There are a number of provisional psychologists working at Peninsula Paediatric Psychology (3P) and there are a few reasons for this. This text aims to explain these reasons as well as outline what this means.

What are provisional psychologists?

Provisional psychologists all have at least 4 years of psychology studies completed. Some have 5 and some others may have 6 depending where they are at in their training journey.

Current Situation about Mental Health/Psychology Services Nationally

The pandemic has triggered a number of needs in terms of mental health as many have experienced additional challenges. This was anticipated by the government and there was an increase of possible rebatable Medicare sessions under Better Access from 10/year to 20/year. Telehealth also became to become part of the service delivery allowing this program to be much more accessible for many.

As a result (and other contributing factors see in this article https://3ppsychologies.com/2022/09/23/why-is-there-a-psychologist-shortage-in-australia), there is currently a shortage of professionals working in this industry. This has been reported by a number of organisations where there have been reports that 1 in 3 psychologists have closed their books or not able to take on clients.

Paediatric Psychology More Particularly

Paediatric psychology has also been particularly impacted with shortages because of what the pandemic has brought in terms of challenges to children and families such as home learning (isolation, learning needs, self-efficacy, behaviour, school refusal, etc.), mental health, as well as as many other challenges families may have experienced. In addition, assessment work was delayed during lockdowns creating a backlog. Paediatric psychology was also already challenged before the pandemic with long waitlist and shortages of qualified psychologists in the paediatric space. The public sector has seen very long waitlists and this had an impact on private practices.

The Importance of Training the Workforce

At 3P, we really value the importance of training the workforce. We offer supervision, team days, training on the 3P learning platform.

“When I arrived in Australia, it was very difficult to find a supervisor and paid work as I was considered as a provisional psychologist despite having a doctorate and professional practice experience in the UK. I also worked in a number of schools and when I moved on to leadership roles, there was no-one to replace me and I felt disheartened to leave as many needed support. I promised myself that I would support the training of others in the paediatric space to ensure children, families and schools continue to be well supported”. (Dr P.)

In addition to all of this, supervision is often accessed externally by many and there is a clear to continue support the workforce in gaining the appropriate skills to work with a paediatric population.

“I have supervised many now in Australia and I have realised how different some of the learnings are compared to my training in Canada and the UK. Many supervisees have commented on how I bring a very different view of professional educational psychology practice and this has been refreshing for them. It is so important that we continue to engage in learning and offer different perspectives to our work. This helps meet better outcomes for clients” (Dr P.).

Passion for Learning and Teaching

In our profession it is very important that we continue to learn even if we have acquired a certain level of qualifications. This support growth as a clinician as well as better outcomes for clients. When supervising others and creating an environment where continued learning is planned, learning and teaching become embedded in professional practice. This also helps achieve best outcomes for clients as the environment encourages learning, supervision, reflections.

Dr P. has continued to study and learn throughout her career which has led to her becoming an educational and developmental psychologist with doctorate qualifications.

“I love learning and transmit knowledge. It’s just beautiful to hear supervisees express their gratitude for the learning opportunities and growth as a result of teachings and supervision.” (Dr P.)

Supervision

All provisional psychologists engage in continued learning and also supervision. They are allocated a board approved supervisor who oversees their work. This includes observations, working together in sessions, reviewing of reports and group/individual supervision sessions. A specific ratio of professional practice to hours of supervision is required. A clear plan for developing competencies is also in place and a number of requirements must be met during the placement/internship.

What to expect when working with a provisional psychologist?

All provisional psychologists at 3P have gone through a careful selection process, with clear evidence of previous experience relevant to the paediatric psychology field.

The fees are slightly reduced so you may be able to access more sessions with a provisional psychologist than you would with a fully registered psychologists. For example, sessions under NDIS are $156 with provisionals compared to $214 with a fully registered psychologist. This is also the case for assessment work, although some of the allocation of the fees also goes to supervision from the board approved supervisor.

At 3P, we aim to offer a varied training program so provisional psychologists experience diversity of work. As result, we offer a school outreach program so provisional psychologists are in clinic on specific days and in schools on other days.

The following professional tasks are likely to take place as part of the supervision process:

• the board approved supervisor to come in sessions for observations of the provisional psychologist
• discussions in supervision about presenting needs, assessment work/counselling program and next steps
• review of all reports and letters by the board approved supervisor and countersigned
• collaborative work such as joint sessions

If you have doubts about the support, assessment or therapy process is at, or finding that you would like some additional support during sessions, speak to the provisional psychologist who will make a plan with he supervisor and may invite the supervisor in sessions to discuss together.

