SURVEY OF NATIONALLY CERTIFIED SCHOOL PSYCHOLOGISTS’ ROLES AND TRAINING IN PSYCHOPHARMACOLOGY

Psychology in the Schools, Vol. 51(7), 2014 C© 2014 Wiley Periodicals, Inc.View this article online at wileyonlinelibrary.com/journal/pits DOI: 10.1002/pits.21776

SURVEY OF NATIONALLY CERTIFIED SCHOOL PSYCHOLOGISTS’ ROLES ANDTRAINING IN PSYCHOPHARMACOLOGY

JEFFREY D. SHAHIDULLAH AND JOHN S. CARLSON

Michigan State University

A randomly selected group of Nationally Certified School Psychologists (NCSPs; n = 817) weremailed the 42-item School Psychopharmacology Roles and Training Evaluation (SPRTE) whichinquired about their caseloads, practice roles as proposed by DuPaul and Carlson (2005), andprior training in psychopharmacology. A modified Tailored Design Methodology (TDM; Dillman,Smyth, & Christian, 2009), involving four mail-based contacts, was used to yield a 74% surveyreturn rate (n = 607). Of the returned surveys, a 72% (n = 548) usable response rate was ob-tained and used in the present study. Consistent with prior literature, nearly all (99.6%) schoolpsychologists reported serving at least one student taking psychotropic medication. Primary directservice roles included monitoring behavioral response to psychotropic treatment (28%), monitoringtreatment side-effects (23%), and developing psychotropic treatment goals from direct assessmentmeasures (14%). Primary indirect service roles included providing behavior management con-sultation to teachers of students taking medication (96%), implementing adjunctive psychosocialsupports (87%), and providing assessment data to physicians for diagnostic purposes (84%). De-spite differences in established psychopharmacological training standards, actual practice roles andtraining received did not differ between NCSPs from APA-accredited programs and those fromNational Association of School Psychologists (NASP)-approved programs. Implications for schoolpsychopharmacology practice, training and research are addressed. C© 2014 Wiley Periodicals, Inc.

An important macrosystem variable in contemporary mental health service delivery to childrenand adolescents that school psychologists must acknowledge is the increased prevalence of treat-ments, such as psychotropic medication, that occur outside the school setting (Thomas, Conrad,Casler, & Goodman, 2006). With appropriate implementation procedures and safeguards in place,the use of psychotropic medication can be a safe and efficacious intervention for children whofail to respond to school-based services (Pappadopulos, Guelzow, Wong, Ortega, & Jensen, 2004).However, when these medications are prescribed, monitored, or evaluated inappropriately, their sideeffects and adverse reactions may adversely affect school performance and health (Food and DrugAdministration, 2004; Kubiszyn, Mire, Dutt, Papathopoulos, & Burridge, 2012).

Available psychotropic-prescribing physicians working with children cannot always employlong-term medication monitoring, evaluation, and follow-up procedures, given their large caseloadsand time constraints. Commonly, these physicians prescribe psychotropic medication outside theschool setting and are unable to observe treatment effects within the school, where children typicallypresent with a wide array of academic, behavioral, and social–emotional difficulties. Without anestablished line of communication and rapport with school staff, it is difficult to determine whetherand when medications require titration in determining a therapeutic dose-response or discontinuationdue to ineffectiveness, adverse effects, or contraindications. These issues underscore the need fortreatment decision making to include communication and collaboration with school personnel toensure needs are addressed, both outside and within the school setting, and that students receive themaximum benefit with minimal risks from these medications.

Trained in psychological assessment and intervention, program evaluation, and consultationusing data-based decision-making approaches, many in the field of school psychology (e.g., Ball,

This research was supported through funding provided by the College of Education, the Graduate School, andthe School Psychology Program at Michigan State University.

Correspondence to: Jeffrey D. Shahidullah, Michigan State University, School Psychology Program, 620 FarmLane, 435 Erickson Hall, East Lansing, MI 48824. E-mail: [email protected]

705

706 Shahidullah and Carlson

Kratochwill, Johnston, & Fruehling, 2009; DuPaul & Carlson, 2005; Gureasko-Moore, DuPaul, &Power, 2005; Kubiszyn, 1994; Roberts, Floress, & Ellis, 2009) recognize the advantageous positionthat school psychologists are in to provide improved accountability to physician-initiated medicationplanning, implementation, and evaluation within schools. This accountability includes collaborativeassessment protocols, whereby diagnostic accuracy is enhanced and treatments are individualized,implemented with fidelity, and empirically monitored to ensure high-quality care. Most schoolpsychologists work directly with students taking psychotropic medication (Carlson, Demaray, &Hunter-Oehmke, 2006; Kubiszyn & Carlson, 1995) and already have established rapport with thesestudents and their families through previous correspondence within counseling, consultation, re-ferral, and/or other entitlement meetings. With this rapport, they are well positioned to advocatefor a student’s treatment needs, facilitate cross-setting communication, and support school-basedtreatment monitoring and evaluation by collaborating with physicians to integrate academic, behav-ioral, and pharmacological interventions into a comprehensive treatment plan that ensures sustainedlong-term progress with the lowest therapeutic dose (Evers, 2011).

Although it is clear that there are roles for school psychologists to play in providing safe andeffective supports to students taking medication, for many practitioners, there is uncertainty andambiguity as to what their appropriate role should be in light of their training competencies and localand federal guidelines regarding involvement in medication-related matters. To provide clarity as towhich roles are considered appropriate and which roles are not for school psychologists to undertake,DuPaul and Carlson (2005) offered of an extensive list of roles related to working with students takingpsychotropic medication. Specifically, this articulation of school psychopharmacological roles waspresented in the context of what services school psychologists may reasonably be able to providebased on both their training and relevant ethical and legal guidelines.

