Preparing psychologists to work with underserved populations: a faith-based pre-doctoral training model.

The purpose of this article is to provide a pre-doctoral training model for preparing future psychologists to work with underserved clients and communities from a uniquely Christian perspective. Another major goal of this article is to encourage others to develop pre-doctoral training programs dedicated to working with underserved groups. The training model presented in this article is based on the Chicago Area Christian Training Consortium (CACTC) Internship in Professional Psychology, which provides pre-doctoral interns the opportunity to work with underserved urban, suburban, and rural populations. In this work, interns are challenged to expand their repertoire to also include non-traditional modes of service delivery which, in many cases, is considered to be more effective in work with underserved populations. Consequently, the CACTC (a) mission statement, (b) program description, (c) training objectives, (d) CACTC sites, and (e) training philosophy are highlighted.

**********

Throughout the Scriptures there are numerous references calling Christians to serve the poor, marginalized, and oppressed--to reach out to the underserved (Deuteronomy 14:28-29; Matthew 5:17-18; Matthew 25:34-40). Ethnic minorities, older adults, children, low-income individuals, persons with Human Immunodeficiency Virus (HIV) or Acquired Immune Deficiency Syndrome (AIDS), persons with disabilities, inner-city residents and rural residents represent just a few of the modern day people groups who remain underserved (Acuff, Archambeault, Greenberg, Hoeltzel, McDaniel, Meyer, et al., 1999; American Psychological Association, 1999; 2000; Center for Mental Health Services, 1998; Department of Health and Human Services, 2001; Hahn, 1988; Sue & Lam, 2002; Walker, Mays, & Warren, 2004; Wong-McDonald, 2002). This is particularly true in regards to access and utilization of mental health services (i.e., Merwin, Dembling, Hinton, & Stern, 2003; Power, Eiraldi, & Clarke, 2005). Variables such as oppression, racism, discrimination, poverty, stigma, lack of available mental health professionals, and inadequate (if not unattainable) health insurance make it difficult for the aforementioned to receive adequate psychological treatment (American Psychological Association, 2000; Burns & Friedman, 1990; Hahn, 1988; Kallen, 2004; Surgeon General, 2002).

Fortunately, professional organizations such as the American Psychological Association (APA) are bringing attention to these issues (i.e., APA, 1999). A number of task force teams have been vested with the responsibility of studying underserved populations. For Example, groups like the APA Working Group on the Older Adult (APA, 1998) are attempting to identify mental health trends present in underserved populations and clinical competencies for mental health professionals who practice with underserved clients.

Researchers have also begun to attend to the unique needs of underserved populations (i.e., Bond, 1997; Campbell & Gordon, 2003; Stuart, 2004). Grant funding agencies (i.e., National Institutes of Health and the National Institutes of Mental Health) are also supporting research studies that investigate issues pertaining to underserved populations. Also, the special issue volume (volume 21) of the Journal of Psychology and Christianity (2002) on underserved populations represents a growing interest among Christian scholars. While this recent increased scholarship is notable, sufficient research on underserved populations is still lacking and a paucity of mental health providers who are engaged with these people groups remains. This reality is underscored by the disproportionately low number of psychologists who provide therapeutic services to underserved clients despite the ever-increasing number of psychologists who enter the field annually (APA, 1995; Kruse & Canning, 2002, Robiner & Crew, 2000; Peterson & Rodolfa, 2000; Pion, Kohout, & Wicherski, 2000). In response to this trend, Kruse and Canning (2002) noted, "The fact that there are too many psychologists for some communities and too few for others begs an explanation" (p. 58).

While far from being the only explanation, the lack of specialized or applied training opportunities for psychologists focused on underserved populations is a plausible contributing factor. Despite the pioneering efforts of community psychology training programs during the 1960's and 1970's, opportunities to specialize in work with the underserved still appear to be lacking in comparison to other pre-doctoral internship focuses (i.e., specialization in child psychology). This is unfortunate given the fact that there is research to support the notion that professionals who report having an increased sense of competence based on prior training with underserved groups tend to work with them to a greater degree (Kruse & Canning, 2002).