Dr Pascale Paradis

Educational and Developmental Psychologist

Director at Peninsula Paediatric Psychology

Many have been reflecting on this in recent months. I have been particularly interested in this topic as I opened the doors of Peninsula Paediatric Psychology in between 2 lockdowns in June 2021. Opening a clinic had been something I had debated for a few years, should I or should I not. As I opened the doors, I did not anticipate such a flow of referrals. Since then, we have grown the team, from just me, working alone in the cottage last year, to now, 10 clinicians and 4 admin and management staff.

We have steadily grown by simply meeting demands…

It has indeed been a crazy year!

It took me a few years to make the plunge after our relocation from the UK to Australia. There was always an intention to open a private practice but a number of barriers or contributing factors led to wait and wait…until last year. I asked myself so many times, will this be ok, am I making the right decision, what if…

I have been very surprised at the flow of demands since I opened and reflected on why there is such as demand and a shortage of psychologists at the moment. Clearly the pandemic has not helped but it is not that simply…

Increase of sessions on Better Access – 10 to 20

In covid, there was an acknowledgment by the government that the population would need additional mental health support so there was an increase of sessions rebatable on the Better Access Medicare program. This increase had been lobbied for a long time as needed for better client outcomes but had never been implemented until then. This created a significant increase in sessions clients accessed by a psychologist. It is unknown as to whether these 20 sessions will stay past the 31st December 2022.

Telehealth – offering alternative ways of working

In addition, Telehealth was implemented as a possible mode of service delivery. This mode had only been allowed in the past for rural/regional clients. This mode of delivery then increased accessibility for sessions and alternative ways to deliver services. This also allowed psychologists to review their ways of working to meet their family commitments. This mode of delivery has now been agreed to stay.

Skilled Migrants Stuck Overseas

For the 2 to 3 years, many skilled migrants whom applied for a visa to come to Australia could not come during the covid lockdowns/international arrival closures. Many bureaucratic challenges emerged as a result and delayed arrivals of skilled migrants when Australia has relied on this workforce for may years.

Retirement of the 4+2

Ahpra has announced the retirement of the training route 4+2 where last provisional psychologists were agreed onto this program in June 2022. This is the end to opportunity for psychology graduates to embark on a 2 years internship. This has been a decision made prior to the pandemic started but will have a significant impact on the workforce if no additional training places are funded in universities for the Masters in Professional Practice (MPP) and other Masters routes. Typically, graduates who chose the 4+2 route did because of the challenges related to finance internship and studies so unless significant funding is injected into training, it is possible we will see a big impact on graduates completing a psychologist training route.

Female Workforce

During the 2-3 years, as the workforce is dominated by females, there have been some noticeable shifts of working patterns so that psychologists can combine a number of demands such as home learning, parenting, childcare, and supporting their own family needs.

Work-Life Balance and Choices

As a result, there may have been clear decisions made about work-life balance such as reducing workload, working on specific days, reducing hours, or branching out to different work to reduce the emotional load of session work. Telehealth and the online market booming allowed this to happen and for psychologists to explore other type of work.

Being sick and Recovering

Having covid and other illnesses have also increased absenteeism and rescheduling of sessions and assessment work. Isolation, sickness from children and families as well as clinicians has been particularly impactful since January 2022, with many being sick due to colds and flu in the last few months. The recovery time from these illnesses may have been impacted by time taken to recover after a few illnesses, as well as full households being sick.

Victoria Hit Hard

Victoria was clearly hit hard during the pandemic with so many days in lockdown, home learning with a clear impact of isolation and mental health challenges. Children keep talking about it in counselling sessions and the repercussions are still very real. Similarly, the impact on learning has been observed in assessments where children are clearly struggling to engage and participate at school, even now.

Families also tried to keep it together during these lockdowns and may now feeling like what happened, where have I been, and reevaluating life goals and future.

Has the paediatric allied health professionals been more particularly impacted by this shortage?

Although parents and children have engaged well with Telehealth, and have accepted it as being a good mode of service delivery, many also report that with a paediatric population, it can only be a short term solution as children engage so much better face to face. Many children and adolescents with socio-communication and language needs express not wanting to engage in this mode of psychological support, and prefer face to face sessions. Parents are engaging well with this type of support for initial consultations and parenting support, even preferring it due to busy lives and many commitments. However, it does not fully support the children and adolescents themselves.

