, L., Martin, N., & Woolsey, I. (2009). What do students with Asperger syndrome or high-functioning autism want at college and university? (in their

own words). Good autism practice, 10(2), 35-43.Broderick, A. A., & Ne’eman, A. (2008). Autism as metaphor: Narrative and counter narrative. ‐ International journal of inclusive education, 12(5-6), 459-476.Chiang, H. M., Cheung, Y. K., Hickson, L., Xiang, R., & Tsai, L. Y. (2012). Predictive factors of participation in postsecondary education for high school leavers

with autism. Journal of autism and developmental disorders, 42(5), 685-696.Dente, C. L., & Coles, K. P. (2012). Ecological approaches to transition planning for students with autism and Asperger’s syndrome. Children & schools, 34(1),

27-36. Dolyniuk, C. A., Kamens, M. W., Corman, H., DiNardo, P. O, Totaro, R. M., & Rockoff, J. C. (2002). Students with developmental disabilities go to college:

Description of a collaborative transition project on a regular college campus. Focus on autism and other developmental disabilities, 17(4), 236-241.Greenbaum, A. (2010). Nurturing difference: The autistic student in professional writing programs. The journal of the assembly for expanded perspectives on

learning, 16(1), 40-47.Gobbo, K., & Shmulsky, S. (2014). Faculty experience with college students with autism spectrum disorders: A qualitative study of challenges and solutions.

Focus on autism and other developmental disabilities, 29(1), 13-22.Hart, D., & Grigal, M. (2009). Students with intellectual disabilities in postsecondary education: The question of “otherwise qualified.” In M. L. Vance & L.

Bridges (Eds.), Students with disabilities: Striving for universal success (2nd ed., pp. 37-46). Manhattan, KS: National Academic Advising Association.Hendricks, D. R., & Wehman, P. (2009). Transition from school to adulthood for youth with autism spectrum disorders: Review and recommendations. Focus

on autism and other developmental disabilities, 24(2), 77-88.Mazzotti, V.L., Rowe, D.A., Kelley, K.R., Test, D.W., Fowler, C.H., Kohler, P.D., & Kortering, L.J. (2009). Linking transition assessment and postsecondary goals:

Key elements in the secondary transition process. Teaching exceptional children, 42(2), 44-51.

Further Reading on ASDMcGuire, A. (2012). Representing autism: A sociological examination of autism advocacy. Atlantis: Critical studies in gender, culture & social justice, 35(2),

62-71.Nevill, R. E. A. & White, S. (2011). College students’ openness toward autism spectrum disorders: Improving peer acceptance. Journal of autism and

developmental disorders, 41, 1619-1628.Roberts, K. D. (2010). Topic areas to consider when planning transition from high school to postsecondary education for students with autism spectrum

disorders. Focus on autism and other developmental disabilities, 25(3), 158–162.Shattuck, P. T., Narendorf, S. C, Cooper, B., Sterzing, P. R., Wagner, M., & Taylor J.L. (2012) Postsecondary education and employment among youth with an

autism spectrum disorder. Pediatrics, 129(6), 1042-1049.Taylor, J. L., & Mailick, M. R. (2014) A longitudinal examination of 10-year change in vocational and educational activities for adults with autism spectrum

disorders. Developmental psychology, 50(3), 699-708.Taylor, J. L., & Seltzer, M. M. (2011). Employment and post-secondary educational activities for young adults with autism spectrum disorders during the

transition to adulthood. Journal of autism and developmental disorders, 41(5), 566-574.Test, D. W., Smith, L. E., & Carter, E. W. (2014). Equipping youth with autism spectrum disorders for adulthood: Promoting rigor, relevance, and

relationships. Remedial and special education, 35(2), 80-90.Tipton, L. A., & Blacher, J. (2014). Brief report: Autism awareness: Views from a campus community. Journal of autism and developmental disorders, 44(2),

477-483.VanBergeijk, E. O., & Cavanagh, P. K. (2012). Brief report: New legislation supports students with intellectual disabilities in post-secondary funding. Journal

of autism and developmental disorders, 42(11), 2471-2475.Zager, D., & Alpern, D. S. (2010). College-based inclusion programming for transition-age students with autism. Focus on autism and other developmental

disabilities, 25(3), 151-157.