Regarding training, DuPaul and Carlson (2005) refer specifically to the American Psycho-logical Associations’ (APA) conceptualization of psychopharmacology training, which consists asa continuum of three levels: Level 1—Psychotropic Information Provider (most common level):School psychologists in this role can provide indirect services by working with families, teachers,and physicians within a consultative capacity to inform and enhance data-based treatment decisionmaking regarding the use of medication; Level 2—Psychotropic Monitor/Evaluator: School psy-chologists in this role can provide direct services by using standardized quantitative approachesof applied psychological practice in assessment or intervention, such as monitoring and evaluatingthe effects of medication on student performance; and Level 3—Prescriptive Authority: This allowsappropriately trained personnel to prescribe psychotropic medication, usually under the supervisionof a physician and limited to the scope of their practice (Smyer et al., 1993).

Given the critical indirect and direct psychopharmacological service roles that school psychol-ogists can undertake, which are legally and ethically contingent on the training they have received(APA, 2010; National Association of School Psychologists [NASP], 2010b; Shahidullah, 2014), it isimportant to empirically investigate their training competencies to undertake these roles. Obtainingadditional information about these important issues from practicing school psychologists across thecountry contributes to the current empirical knowledge base pertaining to school psychopharmacol-ogy (e.g., Carlson et al., 2006; Gureasko-Moore et al., 2005).

The purpose of this study was to (1) empirically investigate the psychopharmacological practiceroles proposed in the school psychology literature (DuPaul & Carlson, 2005), (2) identify the typesof psychopharmacological training that school psychologists currently receive within their graduateprogram, and (3) assess the practice role and training differences between school psychologists fromdifferent degree and accreditation types. To elicit these data, the School Psychopharmacology Rolesand Training Evaluation (SPRTE) was distributed to a national sample of 817 Nationally CertifiedSchool Psychologists (NCSPs) who practice presently in schools. Data elicited by the SPRTE

Psychology in the Schools DOI: 10.1002/pits

Roles and Training in Psychopharmacology 707

provides the field of school psychology with an assessment of how training within university-based school psychology graduate programs aligns with potential practice roles, as delineated byDuPaul and Carlson (2005). These potential roles that appropriately trained school psychologistsmay undertake in working with students taking medication are compared with practice roles reportedby presently practicing school psychologists and the training they receive to perform those roles.

METHOD

Participants

A randomly selected national sample of NCSPs was recruited for study participation. A surveyreturn rate of 74% (n = 607 of 817 sent) was obtained. Of the returned surveys, 59 respondentsindicated either their refusal or inability to participate by checking a box at the front of the surveyand returning it or failing to complete enough of the survey that would deem it complete and usable.The criterion for whether a returned survey was complete and usable was if at least 80% of thesurvey (34 of 42 items) was completed. A complete and usable response rate of 72% (n = 548 of 758sent; adjusted denominator to account for the 59 respondents who did not provide usable responses)was obtained.

The background and caseload information of the 548 participants in this study are summarizedin Table 1. When applicable, background and caseload information from participants in the presentstudy are compared with previous NASP membership survey results (Castillo, Curtis, Chappell, &Cunningham, 2011; Curtis et al., 2008; NASP, 2001).

Most (84%) respondents held a masters, specialist, or Certificate of Advanced Graduate Studydegree (i.e., nondoctoral group), whereas 16% held a doctorate as their highest degree. Of those witha doctorate, 87% had earned it in the field of school psychology, with 65% of those earning it froman APA-accredited program. Also, 63% of participants had a specialist degree in school psychology,with 92% of those earning it from a NASP-approved program. Although most respondents held theirhighest degree in the field of school psychology (95%), some (5%) held their highest degree in othersubfields (e.g., clinical, educational psychology). The present study included more nondoctoral-levelpractitioners than did a NASP membership survey (75%; Curtis et al., 2008). The mean years ofexperience as school psychologists was 13.2 (SD = 10.6; range, 1 to 47) years. The mean years ofexperience in this study was similar to the 14.8 years of the 2004–2005 NASP membership survey(Curtis et al., 2008).

By geographic region of the United States, 27% (78% nondoctoral; 22% doctoral) of participantspracticed in the Northeast, 30% (86% nondoctoral; 14% doctoral) practiced in the Southeast, 25%(87% nondoctoral; 13% doctoral) practiced in the Central Region, and 17% (83% nondoctoral; 17%doctoral) practiced in the West Region. By type of work site, 20% practiced in urban settings, 55%practiced in suburban settings, and 25% practiced in rural settings. This geographic and type of worksite ratio is similar to that of Curtis and colleagues’ (2008) study.