Moreover, the lack of training models available in the psychological literature for preparing psychologists to work with underserved populations may be another likely reason. This void is particularly noticeable in regards to pre-doctoral training models (while these training models may exist, they do not exist in the current literature). In fact, the majority of published pre-doctoral training models have emphasized primary care (e.g., Talen, Fraser, & Caulcy, 2005; Masters, Stillman, & Browning, 2005), primary behavioral health care (e.g., Dobmeyer, Rowan, & Etherage, 2003), and psychopharmacology (e.g., Tulkin & Stock, 2004; Dunivin & Southwell, 2000). Consequently, a pre-doctoral internship training model which emphasizes a Christian response to working with the underserved appears absent in the literature.

PURPOSE STATEMENT

The purpose of this article is to provide a pre-doctoral training model for preparing future psychologists to work with underserved clients and communities from a uniquely Christian perspective. By providing a framework, the authors hope to promote the development of other training programs dedicated to cultivating a greater number of psychologists equipped to work with marginalized groups. The training model presented in this article is based on the Chicago Area Christian Training Consortium (CACTC) Internship in Professional Psychology, and highlights the CACTC (a) mission statement, (b) program description, (c), training objectives (d) CACTC sites, and (e) training philosophy.

CONSORTIUM MISSION STATEMENT

The purpose of the CACTC Internship in Professional Psychology is to strengthen psychological service delivery to underserved persons and their communities by equipping and preparing pre-doctoral interns to work competently with these groups. In the context of a multidisciplinary training consortium, a distinct course of study is provided for pre-doctoral interns in professional psychology. This training is founded on a commitment to develop pre-doctoral interns' competence as professional psychologists in service provision to underserved groups from a distinctly Christian perspective. Furthermore, given CACTC's commitment to excellence in training, the program has been accredited by the American Psychological Association (APA) since 2002 and has been a member of the American Pre-doctoral and Post-doctoral Internship Centers (APPIC) since 2000.

CACTC was initially created in 2000 in response to a need for internship training specifically geared towards increasing the number of psychologists able to effectively work with underserved populations. Thus far, this goal is being reached as outcome data of CACTC graduates indicates that around 80% of its graduates are currently working in settings with underserved groups (Kruse & Gorham, 2006). While this high percentage may be explained to some degree by self-selection bias (i.,e., interns who intend to engage with underserved groups post-graduation are the ones who tend to gravitate toward CACTC), it also seems likely that the CACTC program has had a critical shaping influence on the professional direction of its graduates.

For example, while professionals would likely agree about the need to serve underserved groups, many may shy away from engaging in such work given their perceptions of the challenges inherent in work with these populations. One such challenge is the belief that working with underserved groups is less rewarding due to the decreased financial compensation associated with this work. Though this may be true in some settings and with some populations, this does not appear to be true across the board. In fact, research by Lindberg, Canning and Johnston [Kruse] (1999) indicated that while some practitioners associate work with underserved populations with obtaining less economic rewards, data from their study revealed no significant relationship in engagement with underserved populations. In other words, the belief that working with underserved groups may be less financially rewarding is a perception that, when studied, may not be supported.

Notwithstanding, there are still some professionals that may need assistance in repaying student loans in order to make their engagement with underserved populations more feasible. Groups such as the National Health Service Corps (NHSC; www.nhsc.bhpr.hrsa.gov), a program through the U.S. Department of Health and Human Services, provide scholarships and loan repayment awards to health and mental health providers who commit (typically for 2 years) to work in areas with a shortage of providers. Additionally, there are also loan forgiveness programs which operate on a state level. For example, the State Loan Repayment Program is a part of the Health Resources and Services Administration's (HRSA) Bureau of Health Professions strategy to improve access to underserved communities. NHSC grants matching funds directly to States to operate their own loan repayment programs, thus creating another avenue for newer professionals to receive loan forgiveness support while also making a meaningful contribution in underserved communities.

PROGRAM DESCRIPTION

CACTC is a collaborative effort of five mental health organizations and one graduate institution. The partner agencies working together are: Outreach Community Ministries (Wheaton, IL), Lydia Home Association (Chicago, IL), Cornerstone Counseling Center of Chicago (Chicago, IL), Lawndale Christian Health Center (Chicago, IL), Center for Rural Psychology (Elburn, IL), and the partner institution is Wheaton College Graduate School (Wheaton, IL). While the benefits of creating this consortium were/are numerous (pooling resources, expanding training opportunities offered, sharing expertise among sites), there are also unique challenges inherent in developing a consortium that had/have to be addressed and managed well in order to ensure the long term success of the program (See Kruse 2003, for a more specific discussion of the challenges in creating a pre-doctoral consortium internship program).

