Principles for the Training of "New Professionals" in Mental Health Carl Eisdorfer, Ph.D., M.D. Stuart E. Golann, Ph.D.
ABSTRACT: Experience with two of the recent programs for training mature women in "new professions" for mental health service has led the authors to develop a series of hypotheses concerning such new training programs. These hypotheses are presented as guidelines or principles of planning and training for developing new programs in nontraditionaI mental health roles. The emerging Community Mental Health Centers program in the United States would require the services of half the professional membership of the American Psychiatric Association, the National Association for Social Workers, and the American Psychological Association combined. This prognosis was made by Albee (2963) from his studies of mental health manpower statistics. The shortage of skilled manpower has emerged a s the salient problem in mental health programming. This is not only a long-range concern; staffing difficulties are already reflected in large numbers of budgeted but unfilled positions throughout the country. In response to these needs and the limitations of available manpower resources in the foreseeable future, a number of training programs have been created to equip persons without prior professional training for roles in what have come to be called "new professions." While Webster (2964) describes a profession as "requiring specialized knowledge and often long and intensive academic preparation including instrnction in skills and methods as well as in the scientific, historical, or scholarly principles underlying such skills," it is clear that the time for long and intensive preparation may not be available to many persons capable of Dr. Eisdorfer is associate professor of medical psychology and psychiatry at Duke University, Box 30o3, Duke University Medical Center, Durham, N.C. 277o6; and director of training and research coordinator at the Duke University Center for the Study of Aging and Human Development. He is also the coordinator of the Halifax County (N.C.) Community Mental Health Program. Dr. Golann, a clinical psychologist, was at the time this paper was written with the Department of Psychology at the University of Maryland and is currently associate administrative officer for professional affairs, American Psychological Association, Washington, D.C. This work was supported by a grant from the National Institute of Mental Health, MH 8322. Community Mental Health Journal, Vol, 5 (5), 1969
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assisting with the care or prevention of emotional illness, The demands of society exert a powerful stimulus toward the most expeditious training of capable persons while manpower resources which have been relatively untapped may be found in population groups such as mature women, retirees, and indigenous leaders in poverty areas. For such persons, academic training may be quite impractical and, to a large measure, perhaps unnecessary. Two training programs designed to equip individuals to act in such new professional roles are the National Institute of Mental Health Training Program for Mental Health Counselors (Rioch, Elkes, & Flint, ~965) and the District of Columbia Children's Hospital Training Program for Child Development Counselors (Lourie, Rio&, & Schwartz, x967). Both took place in the Washington, D.C., area and both involved part-time training of middleaged females. The objective of the Mental Health Counselor (MHC) program initiated by Margaret Rioch was the training of mature women to act as counselor-therapists. The trainees were selected from a large pool of interested women who were trained (half-time) for a two-year period at the NIMH. The program has been described by Rioch, Elkes, and Flint (x965), and the evaluation of the trainees on the job has been reported by Golann, Breiter, and Magoon (z966); Magoon, Golann, and Freeman (1969). Lourie, Rioch, and Schwartz used a similar format to organize a program for training child development counselors (CDC) to work in well-baby clinics. These women were to supplement the work of clinic staff by acting in the "preventive" capacity through helping mothers with problems of child development. This seemed particularly important in view of the limited time available to the physicians and nurses in well-baby clinics. Training for the CDCs was conducted in the Children's Hospital by the Psychiatry Department in collaboration with pediatricians from the Health Department. The findings of the on-the-job follow-up have been reported by Golann (2967). Most of the graduates of these two programs are now at work. Such new training programs carry with them the potential for major improvements in the manpower situation, but also for costly personal and programmatic failures. Riessman (2967) has presented a number of strategies and recommendations for training nonprofessionals, including class discussion, on-the-job training, and coordinating training and supervision. This paper stresses the planning of new programs. Several principles are set forth which are offered for consideration as working hypotheses. PLANNING The initial phases of planning include: (I) role definition; (2) faculty selection; (3) trainee selection; (4) field staff; (5) financing; (6) initial job placement; (7) communication with trainees; and (8) evaluation planning. The first principle concerns the need for explicit role definition in planning the program of training for the new professional. One of the salient
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problems in program organization is clarification of the distinction between role models and training models. In training the mental health counselor (MHC), the working role model of the counselor-trainee was a familiar one, i.e., individual or small group interactions with troubled people for the purpose of helping them understand and resolve their problems with more insight. It should be clear that while the training program could hardly be thought of as traditional (i.e., there was no professional institution or degree program to which the instruction could be grafted), the role of psychotherapist was a recognized one. In contrast, the role of the child development counselor was a new one. There are no professional persons who currently identify themselves in this way, nor are there established training programs designed to produce such persons. Consequently, While the trainees in the MHC program may have had a reasonably good idea of the goals toward which they were heading, such goals remained ambiguous throughout the two years of training of the CDCs. It appeared that this role definition facilitated the learning of the MHCs, while the ambiguity frustrated the CDCs and they began to move toward a self-definition away from such ambiguity and toward a MHC model.