Most practitioners’ (33%) caseload size ranged between 1,001 and 2,000 students. Additionally,28% of practitioners served between 501 and 1,000 students; 22% served 500 students or fewer;and 13% served 2,000 or more students. The average caseload size was 1,224.8 (SD = 968.3)and ranged from six to 6,600 students. Sixty percent of the students they served were in specialeducation. Participants indicated that 23% (SD = 20.5) of their caseloads were taking prescribedpsychotropic (e.g., stimulants, antidepressants, antipsychotics, anxiolytics) medication. The percent-age of caseloads prescribed medication ranged from 0% to 95%. Specifically, 2% of participantsindicated that between 76% and 100% of their caseload were taking medication; 7% indicated thatbetween 51% and 75% of their caseload were taking medication; 21% indicated that between 26%and 50% of their caseload were taking medication; 49% indicated that between 6% and 25% of



Table 1Background and Caseload Information

Current Sample NASP MembershipItem % n %

Area of Highest DegreeSchool Psychology 95 522 –Educational Psychology <1 2 –Clinical Psychology <1 5 –Other 3 19 –

Degree Type in School PsychologySpecialist/Master’s Degree 84 459 76a

NASP-Approvedb 92 315 –Doctoral Degree 16 89 24a

APA-Accredited 65 50 –Mean Years Since Degree/Graduation Year

1995 or Earlier 29 156 –After 1995 70 385 –

Years in Practice0–5 31 167 30c

6–10 23 124 16c

11–15 13 73 14c

� 16 33 182 28c

School Site LocationRural 25 134 24d

Suburban 55 301 43d

Urban 20 111 27d

Approximate Number of Students Served�500 22 123 –501–1,000 28 153 –1,001–2,000 33 181 –�2,000 13 72 –

Percentage of Caseload Served Taking Psychotropic Medication0 <1 2 –1–5 20 96 –6–25 49 234 –26–50 21 101 –51–75 7 33 –75–100 2 9 –

Percentage of Caseload Served in Special Education0 1 3 –1–25 27 144 –26–50 14 74 –51–75 15 81 –76–99 35 186 –100 9 49 –

Note. Values that do not add up to the total group n are due to unreported data.aCurtis et al., 2008. bReflects only specialist-degree respondents. cNASP, 2001. dCastillo, Curtis, Chappell, & Cunningham,2011.



their caseload were taking medication; 20% indicated that between 1% and 5% of their caseloadwere taking medication; and fewer than 1% indicated that no student on their caseload was takingmedication. These results suggest that more than 99% of participants had at least one student thatreceived psychotropic treatment.

Instrumentation

The SPRTE is a 42-item survey developed by study investigators to identify the psychopharma-cological roles that school psychologists undertake and the training they receive. The SPRTE assessespractice information along a continuum of involvement, from providing psychotropic informationand education to parents and teachers, to collaboratively monitoring and evaluating medication ef-fects with a physician, to prescribing medication under the supervision of a physician. Additionally,it assesses the type and amount of psychopharmacological training that school psychologists havereceived both within and outside of their formal university-based graduate training program. TheSPRTE is organized into the following three sections:

Background and Caseload Information. This section consisted of 11 items designed to elicitinformation regarding participants’ primary employment setting, employment setting type, fieldof degree, year of degree, years in practice, and state of practice. This section also identifies thenumber, setting, and grade range of students they serve and the percentage of those students takingpsychotropic medication.

Practice Information. This section consisted of 19 items designed to identify the various rolesthat school psychologists undertake in working with students prescribed psychotropic medication.Participants were instructed to answer these items based on their roles throughout the 2011–2012school year.

Training Information. This section consisted of 12 items designed to identify the types oftraining and education in psychopharmacology that school psychologists have obtained both withinand outside of their university-based graduate programs.

Item development was based largely on a review of Carlson and colleagues’ (2006) survey usedto identify school psychologists’ knowledge and training in psychopharmacology. Also, specificsurvey items related to practice roles (items 12–30) were developed directly from DuPaul andCarlson’s (2005) review of possible roles for school psychologists working with students withprescribed psychotropic medication.

The SPRTE includes a variety of item formats, including 36 multiple-choice items and sixsupply items, which ask respondents to list the year in which they earned their degree, state in whichthey currently practice, years in which they have practiced, total number of students on their caseload,approximate percentage of students on their caseload who are taking psychotropic medication, andpercentage of their student caseload served in special education. A pilot study using this instrumentwas conducted with a group of currently licensed and practicing school psychologists in Texas.Some modifications were made to the survey (e.g., item wording, response options, format) with therespondent feedback. It was determined that the survey took approximately 10 minutes to complete.

Procedure

After approval by the Michigan State University Institutional Review Board, a modifiedTailored-Design Methodology (TDM; Dillman, Smyth, & Christian, 2009), a research-based dataelicitation strategy, was used to distribute the survey to 817 participants, using up to four mail-basedcontacts (i.e., pre-notice letter, survey, follow-up postcard, replacement survey), which included a $2bill as an unconditional incentive. The TDM was modified by omitting the use of a fifth participant



contact via a phone call to participants because participants were likely already out of their officesfor summer break.

Participants were recruited from the NCSP database listed on the NASP website. The NCSPcredential is issued by the NASP National School Psychology Certification System. The NCSPdatabase comprised 13,156 individuals and the school districts they worked for. One thousandnames were randomly selected from the database, and an Internet search was conducted with eachto (1) verify the current school district mailing address, and (2) verify they met the study’s inclusioncriteria set to include NCSPs practicing as school psychologists (2011–2012 school year), either fullor part time in kindergarten-through-12th-grade schools. School psychologists working in privatepractice, agencies, or organizations were ineligible, but school psychologists employed by privateor charter schools were eligible.

In addition to descriptive statistics to report prevalence rates of practice roles and train-ing, a Pearson chi-squared test of independence was conducted using a 95% level of confidence(α = .05) to assess for statistically significant role or training differences between nondoctoral- anddoctoral-level school psychologists and between NASP-approved and APA-accredited programgraduates. Although many doctoral-level programs are dually accredited by both APA and NASP,the results in the following sections regarding accreditation differences focus specifically on NASP-approval for nondoctoral-level programs and APA-accreditation for doctoral-level programs.