All pre-doctoral interns maintain responsibilities at two of the five agencies through primary and secondary placements. The length and duration of secondary rotations may vary, depending on intern interest and program need. However, in most cases, interns spend four days at their primary rotation and one day at their secondary rotation.

Furthermore, all interns receive training that focuses on the integration of psychology and Christianity in clinical practice. This training may take the form of training seminars, spiritual retreats, collaborative professional scholarship (i.e., writing articles and presenting at conferences), reading resource packets, and/or supervision which cultivates the intern's psychological framework in light of a Christian worldview. CACTC supervisors embrace a mentorship model of supervision which focuses on the character formation of the intern in addition to training in psychotherapeutic techniques and skills. The culmination of these experiences exposes interns to a variety of ways to conceptualize and practice faith integration, with the hope of creating an enriching atmosphere for the intern to then develop and articulate their own emerging worldview.

TRAINING OBJECTIVES

The internship is an important year in an intern's professional development, which provides a "bridge" between their prior academic and clinical training and future professional practice. Through supervision, mentoring and involvement in the activities of the CACTC, pre-doctoral interns are encouraged to grow in their awareness of the multifaceted nature of persons, and the interface between the psychological, sociological, biological, and spiritual dimensions of life. The CACTC internship program embodies a practitioner-scholar model of training in order to promote competencies congruent with the discipline of professional psychology and informed by the Christian faith. While this model of training is primarily geared towards preparing interns for applied practice, it is built on the assumption that well-researched and empirically supported treatments help to provide a strong conceptual framework for this clinical practice to take place.

Furthermore, the program was built on the premise that service to underserved groups is directly related to our Christian calling to reach out to those in need, who in contemporary society are those who have been marginalized due to their race, age, socioeconomic background and so forth. Thus, one aspect of Christian integration in the CACTC program includes encouraging interns to develop their heart and voice for social justice.

CACTC has the following objectives: 1) To develop pre-doctoral interns' knowledge of the APA ethical standards in the practice of psychology, and the ability to demonstrate behavior consistent with these standards, 2) To assist pre-doctoral interns' in the acquisition of a broad range of scientific and clinical knowledge and skills in professional psychology practice, including the ability to approach cases with a holistic understanding of persons (i.e., biological, psychological, systemic, spiritual and social), 3) To facilitate pre-doctoral interns' ability to effectively integrate psychological and religious/spiritual dimensions of personhood from a distinctly Christian perspective, while also valuing a diverse range of religious perspectives in their work with clients, 4) To develop pre-doctoral interns' critical thinking skills regarding the contemporary models of Christian integration and practice, 5) To develop pre-doctoral interns' capacity to both assess and provide treatment to a diverse range of persons, especially those who are traditionally underserved by mental health providers, 6) To expand pre-doctoral interns' multicultural competence in work with a diverse spectrum of client populations and presenting problems, 7) To promote the development of pre-doctoral interns' emerging identity as a practitioner-scholar psychologist by promoting the active utilization of, and/or contribution to, the professional scholarly literature as it applies to direct service provision, and 8) To provide broad based clinical training in order to prepare pre-doctoral interns for licensure as professional psychologists.

Training objective three may be of particular interest to readers, with emphasis being placed on the integration of psychology and Christianity. The interns in the CACTC come from a wide background of educational experiences, with Christian, secular, and seminary backgrounds (or a combination of the aforementioned). A developmental approach based on interns' theological background and understanding, is facilitated through a spiritual retreat, trainings on the integration of psychology and Christianity, clinical supervision, and additional educational opportunities made available through Wheaton College (i.e., attending colloquiums or seminars). Though no test of theology is administered before embarking on their field placements, interns are evaluated on this training objective (as are the other training objectives) throughout their pre-doctoral internship year.