Principle I: Role Definition a. A clear role definition should be an essential part of program planning. This is especially important when the proposed role is not well established. b. The training faculty should take great care to identify the nature of relationships and skills necessary for successful performance of such a role. e. The limitation of responsibility is a particularly important aspect of this planning. Where this is not done, the confusion and anxiety of the trainee will be heightened. d. Nontraditional training may entail a different set of problems from the creation of nontraditional roles. In setting performance levels in traditional roles it is possible to use established criteria for the results of training and on-the-job functioning. It is even more difficult, however, to establish guidelines for a profession without any historic basis. This is particularly important with respect to the limitation of responsibilities for the new professional. The most reasonable and efficient procedure may be to base such guidelines upon the nearest relevant model (as defined by training, approximate level of expertise desired, and so on). In establishing a new role, it is necessary that such limitations be explored in detail, including perhaps the establishment of arbitrary limits at the outset. It should be recognized that nontraditionally trained personnel are likely to be sensitive to such limitations and thus their purposes should be clearly spelled out. These principles do not imply that the specifics of operation within the role should be unnecessarily overstructured. A good deal of flexibility must be allowed within the limitation of the role responsibility and the new professional's on-the-job functioning may require considerable freedom with
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shifting of techniques and behavior patterns from one assignment (and one client) to another. Perhaps the earliest component of planning should be a feasibility study. There may be a great gap between the settings of goals and the feasibility of working toward these goals in a given setting. Thus the proposition that a new professional working in an old setting would be a significant asset might be open to question if there were no opportunity for the new professional to become part of a working team or if the client group were resistant to utilizing the services of such new persons. The new professional will be most likely to adopt a role model closest to that of a key member of his training staff. This creates a situation maximizing the opportunity for role conflict. Since the trainees are instructed in the techniques of their new role by an individual who is closely identified with the practice of a familiar (existing) role, problems are likely to arise. It would not be unusual, in fact, for the trainer to have little or no experience and perhaps relatively little interest in the work to be undertaken by the new professional. Thus the new professional trainee identifying with such a person may be in a confusing situation.
Principle Ih Faculty Selection a. A careful orientation to the anticipated needs of the trainees should be a requisite for the training faculty. b. In organizing the training staff for a "new professional" program, care must be exercised to structure the interaction between the trainees and those professional persons with techniques and principles consistent with the newly defined role. This is particularly important during the early phases of training. It is recommended that caution should be exercised in allowing new trainees to overidentify with highly capable professionals necessarily employing old models, even where the trainers are "friendly" to the new profession. It may become necessary, therefore, to allow for a period of time to train the trainers. As a minimum, the trainer might be put into the situation to be occupied by the trainee so that he can understand the setting in which the new professionals will have to function, as well as something of the demands of the role. At that point, it may be possible to employ a selfselection process with the trainers. Do they feel that their techniques are applicable to this situation? Are they interested in pursuing the training program given the needs of the situation?
Principle IIh Trainee Selection a. A basic principle of nontraditional approaches is the assumption that through careful selection of trainees certain aspects of training become unnecessary. b. The target groups for selection should not ordinarily be employed in other closely related service capacities, as this would simply move a person from one role to another without adding to tota! manpower. c. The selection criteria should be specified operationally and as clearly as possible.
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It is suggested that the motivation behind the prospective trainees' interest in the program be considered. Why do the applicants want to return to school? Why do they want this type of employment? How would the new role fill their needs? Also of significance is the question of why the applicant is willing to be involved in a program which carries the risks inherent in nontraditional programs. The answers to such questions may be important in the selection process.