RESULTS

Reported Psychopharmacology Involvement

The reported psychopharmacological practice roles of the 548 participants in this study aresummarized in Table 2. The most common practice roles participants undertook in working withstudents taking psychotropic medication included providing teacher consultations (94%), assessingemotional or behavioral problems that may warrant medication (93%) and providing this informationto families (83%) and physicians (84%), and implementing school-based interventions as adjunctsto medication (87%). Other common practice roles included providing intervention monitoring data(e.g., academic performance rating scales, side effect checklists, systematic direct behavior obser-vations) to physicians (74%), contacting and/or initiating consultative or collaborative relationshipswith physicians (63%), providing parent consultation to ensure medication treatment adherence andcompliance (56%), and having “face-to-face” follow-up with a student soon after initiation of amedication trial (53%).

Less common practice roles included working collaboratively with physicians in diagnosticdecision making or determining the need for psychotropic medication (40%), providing physicianswith periodic updates regarding a student’s progress (36%), being contacted by physicians regardinga student’s medication regimen (30%), interpreting and/or sharing results of medication monitoringprotocols with families, school staff, and/or physicians (27%), notifying physicians when a med-ication change or dosage titration may be needed (24%), collecting progress-monitoring data oftreatment side effects (23%), consulting with physicians regarding an initial medication type ordosage amount (16%), identifying or developing intervention goals (14%), and using systematicschool-based medication evaluation protocols (3%). School psychologists did not report that theyprescribed psychotropic medication, either independently or under the supervision of a physician.However, participants were instructed to answer this item only if they practiced in Louisiana or NewMexico, as those are currently the only states in which psychologists have prescriptive authority.

Chi-squared analyses confirmed no significant differences (df = 1; p < .05) between thenumber of nondoctoral (n = 459) and doctoral-level (n = 89) practitioners who undertook spe-cific psychopharmacology practice roles. Also, there were no significant practice role differences



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between practitioners who matriculated from NASP-approved programs compared with those whomatriculated from APA-accredited programs.

Reported Psychopharmacology Training

The training information of the 548 participants in this study is summarized in Table 3. Fewerthan 23% of respondents had taken a psychopharmacology course in their graduate training program.Even fewer (14%) had taken a course specifically on child and adolescent psychopharmacology.Fewer than a quarter of participants acknowledged that a course on psychopharmacology was avail-able at their school. However, about twice as many doctoral- (40%) as nondoctoral-level programs(21%) were reported to have this coursework available. Also, fewer than half (48%) of participantsindicated that the biological basis of behavior, biopsychology, or psychopharmacology courseworkwas a program requirement.

The mean overall response indicated that 37% (SD = 28.9) of participants’ training in psy-chopharmacology came through independent study (e.g., scholarly journals, books, videos), withmore than a quarter of participants (26%) indicating that this modality accounted for more than halfof their training and 2% indicating that it accounted for all of their training in psychopharmacol-ogy (range, 0%–100%). Nondoctoral- (37%) and doctoral-level (36%) practitioners obtained nearlyidentical percentages of their psychopharmacology training through independent study.

The mean overall participant response indicated that 35% (SD = 26.8) of their psychopharma-cology training was obtained “on the job” (e.g., conversations with other mental health and medicalpersonnel), with almost one-fifth of participants (18%) indicating that this modality accounted formore than half of their training and 2% indicating that it accounted for all of their training inpsychopharmacology. The range for on-the-job training was 0 to 100%. A higher percentage of non-doctoral practitioners (36%) reported that their training was obtained on the job than doctoral-levelpractitioners (30%).

Chi-squared analyses confirmed no significant training differences (df = 1; p < .05) betweenthe number of nondoctoral- and doctoral-level practitioners who reported to have taken specific typesof psychopharmacology training. Also, no significant differences were found in university trainingbetween practitioners graduating from NASP-approved and APA-accredited programs. However,regarding outside-of-program training, APA-accredited program graduates were significantly morelikely to obtain additional training through a workshop or in-service program, χ2 (197) = .009, p >

.05, than were NASP-approved program graduates.

DISCUSSION

The purpose of this study was to examine the results from a national survey of randomlyselected practicing NCSPs (n = 548). This investigation continued the prior survey work pertainingto school psychopharmacology (Carlson et al., 2006; Gureasko-Moore et al., 2005) and provides aunique contribution to the literature by empirically investigating the proposed medication evaluationpractice roles described within the school psychology literature by DuPaul and Carlson (2005).In addition, the prevalence of training received across an array of recommended training types(APA-conceptualized Levels 1–3) was examined more comprehensively than prior work in this area.Finally, this is the first study to quantify the extent of practice and training differences betweendegree and accreditation types. This study’s use of best practice in survey methodology and theresulting 72% response rate from practicing NCSPs clearly distinguishes it from previous surveystudies (e.g., Carlson et al., 2006, 37% response rate; Gureasko-Moore et al., 2005, 65% responserate). By minimizing nonresponse and selection bias, the response rate of this survey-based studyyields a high degree of generalization to school psychologists who hold the NCSP credential.



Tabl

e3

Scho

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sych

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ists

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ng,D

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ccre

dita

tion

Type

Tota

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ondo

ctor

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ral

NA

SP-

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rove

dbA

PA-A

ccre

dite

d(n

=54

8)(n

=45

9)(n

=89

)(n

=31

5)(n

=50

)

%n

%n

%n

χ2/p

Val

uea

%n

%n

χ2/p

Val

uea

With

inG

radu

ate

Deg

ree

Prog

ram

Tra

inin

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lbas

is/is

sues

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logi

cald

isor

ders

cour

se

7440

473

332

8172

χ2

=2.