TRAINING SITES

Outreach Community Ministries

(Suburban Outpatient Setting)

Outreach Community Ministries is a Christian community-based not-for-profit organization located in the western suburbs of Chicago. With their mission to "put Christian faith into responsible action," the commitment of Outreach Community Ministries over the past thirty-five years has been to provide distinctively Christian mental health and social services in several communities, focused specifically on responding to the needs of the lowest income residents. Outreach Community Ministries programs include shelter care for homeless young women and their children, counseling centers in three communities, and a large community center with counseling, mentoring, basic needs and children and youth programs serving racially diverse poor families and children in one of the largest low-income census tracts in DuPage County. Outreach Community Ministries serves a low-income, multi-age, multi-ethnic population with problems which include domestic violence, child physical and sexual abuse, substance abuse, and family instability. Interns are involved in the counseling program with those who are already identified as at-risk as well as in prevention and community-based education programs at the community center to reduce risk in the community-at-large.

Lydia Home Association

(Inner-City Residential Setting)

Founded as an orphanage in 1916 to serve children, Lydia Home Association is an inner-city Christian social service agency that now includes a residential treatment facility, outpatient counseling centers, foster care, emergency youth shelter, abstinence education, Healthy Families Program, preschool, truancy prevention, and Mother's Program (for mothers who have lost custody of their children). Pre-doctoral interns primarily focus their clinical work within the residential treatment facility. This facility provides intensive residential treatment for approximately 40 children between the ages of five and fifteen with severe emotional and behavioral disorders. The outpatient counseling center offers individual, marital, family therapy and Parent-Child Interaction Therapy to clients from the community and local churches.

Cornerstone Counseling Center of Chicago

(Inner-City Outpatient Setting)

Located near the heart of Chicago across from the Cabrini-Green Public Housing Project, Cornerstone Counseling Center of Chicago is a non-profit counseling center started by LaSalle Street Church in the early 1970's. Cornerstone Counseling Center of Chicago staff seeks to participate in developing a deeper understanding of the interface between faith and the human condition as related to emotional, relational, and spiritual life and works to serve those who have been oppressed or marginalized by society. Mental health services in the areas of individual, couples, family, and group counseling, along with psychoeducation and assessment services for adults, children, families and the surrounding community are provided. Community-based services are also provided in schools to at-risk children throughout the city of Chicago.

Lawndale Christian Health Center

(Inner-City Primary-Care Setting)

Lawndale Christian Health Center is a faith-based community medical clinic located on the Westside of Chicago and serving the Lawndale and East and West Garfield communities. Pre-doctoral interns who are completing their primary rotation at Lawndale Christian Health Center are trained in the Behavioral Health Consultant Model, an innovative approach to adapting clinical psychology skills to a primary care setting (pediatric to geriatric). The health center is a Federally Qualified Health Center providing primary care medical services to an African-American and Hispanic population. The clinic was founded in 1984 through the efforts of local residents and members of the Lawndale Community Church who sought to address the stark health disparities in these medically underserved neighborhoods. Lawndale Christian Health Center now serves over 30,000 patients, providing comprehensive pediatric and adult medicine, health support services in the areas of diabetes, asthma, HIV, substance abuse, maternal-child health, and pastoral and behavioral health services. Lawndale Christian Health Center patients are primarily first and second generation Mexican immigrant and African-American in background, with a variety of psychosocial issues related to poverty and multiple life stressors.

Center for Rural Psychology

(Rural Out-Patient Setting)

The Center for Rural Psychology is a training site for pre-doctoral interns who want to focus on the needs of rural clients and communities. Opportunities are available in individual, couple family, and group therapy as well as experiences in providing supervision, assessment, program development, equine assisted psychotherapy, and community education. Opportunities to collaborate with local schools in prevention and intervention efforts for children are also available. The mission of Center for Rural Psychology is to train Christian mental health professionals with the unique skills and knowledge needed to effectively serve in rural communities and to provide psychological consultation, support, and training to professionals and natural helpers in underserved rural communities.

TRAINING PHILOSOPHY

Prior to internship, most interns have been trained in traditional models which tend to be grounded in a Western perspective valuing individualism (i.e., autonomy, internal processes and behavior) and are geared towards those who are economically resourced. Services from this perspective typically follow the traditional office-based, private practice model. While this model of service delivery may be effective for some people groups, it is less so for those who have been marginalized. Given this, interns are encouraged to broaden their perspective of what assessment and intervention should look like and to consider what approaches may be more helpful to a wider range of persons and communities.