Principle IV: Field Setting To the extent that the new professional model is oriented to a proposed job, it is important that the staff of potential placement agencies be included in the planning of the program as well as the plan for subsequentemployment. This is accomplished easily in a captive program where a given agency trains for its own needs, but the principle is particularly important where the training setting is wholly separate from the probable placement settings. In such situations, training should include core material which is designed to facilitate subsequent employment and is planned in conjunction with field placement agencies. Consultation from several similar agencies may be required to develop the core curriculum.
Principle V: Financing New professional training programs should not be initiated until complete funding is available. Ideally, funding should go beyond one cycle so that an adequate group of individuals may be available to the field within a reasonable time after the initial graduation of a group of new professionals. The financial aspects of such new professional training programs are crucial issues. While the support for new and nontraditional training programs will probably be derived initially as special projects from Federal or state governments or from private foundations, eventually the cost will have to be assumed as an educational expense consistent with more traditional support. Arrangements between city- or state-level health and welfare agencies and training institutions such as universities, community colleges, and technical institutes should be explored to establish reasonable alternafives. Eventually such programs will have to be self-supporting, at least in the sense that they produce sufficient benefits to the community to constitute a worthwhile investment. Apart from its demonstration value, the "one shot" approach has only limited effectiveness. The number of persons produced is likely to be limited particularly in terms of cost; the interactions of personality and program make evaluation most complex; and the "in group" flavor inhibits the open explorations of the role limitations. When the trainees are selected from the lower socioeconomic levels, and particularly when they are already employed, income replacement for trainees will probably be necessary. The provision of stipends for the trainees is
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a complex issue involving primarily the needs and level of attainment of the potential trainee. In the comparison between the mental health and child development counselor programs, no effect could be seen directly relatable to the availability of stipends during training to the CDCs.
Principle VI: Initial Job Placement a. Placement posttraining should be an integral part of program planning. Such placement should be designed to cover a posttraining period of one or two years. b. In developing such plans, it may be necessary to allow for a reasonable supplementation of income at the outset since prospective employers may not be in a position to support such new professionals, even with advanced planning. Not only will the trainee entering a new program be anxious about job placement subsequent to training, but the job has an important impact upon training itself, for such issues accentuate the necessity for early planning of the posttraining placement. Meaningful job placement is important to prevent the waste of the trainees in roles other than those for which they were trained. It also avoids having the trainees' time divided among a number of part-time jobs which may be patched together at the last minute to provide employment and income. The MHC project included half salaries which were paid to the counselors during the two years following completion of training. The plan for the CDCs did not include such stipends and the hoped for placement in wellbaby clinics did not materialize. As a result, the CDCs found it necessary to work in more than one job with the subsequent criticism that they were spread too thin to be effective within a given agency. In addition, of course, the CDCs had to shift from one role relationship to another several times during their (part-time) work week. A most significant issue in job placement is salary level, particularly with governmental agencies. The new training program may have less effect upon salary levels than other formal education and the civil service grade of the new job category may subsequently be established to reflect the level of the trainee with the most limited formal education. This may have profound consequences for the program and its viability.
Principle WI: Communication with Trainees a. As part of the selection process, the candidates should be informed as to the experimental nature of the training program, as to the nature of the role model, and any vagaries which exist with respect to employment after training. b. There is an understandable tendency to maintain an open and frank communication with the trainees about problems encountered regarding the program, but such communication may adversely affect morale. Since new professional programs are in a state of marked transition, i t might be anticipated that the training staff will become involved in frustrations, unfilled promises from other agencies, and the need to alter plans on
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a very short-term basis. Care should be exercised so that the prospective trainee understands the problems involved in training for a new professional role and the relatively experimental nature of such programs. While this may do more to alleviate the anxiety of the trainer than trainee, it is essential that such programs proceed on the basis of frank open communication by the training staff. On the other hand, a detailed accounting of the daily trials and tribulations of the program should probably not be shared with the trainee; this may hinder the training.
Principle VIII: Evaluation a . Timing of follow-up. The evaluation of training should be a n integral aspect of the program and the opportunity should be made available for such studies to begin before the training gets underway. b. The statement of a programmatic goal is a most valuable factor.