64p

=.1

175

253

8745

χ2

=3.

53p

=.0

6

Psyc

hopa

thol

ogy

cour

se81

446

8036

789

79χ

2=

3.56

p=

.06

8027

090

47χ

2=

3.15

p=

.08

Evi

denc

e-ba

sed

inte

rven

tions

cour

se74

403

7434

368

60χ

2=

1.63

p=

.20

8127

375

39χ

2=

.86

p=

.36

Psyc

hoph

arm

acol

ogy

cour

se23

124

2310

027

24χ

2=

1.12

p=

.29

2170

2513

χ2

=.5

1p

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8C

hild

and

adol

esce

ntps

ycho

phar

mac

olog

yco

urse

1476

1465

1311

χ2

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8p

=.6

714

4610

5χ

2=

.55

p=

.46

Out

side

ofG

radu

ate

Deg

ree

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ram

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gPs

ycho

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mac

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urse

3519

133

152

4439

χ2

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65p

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621

7127

14χ

2=

.95

p=

.33

Mul

tiple

cour

ses

One

cour

sePo

rtio

nsof

aco

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14 13 8

74 72 42

12 13 8

55 58 35

19 16 8

17 14 7

17 3 1

33 5 2

13 19 4

9 7 3Ps

ycho

phar

mac

olog

yin

-ser

vice

c76

416

7534

382

73χ

2=

2.17

p=

.14

4816

267

35χ

2=

6.77

p=

.01

Inde

pend

ents

tudy

9249

892

419

9279

χ2

=.0

2p

=.8

930

102

3920

χ2

=1.

44p

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3O

n-th

e-jo

btr

aini

ng96

515

9643

395

82χ

2=

.08

p=

.78

7324

677

40χ

2=

.44

p=

.51

Not

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orks

hops

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type

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inde

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with

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Survey results indicated that nearly all (99.6%) school psychologists have students who aretaking psychotropic medication on their caseloads. Further, this population segment accounts fornearly a quarter (23%) of their total caseloads, mirroring the findings of Carlson and colleagues’(2006) study. These data highlight the prevalence of youth prescribed medication in the schoolsetting and call attention to the need for knowledge and training in school psychopharmacology.

This empirical investigation of NCSPs’ involvement in the proposed medication-related rolesdescribed by DuPaul and Carlson (2005) found that school psychologists actively participate inboth direct (i.e., using standardized quantitative approaches of applied psychological practice inassessment or intervention regarding psychotropic medication) and indirect (i.e., working withfamilies, teachers, and physicians within a consultative capacity to inform and enhance treat-ment decision making regarding the use of psychotropic medication) roles. These direct and in-direct roles involve working with multiple clients and consultees. Specifically, in working withstudents, most NCSPs reported implementing adjunctive interventions to provide comprehensivesupport to foster sustained treatment effects with the lowest therapeutic dose. They also provideface-to-face follow-up with students soon after initiating a medication trial to assess their adjust-ment to change and/or possible side effects. In working with families, most NCSPs reported pro-viding consultation in determining the need for medication, facilitating a family-initiated physicianreferral, and promoting treatment adherence and compliance. In working with teachers, most NC-SPs provided consultation on the management of academic, social, emotional, and/or behavioralexpectations, and/or difficulties that may result from students taking medication. In working withphysicians, most NCSPs reported sharing assessment data, such as cognitive or academic achieve-ment information, side effect monitoring protocols, or data gathered from direct observation.

Regarding training, similar to results from Carlson and colleagues (2006) and Gureasko-Mooreand colleagues (2005), most NCSPs’ training in psychopharmacology appears to come throughnonformal modalities, such as in-service workshops and independent study. A consensus findingamong the present study and these previous studies appears to be the lack of access to formal trainingopportunities. Gureasko-Moore and colleagues (2005) found that only 14% of school psychologistshad received formal graduate training in medication monitoring. In Carlson and colleague’s (2006)study, although only 20% of participants took a university-based psychopharmacology course, thiscoursework was only available in fewer than a quarter of the respondents’ respective institutions.Similarly, the present study found that although 23% of participants had taken a psychopharma-cology course, only 24% indicated that this coursework was offered at their institution. Whereasdoctoral-level practitioners were more likely to take graduate psychopharmacology coursework, re-sults suggest that this coursework is about twice as likely (40%) to be available within doctoral-levelthan nondoctoral-level programs (21%). However, this finding is likely explained by the longerlength of training (5–6 years) in doctoral-level programs compared with nondoctoral-level programs(�3 years).

Results of the present study verified a widespread reliance on training that occurs outsideof graduate school. For example, the four most common psychopharmacology training modalitiesreported were on-the-job training (96%), followed by independent study (93%), professional work-shops (76%), and coursework outside of the graduate program (35%). Although these options areideal as ancillary modalities, they are not substantive replacements for training regarding the up-take and transportability of evidence-based interventions (e.g., medical interventions) into schoolsthat can occur within graduate programs (Kratochwill, 2007). Specifically, the provision of psy-chopharmacology training in school psychology graduate programs, where nearly all practitionersmatriculate, is ideal, given their ability to provide a standardized curriculum, especially as theyuphold accreditation requirements.