Furthermore, there are specific elements that are essential in working with underserved groups. In the U.S. Surgeon General's Report on Mental Health (2002), services which are integrated, community-based, family supportive and culturally sensitive are considered to be vital components of effective service. Moreover, others have argued that effective services to marginalized persons are most effective when they are: (a) community-based, (b) collaborative, (c) home-based, (d) strength-based, (e) culturally sensitive, and (f) advocating/empowering (Canning, Case, & Kruse, 2001). The following section will highlight a few of these elements and provide examples of how they are implemented throughout the various CACTC sites.

Community-based

Consistent with its name, community-based services are services delivered in the community or neighborhood in which they are needed as opposed to the more medical-model practice of providing services only from a clinic or hospital setting. However, despite the proven effectiveness of many community-based programs, there still remains a dearth of providers working from a community-based perspective (Department of Health and Human Services, 2001). The importance of this type of community-based service in work with underserved persons is three-fold: it increases accessibility to services, it demonstrates a commitment to the community, and it provides increased contact with the community and its specific needs, thus creating increased potential for more relevant services within the community.

Throughout CACTC, the application of a community-based perspective can be seen by how the agencies are located in specific communities where mental needs have been identified and work to partner with those in the community to provide services specific to those needs (i.e. starting Heartland Counseling Center through Center for Rural Psychology to meet the needs of a rural community, Lawndale's community-based medical center to serve the needs of the Lawndale community, a Latino Services Program through Cornerstone Counseling Center of Chicago and Outreach Community Ministries to meet the needs of the lower-income, Latino families in the community, etc.).

Collaborative

Community-based collaboration with other service providers may also be an effective means of providing mental health services to underserved persons. For example, in many rural locations, there has been increased movement in integrating mental health services with medical care (Bird, et al., 1998). This approach may be an effective way to increase visibility of services while also decreasing the level of stigma associated with mental health care. This is exemplified at LCHC where interns work in a primary health care setting as behavioral health consultants to the physicians within the health center. In this role, they learn how to diagnose and screen for psychological disorders, and design problem and strength-based behavior change plans. Pre-doctoral interns also consult with medical providers and to assist providers in utilizing pharmacological treatment effectively. By pairing mental health services with medical services, the stigma of receiving psychological services decreases while the utilization rates of services increases.

This same collaborative movement has also been noted in recent efforts to provide mental health services within school settings, which typically is the first place first to identify mental health concerns in many children and adolescents. Given this, CACTC sites such as Center for Rural Psychology and Cornerstone Counseling Center of Chicago provide school-based groups in order to meet the needs of those who may be at-risk or to help prevent future disruptions emotionally or academically for the children served.

Furthermore, CACTC interns engage in church-based consultation and collaboration where they work with area churches on developing programs targeting key areas of mental and spiritual health. They also provide consultations to local pastors, missions organizations, private Christian schools and ministries on mental health topics and provide guidance regarding making appropriate referrals when necessary (the specific opportunities differ depending on the site).

Home-based

Additionally, there is a growing body of literature regarding the need for, and effectiveness of, a specific type of community oriented services, or home-based services in order to serve at-risk children and their families (Evans & Boothroyd, 1997; Veraaijen & VanAcker, 1993). While this may seem foreign, and possibly be perceived by some as inappropriate for clinicians trained to provide services in more traditional office settings, there are some advantages to providing these services in the home. Some of these advantages include the provision of more information on the home context (environmental conditions, members of the family, neighborhood, etc.), communicating willingness to "meet on the client's turf", and providing services to those who are home bound (i.e., older adults, persons with disabilities) or lacking in transportation. For example, interns who work in the Outreach Community Ministries Older Adults Program, provide mood and memory assessments which include a home visit in order to assess the older adult's activities of daily living skills and independent functioning in their home environment.