Assessments can also not be done solely on Telehealth. Although there have a number of suggestions and changes to how we can use some psychometric tools, there is still an element of the work that would be not ethical and professional to do solely on Telehealth. This has therefore created a backlog of assessment work as many assessments had to be paused during lockdowns.

In between lockdowns and when clinics reopened, there was a significant flow of demands for assessments. These are time consuming and requiring lots of time and dedication, and cannot be done quickly and simply. Subsequent cancellations due to illnesses also delayed processes as many became sick with covid, flu, colds this winter.

We have heard so many parents talking about 12 to 24 months waitlist in the public sector and private settings to the point they were about to be giving up on support. We cannot let families give up on support when early intervention and preventative work is so important for children and adolescents.

A Tired Workforce

All of these contributing factors have led to a tired workforce, with many deciding to reduce hours and reviewing their work aspirations. It is not just one or 2 factors but a range of factors which have contributed to where we are now. We have seen so much sickness in recent months, after the lockdowns due to covid, many have had to recover from covid as well as the flu, colds, etc., not only the clinicians themselves but full families impacted by illness which have delayed recovery, getting back to work and getting on top of needs and demands.

All of this combined has created a tired workforce and there are no signs of relief in sight…Indeed, the APS and AAPPI

Here are additional readings from these organisations on the current situation:

https://psychology.org.au/about-us/news-and-media/media-releases/2022/looming-cuts-would-see-one-million-subsidised-psyc

https://aapi.org.au/Web/News/Articles/advocacymedia27July22.aspx

https://www.aapi.org.au//Web/News/Articles/update20september22.aspx

Any Solutions?

Solutions that can be imminently implemented:

Support to internship in workplaces, offer pay packages and supervision support

Allow a rebate for provisional psychologist under Medicare

Solutions:

Increase in training places in range of psychology disciplines – also see https://3ppsychologies.com/2022/09/18/sunday-reflections-misinformation-risks-to-perpetuate-the-inequality-of-disciplines-in-psychology/

Increase skilled migrant places in psychology and simplify the process for highly skilled psychologists

Create stability in the workforce by giving reassurance about rebates, training places, and funding

At Peninsula Paediatric Psychology (3P), we are aiming to offer an assessment experience that is aligned with neurodivergent affirmative professional practice.

What does this mean?

It means that we take care in formulating our processes and reports in a way that embraces strengths and differences rather than dwelling in deficits and impairments discourse outlined in diagnostic manuals adopting a medical model to explain behaviours.

In a Therapeutic Process

We use approaches in practice that are play-based, nurturing and based on a child’s interests. This is also aligned with the environment – the cottages – where it is cosy, familial with playrooms. We encourage a parent to discuss challenges before meeting the child so the child is not part of hearing big challenges that may trigger big emotions. We encourage parent-child to collaborate in sessions where challenges of separation anxiety are experienced. We structure sessions with rituals to create predictability and reduce possible challenges with transitions.

We encourage co-construction of sessions such as “what would you like to talk about today”, “let’s make a plan for our session”, rather than having a prescribed topic to be discussed.

We engage the child in the process with including their specific interests in the play and discussions.

We are not typically engaging in talking therapy as this is often not developmentally appropriate for children and adolescents so we offer games, fidgets, resources, books, making, drawing, as part of the process.

As part of the process, we aim to elicit strengths and support strengths development.

The Assessment Process and Reports

We lead an assessment process that is aligned with a neurodivergent affirmative approach. We gather a range of information as part of the assessment process and not only quantitative information. This is to ensure the voice of the child is captured and experiences from informants are also well captured and informing the assessment results. We are careful about selecting tools that are capturing strengths, differences and needs. If a particular tool typically reports results in a deficit and impairment manner, we reframe the language to be neuroaffirming as per below.

We will always use language that is affirmative in our reports and this is very important to us:

Challenges rather than deficits and impairments

Needs rather than a disorder

Strengths and differences

Patterns of observations consistent with x needs

We have a dedicated area in our report where we capture strengths and we highlight these in our formulation. We also formulate recommendations aligned with strengths.

Recommendations

Recommendations are suggestions and aim to include a range of information to support research, psychoeducation and implementation of strategies. We encourage the child and parents to discuss how these recommendations can be implemented in a neuroaffirming way and this aims to be together with the child’s views and within a collaborating approach.