Where goal statements are absent, the role of evaluation becomes more difficult. When the faculty are truly interested in determining the effects of training, the evaluation procedures can be instituted with the onset of training. TRAINING FORMAT The foregoing principles concerned eight phases of program planning. Principles IX through XII relate to the issues of ongoing relationships, group support, continuing education, and indigenous training. Although the pressure for available manpower would seem to press for expeditious training (intensive work over the shortest possible calendar time), there does appear to be some indication that training should be distributed over longer calendar units. Eisdorfer, Altrocchi, and Young (x968) have suggested that more than one year may be necessary to establish certain on-going relationships in a community unit and that "a consultant in training should spread his hours over the longest calendar time." Rioch (~965) has suggested that one year of intensive work is not as appropriate as two years of half-time work. For certain forms of therapy it is essential that the trainees have the opportunity to spend a considerable amount of calendar time, e.g., x8 months or more, with a patient. In other instances, the trainee could well be placed on the job with continued inservice training to supplement the formal aspects of his program.
Principle IX: Stable Continuing Relationships Training should include the opportunity for continuing relationships to be established with individual clients or community agencies.
Principle X: Group Support The maintenance of the training group into the employment period posttraining should be facilitated. One method for accomplishingthis is a seminar extending into the initial years of employment.
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One of the features of training for new professionals is the development of group interaction among the trainees. Since there are no existing groups with which to affiliate, such group interaction will be intensified and the trainees will necessarily turn to themselves for support. This may prove most helpful if continued into the posttraining work experience.
Principle XI" Continuing Education In establishing a program, the opportunity for the graduate of the new trainingprogramto engagein continuededucationshouldbe facilitated. One of the marks of a profession is the continuing education which follows formal training. Such opportunities for advanced training should be made available to the trainees and the ethic for such on-going behavior should be presented during training. It follows, then, that the trainers have a responsibility for making available the opportunities for on-going education.
Principle XII: Indigenous Training In programs which have a clearlydefinedclient group, field training with this group shouldbe started as promptlyas possible. While this may not be possible in programs in which the target group is not as well defined, it would be valuable to come to grips with any cultural "shock" early in the training to facilitate the adjustment to this problem. A significant issue in many training programs may be a difference in the cultures of the target groups and the trainees. In the MHC Project, the counselors were indigenous to the population they served, i.e., upper middle-class suburbanites and their children. The problems of the culture to which these counselors had made an excellent adaptation in the past were the same as those experienced by the client. For the CDCs, however, the work setting was largely in the inner city of the District of Columbia. There were differences between clients and counselors in race, socioeconomic status, and culture, including the presence of basic survival needs (i.e., food, shelter, and clothing) as central themes to the client group. The selection criteria for the CDC, which identified them as eminently well adapted to function successfully in a white middle-class culture, may have had relatively low predictive value for the trainees' ability to operate effectively in the inner city. Such aspects of behavior as making and keeping appointments, talking about one's feelings, and the ability to relate to a white middle-class morality, reflected a high degree of cultural differences between the clients and the counselors in the CDC program. It is strongly recommended that where such cultural differences are to be encountered, they be made explicit and included in the fabric of the training program. The problems faced are quite reminiscent of similar problems reported by Peace Corps volunteers. Not unexpectedly, even language patterns and attitudes toward care-givers were
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not shared by the counselors and the recipient in the inner city of the District of Columbia. While the CDC trainees did not seek gratitude, they often expected it. The client, on the other hand, may take the position that there has to be "something in it" for the care-giver. If there is not some reward, then the client can have little respect for the care-giver. If there is, then clearly there is no need for gratitude, however much it may be expected. Such'interactions may be outside the domain of the trainee's experience and be a source of much confusion or anxiety. The training format used in planning for cultural differences is important. In the CDC program, training included a strong field component, but there was some question as to the relationship between the early aspects of field training and subsequent placement. As a result, many of the CDCs were not prepared to cope with the problems that confronted them. Thus they tended not to get involved in many issues of primary relevance to the clients. They avoided home visits, and they limited their contacts to the clinic at specified appointment times, thus intensifying the effect of cultural differences. Those trainees who were able to remain more comfortable with their clients' culture, even when markedly dissimilar from their own, seemed more successful in their efforts. REFERENCES Albee, G. W. American psychology in the sixties. American Psychologist, I963, I8, 90-95. Eisdorfer, C.; Altrocchi, J.; and Young, R. F. Principles of community mental health in a rural setting: the Halifax County Program. Community Mental Health Journal, 1968, 4, 2 2 1 - 2 2 0 .