Although appropriately trained school psychologists may be uniquely qualified to serve aspsychotropic “knowledge brokers” among the home, school, and medical provider (Kubiszyn, 2011),this “appropriate training” is evidently not acquired simply by one’s matriculation through a graduateprogram in school psychology. Rather, it appears that school psychologists’ qualification to fulfillLevel-1 and Level-2 service roles derive from obtaining supplemental training and education. Theimpetus for obtaining this additional training appears to ensue from the interface among threefactors: (1) school psychologists’ understanding that the potential for positive and negative effectsof medication are likely to manifest within the school setting; (2) their knowledge of the importanceof training in psychopharmacology (Carlson et al., 2006); and (3) their uncertainty regarding theirown skill development in psychopharmacology (Carlson et al., 2006).

This study is the first in the field to directly assess specific psychopharmacology practice rolesalong a continuum of involvement from what APA refers to as Level-1 (providing psychotropic in-formation), Level-2 (monitoring and evaluating medication), and Level-3 (prescribing medication)roles. By including this continuum of involvement, the present study distinguishes those involvedin treatment decision making from those involved in the provision of information and monitoring,evaluating, and implementing adjunctive and follow-up care. Compared with the potential practiceroles delineated by DuPaul and Carlson (2005), at least one school psychologist reported undertakingevery role offered, except prescribing medication. The most frequently reported roles included pro-viding assessment data to families and physicians, implementing adjunctive psychosocial supports,and engaging in behavior management consultation with teachers working with students takingmedication.

Similar to the study by Carlson and colleagues (2006), the present study found that approxi-mately one fifth of nondoctoral-level practitioners had taken a university-based psychopharmacol-ogy course and received most of their training from independent study and professional workshops.Also, only a quarter of doctoral-level practitioners had taken a university-based psychopharmacologycourse and received most training from independent study and on-the-job experience. It is difficultto determine the trend of these rates, as no previous studies have specifically assessed training typesfor doctoral-level practitioners.

No significant practice role differences were found between nondoctoral- and doctoral-levelpractitioners. Also, no significant within-program training differences were reported betweennondoctoral- and doctoral-level practitioners. The only significant training difference betweenNASP-approved and APA-accredited program graduates was in reported prevalence of participat-ing in psychopharmacology workshops or in-service programs outside the respondents’ respectiveinstitutions.

Taken together, these results are interesting in light of the discrepancy in training standardsamong accreditation bodies, as APA has established a three-level pharmacotherapy frameworkfor training and involvement. Most doctoral-level practitioners (i.e., those from APA-accreditedprograms) receive Level-1 training. Conversely, those NCSPs graduating from training programswithout formal psychopharmacology training standards (i.e., NASP-approved programs) still receivewhat APA conceptualizes as Level-1 training. Whereas most school psychologists (all degrees andaccreditations) do not receive APA-conceptualized Level-2 training, their reported practice rolesare indicative of Level-2 involvement, such as medication monitoring and evaluation. Althoughincongruent with training standards, this is important information for the field, given the frequentuse of psychotropic medication in school-aged populations. These findings suggest the realities ofschool psychological practice, whereby nearly a quarter of caseloads are taking medication, areproviding the impetus to obtain additional training to perform these Level-2 roles. Given the lack oftraining within university-based graduate programs and/or the realities of school-based psychological



services, practitioners appear to be appropriately obtaining this training independently to carry outthis professional responsibility.

Limitations

There were several limitations of the present study to consider when interpreting the results.Due to the self-report nature of the data elicitation strategy, it is possible that participant responsesdo not reflect their true practice roles and training experience. A related limitation is the constructof social desirability bias (Dillman et al., 2009). This bias may affect the results if respondentsassume the researcher wants them to engage in psychopharmacology roles and thus overestimatetheir involvement. Also, many of this study’s results cannot be compared directly with previousschool psychopharmacological survey studies (e.g., Carlson et al., 2006; Gureasko-Moore et al.,2005), as different methods were used to ask questions.

Another limitation may be the type of response format used within the practice section of theSPRTE. Participants were asked to select a percentage from a range of 0% to 100%, using 10%increments. This format required participants to independently determine which category to round upor down to if an actual percentage was between two numbers. This likely caused inconsistency amongparticipants, especially if some had an actual number of 25%, but were forced to choose between20% and 30% as an answer choice. Another limitation is that the randomly selected sample ofNCSPs included a slightly lower percentage of doctoral-level practitioners (16%) than that typicallyfound in the NASP membership (24%; Curtis et al., 2008). A final limitation is that the NCSPs whoparticipated in this study may not be reflective of the training and practices of school psychologistswho do not hold this credential. Specifically, it is important to note that the population of NCSPs(n = 13,156) is roughly one third of estimates of the total U.S. school psychologist population (n =32,300; Charvat, 2005).

Implications for Practice, Training, and Research

Although school psychologists traditionally work in the prevention and intervention of student’slearning, emotional, and behavioral impairments, the range of the children served in schools isexpanding (Phelps, 2011). School psychologists will be tasked with a changing yet exigent role inthe coming years. System reform efforts occurring within the context of the public health model, suchas President Obama’s landmark Patient Protection and Affordable Health Care Act (Obama, 2009),will provide increased access to health and mental health services in schools. In addition to servingchildren with mental, neurological, mood, and/or attention disorders, schools increasingly serve thosewith both acute and chronic medical conditions, such as asthma, diabetes, epilepsy, and obesity, andissues related to pharmacological intervention, as the general student population identified withdisabilities (including those with “other health impairments”) has increased steadily over the pastfew decades (United States Department of Education, 2005). With this shift, school psychologicalduties may more greatly emphasize both direct (e.g., medication monitoring/evaluation) and indirect(e.g., medication-related consultation with families, teachers, and physicians) service roles in yearsahead.