Stating a Diagnosis

When we refer to a diagnosis, we will do this subtly and within one sentence in the Summary/Clinical Opinion section at the end of the report to inform the reader that the information gathered meets criteria of a diagnosis as per the DSM-V. This is because funding systems often needs this confirmation in black and white. We understand that the language use in the DSM-V is not necessarily neuroaffirming but as we are operating within systems needing to link with this language, it is difficult to completely omit it. If we feel the diagnostic criteria should be included in the report, we do this in Appendices.

Summary

When coming to 3P, you can expect the following:

Person-centred tools and work

Positive psychology and strengths-based work

Play approaches

Nurturing environments

Neuroaffirming language throughout our reports

Needs and strengths assessment process

Collaboration, discussions and co-construction

Dr Pascale Paradis

Educational and Developmental Psychologist

Director at Peninsula Paediatric Psychology

Parents often come to us as psychologists with a query around ‘we need an assessment’ being slightly unsure about the process, referral question or the purpose. This text aims to support these queries and provide information about psychoeducational assessments.

What are psychoeducational assessments?

These assessments are the collection of quantitative and qualitative data to help support a clinical formulation about a child’s needs, strengths and challenges. The data is triangulated to capture whether a child’s presentation lead to eliciting needs, strengths and challenges. This process may lead to a diagnosis which is often required for funding systems to offer additional support to the child. In some circumstances a diagnosis may not be needed for additional support. This really depends of the funding systems.

In an assessment process, a range of data is data is collected to answer a referral question. A referral question can be varied depending on experiences described by the child, parents and teachers.

Is my child dyslexic?

We experience x at home, is my child autistic?

The teacher at school said that my child is behind in learning. We want to know what is happening?

In this process, a range of data will be gathered as part of the process and will include quantitative and qualitative data to answer the referral question. This will also include face to face activities with the child such as observations, play sessions, standardised assessments, consultations, interviews, questionnaires, discussions, etc. The choice of the assessment tools used to gather this information will depend on the assessor’s clinical judgement, pertinence of the tool in relation to the referral question and in some instances preferences due to training. In some situations the referral question evolves as the assessment process develops and it may be that additional information is needing to be captured as a result. This is also often the case when there are more than one referral question for the assessment.

Quantitative data are all about standard scores, norms, percentiles. This means that the data gathered will look at placing a child’s abilities, when completing a standardised assessment, on a normal curve and compared to other children of the same age. Results will refer to sentences like this “John performed within an average compared to peers his age which means he has developed positive skills in this and will be able to process this type of information in the classroom”.

A standardised assessment means that the exact same activities and tasks are administered using a manual of instructions to ensure that all participants are going through the exact same experience compared to other participants. Assessors must be trained in the administration to ensure they respect what has been prescribed by the manual.

When assessments are normed, it means that a standardisation process took place before the launch of the assessment, pilot studies, and norms created. When reporting results after an assessment, findings will look at placing the scores within an average range (see image from left to right) – extremely low, very low, low average, very high, extremely high on a normal curve. The results will indicate where abilities demonstrated by the child, when compared to peers of the same age, are plotted – see 68% of the children will be situated within the two high peaks on the picture below, and then 13.6% to the blue areas, and less than 2% on the long end at either ends, and also referred as percentiles. Standard scores are based on the average being 100 in the middle with a standard deviation of 15 from the mean for each descriptive category. When receiving a report from an assessment, parents and teachers should expect to receive information on standard scores.

How is the child’s performance deviating from the mean (100) in scores

How is the child’s performance explained in percentiles

How the child’s performance is described with qualitative descriptors

Normed assessment tools also include questionnaires. Questionnaires can be helpful as it aims to have information from a number of informants – parents/carers, teachers and self-report. This is help gain everyone’s views as informants may have a different view of what the needs of the child are. This helps formulating how a child is similar and different across settings and whether some environmental factors may contribute to the child’s needs.

An assessment process will also gather qualitative information – this means that the information gathered is not normed, but will also contribute to formulating the experience of the child, parents and school. This will include play sessions, observations, consultations, interviews, discussions, to elicit perceptions, attitudes, experiences, history, stories, anecdotes, pertinent information. The richness of the information is particularly important as quantitative information does not always fully capture an explanation of the inner world of the child and also experiences on a day to day basis. It is also important to capture the views of the child to inform recommendations so that their voice is captured and the recommendations are tailored to the needs the child is reporting.

Why do psychoeducational assessments? What is their purpose?

The purpose of the assessment is really getting to know the child better and gain an understanding of needs, challenges, strengths and inform support going forward.