Golann, S. E. Initial findings of the follow-up study of child development counselors. A ~'" .~. . . Journal ~ I ~ , ~~vz, 57, 1759-1766. .~m~,zc . . . . . . . . . . .of . . . D.,~.I~. . Golann, S. E., Breiter, D. E., and Magoon, T. M. A filmed interview applied to the evaluation of mental health counselors. Psychotherapy: Theory, Research, and Practice, I966, 3, 21-24. Lourie, R. S., Rioch, M. J., and Schwartz, S. The concept of a training program for child development counselors. American Journal of Public Health, I967, 57, 1754I758. Magoon, T. M., and Golann, S. E. Non-traditionally trained women as mental health counselors/psychotherapists.Personnel and Guidance Journal, I966, 44, 788-792. Magoon, T. M., Golann, S. E., and Freeman, R. W. Mental health counselors at work. New York: Pergamon Press, 2969. Riessman, F. Strategies and suggestions for training nonprofessionals. Community Mental Health Journal, 1967, 3, Io3-Ilo. Rioch, M. Implications of two pilot projects in training mental health counselors. Paper presented at the American PsychologicalAssociation Convention, Chicago, i965 . Rioch, M., Elkes, C., and Flint, A. A. Pilot project in training mental health counselors. USPHS Pub. No. 1254. Washington, D.C.: Government Printing Office, 2965. Webster's New International Dictionary of the English Language (3rd ed., unabridged). Springfield, Mass.: G. & C. Merriam, I964.
ABSTRACT: Experience with two of the recent programs for training mature women in "new professions" for mental health service has led the authors to develop a series of hypotheses concerning such new training programs. These hypotheses are presented as guidelines or principles of planning and training for developing new programs in nontraditionaI mental health roles. The emerging Community Mental Health Centers program in the United States would require the services of half the professional membership of the American Psychiatric Association, the National Association for Social Workers, and the American Psychological Association combined. This prognosis was made by Albee (2963) from his studies of mental health manpower statistics. The shortage of skilled manpower has emerged a s the salient problem in mental health programming. This is not only a long-range concern; staffing difficulties are already reflected in large numbers of budgeted but unfilled positions throughout the country. In response to these needs and the limitations of available manpower resources in the foreseeable future, a number of training programs have been created to equip persons without prior professional training for roles in what have come to be called "new professions." While Webster (2964) describes a profession as "requiring specialized knowledge and often long and intensive academic preparation including instrnction in skills and methods as well as in the scientific, historical, or scholarly principles underlying such skills," it is clear that the time for long and intensive preparation may not be available to many persons capable of Dr. Eisdorfer is associate professor of medical psychology and psychiatry at Duke University, Box 30o3, Duke University Medical Center, Durham, N.C. 277o6; and director of training and research coordinator at the Duke University Center for the Study of Aging and Human Development. He is also the coordinator of the Halifax County (N.C.) Community Mental Health Program. Dr. Golann, a clinical psychologist, was at the time this paper was written with the Department of Psychology at the University of Maryland and is currently associate administrative officer for professional affairs, American Psychological Association, Washington, D.C. This work was supported by a grant from the National Institute of Mental Health, MH 8322. Community Mental Health Journal, Vol, 5 (5), 1969
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assisting with the care or prevention of emotional illness, The demands of society exert a powerful stimulus toward the most expeditious training of capable persons while manpower resources which have been relatively untapped may be found in population groups such as mature women, retirees, and indigenous leaders in poverty areas. For such persons, academic training may be quite impractical and, to a large measure, perhaps unnecessary. Two training programs designed to equip individuals to act in such new professional roles are the National Institute of Mental Health Training Program for Mental Health Counselors (Rioch, Elkes, & Flint, ~965) and the District of Columbia Children's Hospital Training Program for Child Development Counselors (Lourie, Rio&, & Schwartz, x967). Both took place in the Washington, D.C., area and both involved part-time training of middleaged females. The objective of the Mental Health Counselor (MHC) program initiated by Margaret Rioch was the training of mature women to act as counselor-therapists. The trainees were selected from a large pool of interested women who were trained (half-time) for a two-year period at the NIMH. The program has been described by Rioch, Elkes, and Flint (x965), and the evaluation of the trainees on the job has been reported by Golann, Breiter, and Magoon (z966); Magoon, Golann, and Freeman (1969). Lourie, Rioch, and Schwartz used a similar format to organize a program for training child development counselors (CDC) to work in well-baby clinics. These women were to supplement the work of clinic staff by acting in the "preventive" capacity through helping mothers with problems of child development. This seemed particularly important in view of the limited time available to the physicians and nurses in