Strength-based

During graduate training, many interns were immersed in paradigms that are "deficit-focused", placing heavy emphasis on diagnosis and the presence of pathology. While this approach is important, it should not be the only paradigm considered when engaging with underserved groups. Rather, interns at CACTC are encouraged to utilize a strengths-based perspective, which identifies the existing resources, competencies and resiliencies of their clients and communities in which they reside. Interns learn that approaching clients from a strengths-based perspective does not diminish or minimize the problems that clients find distressing. Rather, it enhances therapy in a number of ways by providing a more holistic perspective of personhood. External resources such as a strong church community, and/or internal strengths such as a good sense of humor or a strong faith in God can be employed as catalyst for therapeutic change.

Culturally Sensitive

Far too often, services are created from a Eurocentric, middle-class perspective that does not take into account the unique needs of a diverse range of persons and communities. In order for services to underserved groups to be effective, they must be culturally relevant and culturally sensitive, which include moving beyond the majority perspective to developing an understanding and respect for other world-views. Providing services in conjunction with community gatekeepers, such as pastors and community leaders, is one way to work to learn from those in the community in order to provide services that are more relevant and sensitive. CRP interns routinely consult with community leaders in order to ensure that they are taking into account the specific needs of the rural community.

Furthermore, the therapist must be perceived as culturally credible, which among other things includes having a posture of humility, and a desire to learn from those whom he or she serves. CACTC interns are encouraged to expand their cultural perspectives by engaging in work with persons different from themselves, learning from others and stretching their perceptions of traditional service provision. An exemplary illustration of this can be seen in the way the Lydia Home Association residential unit (which serves ethnically diverse children) seeks to emphasize aspects of the child's cultural background rather than imposing a more majority perspective and worldview. Their cultural heritage is viewed as a strength that needs to be nurtured through celebrating and learning about heroes in their cultural tradition (i.e., political or religious figures, musicians, artists, etc.) expressing their specific faith background, and when possible, staying connected to their family and community throughout their residential placement.

Some CACTC interns over the past few years have also been involved in collaborative research examining the construct of cultural competence and discovering what training methods are being employed in graduate programs and internships across the country in order to increase these competencies. It is hoped that by inviting interns into the process of engaging in this research, they will develop a greater appreciation for the complexity of cultural issues as well as learn the value of contributing to the scholarly literature on critical topics.

Advocating/Empowering

Inherent in an advocacy perspective is the understanding that there are oppressive systemic factors that may be creating additional obstacles, hindering a person's ability to receive fair treatment and thus potentially contributing to the disruption in their functioning and well-being. In the Old Testament, God consistently advocated for the alien, fatherless and widow, leaving Christians with numerous examples of advocacy (e.g., Deut. 15:7-8, 11; Deut. 23; 6, 9).

What does this type of advocacy or empowerment look like in therapeutic settings? Change may occur on either on an interpersonal level (first order change) or structural level (second order change). On an interpersonal level, examples of advocacy or empowerment can be seen at CACTC sites where lay leaders are utilized. Services of this nature focus on empowering and equipping natural or lay people-helpers within the community by providing them with the resources to support those in need. CACTC staff and interns play an important role in providing consultation and/or training to support these services to the community.

Change on a structural level goes beyond the individual in order to alter the larger system or context. Christian mental health professionals can reflect biblical teachings (i.e., love your neighbor) by speaking out against injustice directed toward marginalized persons and working to ameliorate conditions of discrimination or inequities in service provision and/or power. For example, Christian mental health professionals can be advocates in the area of racial reconciliation by engaging in the process of raising awareness of the problem (including the ways they also knowingly or unknowingly harbor racial prejudices), providing a biblical context for advocacy and providing avenues for increased cross-cultural dialogue and relationship. In the past, CACTC interns have engaged in opportunities for more in-depth, cross-cultural relationships through the Culture and Ethnic Studies Initiative (CESI), an ethnically diverse group of students and staff who explore issues of race/ethnicity in order to increase personal and group awareness through dialogue regarding issues of culture, specifically race and ethnicity. This group also hopes to expand this activity to engaging in cultural experiences together (such as attending a museum of African-American history, reading articles on white privilege, watching a movie about the Holocaust and then discussing its impact) in order to challenge and expand their worldview.