For practitioners who are not already involved in these direct roles, which typically requireLevel-2 expertise, this new service emphasis may represent a profound change in their traditionalresponsibilities. This expanded role could appear precarious at first, particularly with austere schooldistrict guidelines that restrict school personnel involvement in medication management or consul-tation. However, many school psychologists are well positioned to undertake both indirect and directroles as long as they abide by the ethical duty to practice within their limits of competence (APA,2010; Carlson, Thaler, & Hirsch, 2005; NASP, 2010b).



Most respondents in the present study indicated that they were actively involved in indirectpractice roles. Fewer, but still a sizeable number of respondents indicated their involvement in directpractice roles. The provision of both of these roles, albeit de facto in nature (i.e., these roles are rarelyincluded in the job description or identified as specific training objectives within graduate school),allow school psychologists to undertake the critical responsibility of being “knowledge brokers” ofinformation for psychotropic treatment decision makers (Kubiszyn, 2011). Results of the presentstudy suggest that school psychology training programs are better positioned to provide trainingfor indirect roles that require Level-1 expertise than to provide training for direct roles that requireLevel-2 expertise.

However, there is a clear need for enhancing formal training opportunities for both Level-1 (i.e.,providing medication information) and Level-2 (i.e., medication monitoring/evaluation) expertisewithin nondoctoral- and doctoral-degree programs, as most practitioners do not currently receivethis formal training. Adding additional coursework will be difficult for most graduate programs,especially if all current courses are requisites for various accreditation requirements. However, bymaking specific foci adjustments at the program level, greater applied psychopharmacology trainingmight be incorporated within existing curricula (Shahidullah & Carlson, 2012).

Regarding training for Level-1 expertise, in addition to the biological basis of behavior orbiopsychology requisites, evidence-based intervention coursework might include a unit on the useof common psychotropic treatments in the school setting; counseling coursework might includetraining on the efficacy and provision of psychosocial treatments as adjuncts to pharmacotherapy(i.e., combined treatments); and consultation coursework might include training on how behavioralconsultation models (e.g., Kratochwill & Bergan, 1990) for use with school staff and physicians canbe used to evaluate a student’s response to medication within a data-based, problem-solving approach.

Regarding training for Level-2 expertise, intervention assessment coursework might includetraining on the use of specific protocols for monitoring and evaluating the effect of psychotropicmedication on school performance. This information can be supplemented and reinforced by behavioranalysis or research methodology coursework that provides training in the use of double-blindplacebo controlled trials using single-case design methodologies that can be useful for monitoringbehavioral response to treatment. Incorporating this training into existing curricula may help to closethe demonstrated gap between pharmacological practice roles that school psychologists are neededto undertake and roles they have been formally trained to perform. By providing enhanced graduateschool training to practitioners within these domains, ideally, school psychologists may feel morecompetent in serving students taking medication.

Taken together, these findings emphasize the importance for school psychologists to closelyexamine their competencies in this practice domain and seek out professional development opportu-nities via school psychopharmacology-related seminars or self-study, if needed. Also, these findingssupport the need for careful evaluation of current training models and specific training foci withinschool psychology graduate programs. It is important for further empirical investigation to examinehow Level-2 training might be embedded as an integral component within existing graduate cur-ricula, particularly specialist-degree programs, which produce the most school-based practitioners.Specifically, it may be advantageous to survey school psychology graduate training program di-rectors regarding their attitudes toward the need for enhanced psychopharmacology training withintheir programs and perceived barriers to incorporating this type of training into their training modeland curricula.

Despite NASP’s endorsement of Level-2 roles, such as medication monitoring, as best practice(Carlson & Shahidullah, in press) for appropriately trained school psychologists who work with stu-dents taking psychotropic medication, the organization, in general, provides little direction in howthis “appropriate training” might be obtained. Therefore, there should be a greater consideration



regarding the role that NASP’s (2010a) Practice Model plays in establishing guidelines for profes-sional competency in evidence-based interventions for children’s mental health issues and how theseguidelines dictate how graduate programs structure their training and educational offerings.

REFERENCES

American Psychological Association. (2010). Ethical principles of psychologists and code of conduct. Washington, DC:Author. Retrieved from http://www.apa.org/ethics/code/index.aspx#

Ball, C. R., Kratochwill, T. R., Johnston, H. F., & Fruehling, J. J. (2009). Limited prescription privileges for psychologists:Review and implications for the practice of psychology in the schools. Psychology in the Schools, 46, 836 – 845.

Carlson, J. S., Demaray, M. K., & Hunter-Oehmke, S. (2006). A survey of school psychologists’ knowledge and training inchild psychopharmacology. Psychology in the Schools, 43, 623 – 633.

Carlson, J. S., & Shahidullah, J. D. (in press). Best practices in assessing the effects of psychotropic medication on studentperformance. In A. Thomas & P. Harrison (Eds.), Best practices in school psychology (6th ed.). Bethesda, MD: NationalAssociation of School Psychologists.

Carlson, J. S., Thaler, C. L., & Hirsch, A. J. (2005). Psychotropic medication consultation in schools: An ethical and legaldilemma for school psychologists. Journal of Applied School Psychology, 22, 29 – 41.

Castillo, J. M., Curtis, M. J., Chappel, A., & Cunningham, J. (2011). School psychology 2010: Results of the nationalmembership study. Retrieved from http://www.nasponline.org/advocacy/spworkforce.aspx

Charvat, J. L. (2005). National Association of School Psychologists study: How many school psychologists are there?Communique, 33, 12 – 14.