well-baby clinics. Training for the CDCs was conducted in the Children's Hospital by the Psychiatry Department in collaboration with pediatricians from the Health Department. The findings of the on-the-job follow-up have been reported by Golann (2967). Most of the graduates of these two programs are now at work. Such new training programs carry with them the potential for major improvements in the manpower situation, but also for costly personal and programmatic failures. Riessman (2967) has presented a number of strategies and recommendations for training nonprofessionals, including class discussion, on-the-job training, and coordinating training and supervision. This paper stresses the planning of new programs. Several principles are set forth which are offered for consideration as working hypotheses. PLANNING The initial phases of planning include: (I) role definition; (2) faculty selection; (3) trainee selection; (4) field staff; (5) financing; (6) initial job placement; (7) communication with trainees; and (8) evaluation planning. The first principle concerns the need for explicit role definition in planning the program of training for the new professional. One of the salient
Carl Eisdorfer and Stuart E. Golann
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problems in program organization is clarification of the distinction between role models and training models. In training the mental health counselor (MHC), the working role model of the counselor-trainee was a familiar one, i.e., individual or small group interactions with troubled people for the purpose of helping them understand and resolve their problems with more insight. It should be clear that while the training program could hardly be thought of as traditional (i.e., there was no professional institution or degree program to which the instruction could be grafted), the role of psychotherapist was a recognized one. In contrast, the role of the child development counselor was a new one. There are no professional persons who currently identify themselves in this way, nor are there established training programs designed to produce such persons. Consequently, While the trainees in the MHC program may have had a reasonably good idea of the goals toward which they were heading, such goals remained ambiguous throughout the two years of training of the CDCs. It appeared that this role definition facilitated the learning of the MHCs, while the ambiguity frustrated the CDCs and they began to move toward a self-definition away from such ambiguity and toward a MHC model.
Principle I: Role Definition a. A clear role definition should be an essential part of program planning. This is especially important when the proposed role is not well established. b. The training faculty should take great care to identify the nature of relationships and skills necessary for successful performance of such a role. e. The limitation of responsibility is a particularly important aspect of this planning. Where this is not done, the confusion and anxiety of the trainee will be heightened. d. Nontraditional training may entail a different set of problems from the creation of nontraditional roles. In setting performance levels in traditional roles it is possible to use established criteria for the results of training and on-the-job functioning. It is even more difficult, however, to establish guidelines for a profession without any historic basis. This is particularly important with respect to the limitation of responsibilities for the new professional. The most reasonable and efficient procedure may be to base such guidelines upon the nearest relevant model (as defined by training, approximate level of expertise desired, and so on). In establishing a new role, it is necessary that such limitations be explored in detail, including perhaps the establishment of arbitrary limits at the outset. It should be recognized that nontraditionally trained personnel are likely to be sensitive to such limitations and thus their purposes should be clearly spelled out. These principles do not imply that the specifics of operation within the role should be unnecessarily overstructured. A good deal of flexibility must be allowed within the limitation of the role responsibility and the new professional's on-the-job functioning may require considerable freedom with
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shifting of techniques and behavior patterns from one assignment (and one client) to another. Perhaps the earliest component of planning should be a feasibility study. There may be a great gap between the settings of goals and the feasibility of working toward these goals in a given setting. Thus the proposition that a new professional working in an old setting would be a significant asset might be open to question if there were no opportunity for the new professional to become part of a working team or if the client group were resistant to utilizing the services of such new persons. The new professional will be most likely to adopt a role model closest to that of a key member of his training staff. This creates a situation maximizing the opportunity for role conflict. Since the trainees are instructed in the techniques of their new role by an individual who is closely identified with the practice of a familiar (existing) role, problems are likely to arise. It would not be unusual, in fact, for the trainer to have little or no experience and perhaps relatively little interest in the work to be undertaken by the new professional. Thus the new professional trainee identifying with such a person may be in a confusing situation.