CONCLUSION

CACTC prepares future psychologists to work with underserved clients and communities through a range of training experiences and opportunities from a distinctly Christian perspective. Pre-doctoral interns are given opportunities to work with underserved populations in urban, suburban, and rural locations and are taught both traditional and nontraditional methods of service provision for increased efficacy with these groups. These diverse experiences are integrated into a practitioner-scholar model of training, in order to highlight the complementary relationship between science and practice.

To date there has been very little written in the literature about training models that equip psychologists with the knowledge and skills necessary for effectively working in underserved areas. Additional models like the one presented in this article are needed. Unique and novel training strategies and exercises that prepare psychologists to work in underserved areas are also needed. Furthermore, qualitative and quantitative investigations on training models, issues, and approaches should be conducted. For instance, psychologists practicing in underserved areas might be interviewed about their preparation for their current work and be asked to make training recommendations. Another key area for further exploration, and perhaps one of the most important, would be to focus on the character formation of professionals going into practice with underserved groups. By working to identify the attributes most associated with higher levels of resilience, compassion and cultural credibility with underserved groups, our methods of training and mentoring could be bolstered in order to cultivate these attributes in the next generation of mental health professionals.

REFERENCES

Acuff, C., Archambeault, J., Greenberg, B., Hoeltzel, J., McDaniel, J. S., Meyer, P., Packer, C., Parga, F. J., Pillen, M. B., Ronhovde, A., Saldarriaga, M., Smith, M. J. W., Stoff, D., & Wagner, D. (1999). Mental health care for people living with or affected by HIV/AIDS: A practical guide. Research Triangle Institute.

American Psychological Association. (2000). The critical need for psychologists in rural America. Retrieved August 10, 2005, from http://www.apa.org/ppo/issues/ebsrural.html.

American Psychological Association. (1999). Executive summary of the behavioral health care needs of rural women. Retrieved August 10, 2005, from http://www.apa.org/rural/ruralwomen.pdf.

American Psychological Association. (1998). What practitioners should know about working with older adults. Professional Psychology: Research and Practice, 29, 413-427.

American Psychological Association. (1995). Profile of all APA members: 1995. Washington, DC: American Psychological Association.

Bird, D., Lambert, D., Hartley, D., Beeson, P., & Coburn, A. (1998). Rural models for integrating primary care and mental health services. Administration and Policy in Mental Health, 25, 287-308.

Bond, M. (1997). The multitextured lives of women of color. American Journal of Community Psychology, 25, 733-743.

Burns, B. J., & Friedman, R. M. (1990). Examining the research base for child mental health services and policy. Journal of Mental Health Administration, 17, 87-98.

Campbell, C. D., & Gordon, M. C. (2003). Acknowledging the inevitable: Understanding multiple relationships in rural practice. Professional Psychology: Research and Practice, 34, 340-434.

Canning, S. S., Case, P. & Kruse, S. J. (2002). Contemporary Christian psychological scholarship and "the least of these": An empirical review. Journal of Psychology and Christianity, 20, 205-223.

Center for Mental Health Services. (1998, December). Children's and adolescents' mental health. Retrieved August 10, 2005, from http://www.mentalhealth.org/publications/allpubs/ca-0004/.

Department of Health and Human Services. (2001, February 13). Fact sheet: The Department of Health and Human Services on mental health issues. Retrieved August 10, 2005, from http://www.hhs.gov/news/press/200.

Dobmeyer, A. C., Rowan, A. B., & Etherage, J. R. (2003). Training psychology interns in primary behavioral health care. Professional Psychology: Research and Practice, 34, 586-594.

Dunivin, D. L., & Southwell, G. D. (2000). Psychopharmacology training in psychology internships: A brief curriculum. Professional Psychology: Research and Practice, 31, 610-614.

Evans, M. & Boothroyd, R. (1997). Family preservation services for families with children who have mental health problems. In S. W. Henggeler & Santos, A. B. (Eds.), Innovative approaches for difficult-to-treat populations (pgs. 27-46). Washington, D. C.: American Psychiatric Press.

Hahn, H. (1988). The politics of physical differences: Disability and discrimination. Journal of Social Issues, 44, 39-47.

Kruse, S., & Canning, S. S. (2002). practitioners' perceptions of the vocational rewards in work with underserved groups: Implication for rightsizing the psychology workforce. Professional Psychology: Research and Practice, 33, 58-64.