Curtis, M. J., Lopez, A. D., Castillo, J. M., Batsche, G. M., Minch, D., & Smith, J. C. (2008). The status of school psychology:Demographic characteristics, employment conditions, professional practices, and continuing professional development.Communique, 36, 27 – 29.

Dillman, D. A., Smyth, J. D., & Christian, L. M. (2009). Internet, mail, and mixed-mode surveys: The tailored design method(3rd ed.). Hoboken, NJ: Wiley.

DuPaul, G. J., & Carlson, J. S. (2005). Child psychopharmacology: How school psychologists can contribute to effectiveoutcomes. School Psychology Quarterly, 20, 206 – 221.

Evers, S. R. (2011). Collaboration between pediatricians and pharmacologically trained psychologists in the treatment ofanxiety disorders in pediatric patients. In G. M. Kapalka (Ed.), Pediatricians and pharmacologically trained psychologists:Practitioner’s guide to collaborative treatment (pp. 153 – 166). New York, NY: Springer.

Food and Drug Administration. (2004). FDA statement on recommendations of the psychopharmacologic drugs and pediatricadvisory committees. Retrieved from http://www.sskrplaw.com/files/fdastatement.pdf

Gureasko-Moore, D. P., DuPaul, G. J., & Power, T. J. (2005). Stimulant treatment for attention-deficit/hyperactivity disorder:Medication monitoring practices of school psychologists. School Psychology Review, 34, 232 – 245.

Kratochwill, T. R. (2007). Preparing psychologists for evidence-based school practice: Lessons learned and challenges ahead.American Psychologist, 62, 829 – 843.

Kratochwill, T. R., & Bergan, J. (1990). Behavioral consultation in applied settings: An individual guide. New York, NY:Plenum Press.

Kubiszyn, T. (1994). Pediatric psychopharmacology and prescription privileges: Implications and opportunities for schoolpsychology. School Psychology Quarterly, 9, 26 – 40.

Kubiszyn, T. (2011). Pediatric psychopharmacology. In M. Bray & T. Kehle (Eds.), The Oxford handbook of schoolpsychology (pp. 696 – 727). New York, NY: Oxford University Press.

Kubiszyn, T., & Carlson, C. (1995). School psychologists’ attitudes toward an expanded health care role: Psychopharmacologyand prescription privileges. School Psychology Quarterly, 10, 247 – 270.

Kubiszyn, T., Mire, S., Dutt, S., Papathopoulos, K., & Burridge, A. B. (2012). Significant differences in pediatric psychotropicside effects: Implications for school performance. School Psychology Quarterly, 27, 4 – 28.

National Association of School Psychologists. (2001). NASP Membership Survey. Unpublished survey data. Retrieved fromhttp://www.nasponline.org/advocacy/NASP_Mbr_Survey_1999-00.pdf

National Association of School Psychologists. (2010a). Model for comprehensive and integrated school psychologicalservices. Retrieved from http://www.nasponline.org/standards/2010standards/2_PracticeModel.pdf

National Association of School Psychologists. (2010b). Principles for professional ethics. Bethesda, MD: Author. Retrievedfrom http://www.nasponline.org/standards/2010standards/1_%20Ethical%20Principles.pdf

Obama, B. (2009, September 9). President Obama’s Address to a Joint Session of Congress. The White House Officeof the Press Secretary. The Patient Protection and Affordable Care Act [PPACA] [P.L. 111–148] (HR 3590). Re-trieved from http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-to-a-Joint-Session-of-Congress-on-Health-Care



Pappadopulos, E. A., Guelzow, T., Wong, C., Ortega, M., & Jensen, P. S. (2004). A review of the growing base for pediatricpsychopharmacology. Child and Adolescent Psychiatric Clinics of North America, 13, 817 – 855.

Phelps, L. (2001). Pediatric health-related disorders: Prevention and early intervention. In M. Bray & T. Kehle (Eds.), TheOxford handbook of school psychology (pp. 685 – 695). New York, NY: Oxford University Press.

Roberts, H. J., Floress, M. T., & Ellis, C. R. (2009). Training school psychologists in psychopharmacology consultation.Psychology in the Schools, 46, 827 – 835.

Shahidullah, J. D. (2014). Medication-related practice roles: An ethical and legal primer for school psychologists. Contem-porary School Psychology, 18, 127 – 132.

Shahidullah, J. D., & Carlson, J. S. (2012). Training considerations for pediatric psychopharmacology in RxP. The Tablet:Newsletter of Division 55 of the American Psychological Association, 13, 6 – 18. doi: 10.1037/e625672012-002

Smyer, M. A., Balster, R. L., Egli, D., Johnson, D. L., Kilbey, M. M., Leith, N. J., & Puente, A. E. (1993). Summary ofthe report of the ad hoc task force on psychopharmacology of the American Psychological Association. ProfessionalPsychology: Research and Practice, 2, 394 – 403.

Thomas, C. P., Conrad, P., Casler, R., & Goodman, E. (2006). Trends in the use of psychotropic medications amongadolescents, 1994 to 2001. Psychiatric Services, 57, 63 – 69.

United States Department of Education, Office of Special Education and Rehabilitative Services, Office of Special EducationPrograms. (2005). 26th annual (2004) report to Congress on the implementation of the Individuals with DisabilitiesEducation Act. Washington, DC: Author.


Documents

SURVEY OF NATIONALLY CERTIFIED SCHOOL PSYCHOLOGISTS’ ROLES AND TRAINING IN PSYCHOPHARMACOLOGY