Principle Ih Faculty Selection a. A careful orientation to the anticipated needs of the trainees should be a requisite for the training faculty. b. In organizing the training staff for a "new professional" program, care must be exercised to structure the interaction between the trainees and those professional persons with techniques and principles consistent with the newly defined role. This is particularly important during the early phases of training. It is recommended that caution should be exercised in allowing new trainees to overidentify with highly capable professionals necessarily employing old models, even where the trainers are "friendly" to the new profession. It may become necessary, therefore, to allow for a period of time to train the trainers. As a minimum, the trainer might be put into the situation to be occupied by the trainee so that he can understand the setting in which the new professionals will have to function, as well as something of the demands of the role. At that point, it may be possible to employ a selfselection process with the trainers. Do they feel that their techniques are applicable to this situation? Are they interested in pursuing the training program given the needs of the situation?
Principle IIh Trainee Selection a. A basic principle of nontraditional approaches is the assumption that through careful selection of trainees certain aspects of training become unnecessary. b. The target groups for selection should not ordinarily be employed in other closely related service capacities, as this would simply move a person from one role to another without adding to tota! manpower. c. The selection criteria should be specified operationally and as clearly as possible.
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It is suggested that the motivation behind the prospective trainees' interest in the program be considered. Why do the applicants want to return to school? Why do they want this type of employment? How would the new role fill their needs? Also of significance is the question of why the applicant is willing to be involved in a program which carries the risks inherent in nontraditional programs. The answers to such questions may be important in the selection process.
Principle IV: Field Setting To the extent that the new professional model is oriented to a proposed job, it is important that the staff of potential placement agencies be included in the planning of the program as well as the plan for subsequentemployment. This is accomplished easily in a captive program where a given agency trains for its own needs, but the principle is particularly important where the training setting is wholly separate from the probable placement settings. In such situations, training should include core material which is designed to facilitate subsequent employment and is planned in conjunction with field placement agencies. Consultation from several similar agencies may be required to develop the core curriculum.
Principle V: Financing New professional training programs should not be initiated until complete funding is available. Ideally, funding should go beyond one cycle so that an adequate group of individuals may be available to the field within a reasonable time after the initial graduation of a group of new professionals. The financial aspects of such new professional training programs are crucial issues. While the support for new and nontraditional training programs will probably be derived initially as special projects from Federal or state governments or from private foundations, eventually the cost will have to be assumed as an educational expense consistent with more traditional support. Arrangements between city- or state-level health and welfare agencies and training institutions such as universities, community colleges, and technical institutes should be explored to establish reasonable alternafives. Eventually such programs will have to be self-supporting, at least in the sense that they produce sufficient benefits to the community to constitute a worthwhile investment. Apart from its demonstration value, the "one shot" approach has only limited effectiveness. The number of persons produced is likely to be limited particularly in terms of cost; the interactions of personality and program make evaluation most complex; and the "in group" flavor inhibits the open explorations of the role limitations. When the trainees are selected from the lower socioeconomic levels, and particularly when they are already employed, income replacement for trainees will probably be necessary. The provision of stipends for the trainees is
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a complex issue involving primarily the needs and level of attainment of the potential trainee. In the comparison between the mental health and child development counselor programs, no effect could be seen directly relatable to the availability of stipends during training to the CDCs.
Principle VI: Initial Job Placement a. Placement posttraining should be an integral part of program planning. Such placement should be designed to cover a posttraining period of one or two years. b. In developing such plans, it may be necessary to allow for a reasonable supplementation of income at the outset since prospective employers may not be in a position to support such new professionals, even with advanced planning. Not only will the trainee entering a new program be anxious about job placement subsequent to training, but the job has an important impact upon training itself, for such issues accentuate the necessity for early planning of the posttraining placement. Meaningful job placement is important to prevent the waste of the trainees in roles other than those for which they were trained. It also avoids having the trainees' time divided among a number of part-time jobs which may be patched together at the last minute to provide employment and income. The MHC project included half salaries which were paid to the counselors during the two years following completion of training. The plan for the CDCs did not include such stipends and the hoped for placement in wellbaby clinics did not materialize. As a result, the CDCs found it necessary to work in more than one job with the subsequent criticism that they were spread too thin to be effective within a given agency. In addition, of course, the CDCs had to shift from one role relationship to another several times during their (part-time) work week. A most significant issue in job placement is salary level, particularly with governmental agencies. The new training program may have less effect upon salary levels than other formal education and the civil service grade of the new job category may subsequently be established to reflect the level of the trainee with the most limited formal education. This may have profound consequences for the program and its viability.