Kallen, E. (2004). Social inequality and social injustice: A human rights perspective. London: Taylor and Francis.

Kruse, S.J. & Gorham, J. (2006). Distal outcomes for CACTC program graduates' post-internship engagement with underserved groups. Unpublished data. Chicago area Christian Training Consortium, Carol Stream, IL.

Kruse, S.J. (2003, March). "You are only as good as your collaboration": Navigating the challenges of a consortium. APPIC Newsletter, XXVII, 5-9.

Lindberg, T.L., Canning, S.S., & Johnston [Kruse], S.L. (1999). Comparisons of income with high and low underserved engagement. Unpublished data. Wheaton College, Wheaton, IL.

Masters, K. S., Stillman, A. M., & Browning, A. D. (2005). Primary care psychology training on campus: Collaboration within a student health center. Professional Psychology: Research and Practice, 36, 144-150.

Merwin, E. Hinton, I., Dembling, B., & Stern, (2003). Shortage of rural mental health professionals. Archives of Psychiatric Nursing, 17, 42-51.

Peterson, R. L., & Rodolfa, E. R. (2000). Too many psychologists? Worrying about Robiner and Crew (2000) and worrying with them. Professional Psychology: Research and Practice, 31, 272-275.

Pion, G., Kohout, J., & Wicherski, M. (2000). "Rightsizing" the workforce through training reductions: A good idea? Professional Psychology: Research and Practice, 31, 266-271.

Power, T. J., Eiraldi, R. B., & Clarke, A. T. (2005). Improving mental health service utilization for children and adolescents. School Psychology Quarterly, 20, 187-205.

Robiner, W. N., & Crew, D. P. (2000). Rightsizing the workforce of psychologists in health care: Trends from licensing boards, training programs, and managed care. Professional Psychology: Research and Practice, 31, 245-263.

Stuart, R. B. (2004). Twelve practical suggestions for achieving multicultural competence. Professional Psychology: Research and Practice, 35, 3-9.

Sue, S., & Lam, A. G. (2002). Cultural and demographic diversity. In J. C. Norcross (Ed.), Psychotherapy relationships that work: Therapist contributions and responsiveness to patients. London: Oxford University press (pgs. 401-421).

Surgeon General. (2002). Mental health: A report of the surgeon general. Retrieved August, 10, 2005, from http://www.surgeongeneral.gov/library/mentalhealth.

Talen, M. R., Fraser, J. S., & Cauley, K. (2005). Training primary care psychologists: A model for predoctoral programs. Professional Psychology: Research and Practice, 36, 136-143.

Tulkin, S. R., & Stock, W. (2004). A model for predoctoral psychopharmacology training: Shaping a new frontier in clinical psy-chology. Professional Psychology: Research and Practice, 35, 151-157.

Veraaijen, A., & VanAcker, J. (1993). Family treatment for adolescents at risk of placement. I: Theory and treatment process. Family Therapy, 20, 103-132. Walker, B., Mays, V. M., & Warren, R. (2004). The changing landscape for the elimination of racial/ethnic health status disparities. Journal of Health Care for the Poor and Underserved, 15, 506-521.

Wong-McDonald, A. (2002). Five loaves and two fish for the inner city poor. Journal of Psychology and Christianity, 21, 253-256.

AUTHORS

KRUSE, SANDRA JOHNSTON. Address: Chicago area Christian Training Consortium-Internship in Professional Psychology, 336 Gunderson Drive, Suite B, Carol Stream, IL 60188. Title: Licensed Clinical Psychologist/Director. Degree: PsyD, Wheaton College. Specializations: Professional training, working with underserved groups, supervision, and psychological assessment.

ATEN, JAMIE D. Address: The University of Southern Mississippi, 118 College Drive #5025, Hattiesburg, MS 39406. Title: Assistant Professor of Psychology. Degree: PhD, Indiana State University. Specializations: spirituality, clinical supervision, and rural psychology.

SANDRA JOHNSTON KRUSE

Chicago area Christian Training Consortium/Outreach Community Ministries

JAMIE D. ATEN

The University of Southern Mississippi

Correspondence concerning this article may be sent to: Jamie Aten, PhD, The University of Southern Mississippi, 118 College Drive #5025, Hattiesburg, MS 39406.