It may lead to a diagnosis or it may not. In all cases, it will inform needs, challenges, strengths and will help formulate recommendations and next steps. In the education system, it may be that it will contribute to an Individualised Education Plan (IEP). It may give parents/carers some strategies that have not been tried before. It may also create a process of a deeper understanding such as an affirming process, “ah yes, this all makes sense, this is what we thought”. It may support a child understand better by knowing their brain works differently and this is why they are feeling different. It may also help advocate for a child’s needs and construct conversations to be had with different systems. It may lead to additional funding to support the child’s needs with environmental accomodations.

What is the process of a psychoeducational assessment?

Typically, a process includes the following –

an initial consultation – gather information, developmental history, current needs, referral question

cognitive and learning profile – standardised assessments

questionnaires – standardised assessments

play sessions/clinical interviews – qualitative information – child’s views/voice

Some additional sessions may be needed as the process unfolds depending on results.

feedback session – ensure all understand the results and findings, psychoeducation about needs, formulate a plan about next steps together with the assessor

In what way will these help my child?

The recommendations and the formulation of the plan will aim to create a constructed support plan for the here and now and also the near future such as informing others such as school, funding systems, of the child’s needs and recommendations for additional support. It may also create a process where parents engage in future support to help their child, or the child engages in a therapeutic process to look at skills development, counselling, group work. This will definitely be discussed in the feedback session.

At Peninsula Paediatric Psychology

We do lots of assessments and we will lead you through this process. Depending on the referral question, we will tailor an assessment plan that captures quantitative and qualitative information to formulate tailored to needs recommendations.

Dr Pascale Paradis

Educational and Developmental Psychologist

Director at Peninsula Paediatric Psychology

I did not anticipate a first aid kit would be such a great hit in the playroom. The kit just sits around the playroom and many children have enjoyed discovering all the items in the kit.

The first aid kit has been helpful for purposes such as:

familiarise a child with injection due to the covid vaccination program

discussing with parents about challenges going to the doctor and familiarise the child with the process

promoting child-parent interactions such as close proximity when the child is testing the parent

giving the opportunity for the child to be in charge of doing injections and tests to a parent when it is typically the opposite when unwell

being playful when exploring big feelings about being ill, covid, vaccinations

expressing emotions through play

explore tough experiences in a safe environment

process difficult experiences with related objects which facilitate thinking and language

The kit was just a quick purchase from a popular shop. I realise now how timeline the purchase was considering all the challenges experienced with covid-19. Children are really benefiting from playing it out and exploring big emotions through play in the safety of the playroom.

There is also an easy link here to make for children in terms of health and mental health. The doctor kit being more particularly related to physical symptoms needing to be looked at and then linking to how to look after mental health which is not necessarily visible or have a specific and tangible kit. The conversation can then be extended to building a mental health kit and developing coping cards to fit in the kit.

For parents, playing doctor can also be easily be done at home. Through play, children explore and create constructs of their world so giving them the opportunity to process big and current topics can be helpful for them to process big emotions related to health. Discussions can also be extended to include a mental health kit.

A number of resources are being developed at 3P. For more information, visit our website: https://3ppsychologies.com/products/

The playroom is working like a treat so I wanted to share a few resources that I am enjoying working with in the playroom.

The Postbox has been very popular for a range of purposes either in directed activities or child directed play. Activities have varied such as:

1. to write how we feel and post this message to someone special
2. writing a message to someone we no longer see or miss
3. write a message or make a drawing to the therapist to explain how one feels
4. post an activity when finished
5. thinking about writing a letter of thank you to someone
6. sending a postcard to someone about our life adventures and how one is having a good time
7. sending a message to someone about one’s strengths and skills and/or a success
8. sending a message to someone about a change one would like to make
9. exchanging messages about a difficult event that happened in the week
10. write a message about the session and what we would do next time

The Postbox is certainly a great resource in the playroom. This one was purchased at a popular store. With creativity, a postbox could be easily made with a box. Additionally, postcards and message cards can be created for children to take away messages with them.

As children do not necessarily have literacy skills develop for long messages, encouraging drawings, images, keywords and codes is as successful as writing a message. Processing thinking visually can be helpful in mapping thought and feelings.

When working online, a postbox could be created using the whiteboard during sessions.

Parents can also create a postbox in the house for children to post messages or big emotions about specific events. This can help children express their thoughts and feelings in a different way to talking. As talking can be developmentally challenging for children, a different way to express thoughts and feelings can work well. The process of thinking and writing is also a different process to talking, and can be helpful to children who have challenges in expressing emotions verbally.

The Postbox and narrative therapy activities feature in The Therapist Backpack, see the link below for more information about this concept.