Principle WI: Communication with Trainees a. As part of the selection process, the candidates should be informed as to the experimental nature of the training program, as to the nature of the role model, and any vagaries which exist with respect to employment after training. b. There is an understandable tendency to maintain an open and frank communication with the trainees about problems encountered regarding the program, but such communication may adversely affect morale. Since new professional programs are in a state of marked transition, i t might be anticipated that the training staff will become involved in frustrations, unfilled promises from other agencies, and the need to alter plans on
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a very short-term basis. Care should be exercised so that the prospective trainee understands the problems involved in training for a new professional role and the relatively experimental nature of such programs. While this may do more to alleviate the anxiety of the trainer than trainee, it is essential that such programs proceed on the basis of frank open communication by the training staff. On the other hand, a detailed accounting of the daily trials and tribulations of the program should probably not be shared with the trainee; this may hinder the training.
Principle VIII: Evaluation a . Timing of follow-up. The evaluation of training should be a n integral aspect of the program and the opportunity should be made available for such studies to begin before the training gets underway. b. The statement of a programmatic goal is a most valuable factor.
Where goal statements are absent, the role of evaluation becomes more difficult. When the faculty are truly interested in determining the effects of training, the evaluation procedures can be instituted with the onset of training. TRAINING FORMAT The foregoing principles concerned eight phases of program planning. Principles IX through XII relate to the issues of ongoing relationships, group support, continuing education, and indigenous training. Although the pressure for available manpower would seem to press for expeditious training (intensive work over the shortest possible calendar time), there does appear to be some indication that training should be distributed over longer calendar units. Eisdorfer, Altrocchi, and Young (x968) have suggested that more than one year may be necessary to establish certain on-going relationships in a community unit and that "a consultant in training should spread his hours over the longest calendar time." Rioch (~965) has suggested that one year of intensive work is not as appropriate as two years of half-time work. For certain forms of therapy it is essential that the trainees have the opportunity to spend a considerable amount of calendar time, e.g., x8 months or more, with a patient. In other instances, the trainee could well be placed on the job with continued inservice training to supplement the formal aspects of his program.
Principle IX: Stable Continuing Relationships Training should include the opportunity for continuing relationships to be established with individual clients or community agencies.
Principle X: Group Support The maintenance of the training group into the employment period posttraining should be facilitated. One method for accomplishingthis is a seminar extending into the initial years of employment.
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One of the features of training for new professionals is the development of group interaction among the trainees. Since there are no existing groups with which to affiliate, such group interaction will be intensified and the trainees will necessarily turn to themselves for support. This may prove most helpful if continued into the posttraining work experience.
Principle XI" Continuing Education In establishing a program, the opportunity for the graduate of the new trainingprogramto engagein continuededucationshouldbe facilitated. One of the marks of a profession is the continuing education which follows formal training. Such opportunities for advanced training should be made available to the trainees and the ethic for such on-going behavior should be presented during training. It follows, then, that the trainers have a responsibility for making available the opportunities for on-going education.
Principle XII: Indigenous Training In programs which have a clearlydefinedclient group, field training with this group shouldbe started as promptlyas possible. While this may not be possible in programs in which the target group is not as well defined, it would be valuable to come to grips with any cultural "shock" early in the training to facilitate the adjustment to this problem. A significant issue in many training programs may be a difference in the cultures of the target groups and the trainees. In the MHC Project, the counselors were indigenous to the population they served, i.e., upper middle-class suburbanites and their children. The problems of the culture to which these counselors had made an excellent adaptation in the past were the same as those experienced by the client. For the CDCs, however, the work setting was largely in the inner city of the District of Columbia. There were differences between clients and counselors in race, socioeconomic status, and culture, including the presence of basic survival needs (i.e., food, shelter, and clothing) as central themes to the client group. The selection criteria for the CDC, which identified them as eminently well adapted to function successfully in a white middle-class culture, may have had relatively low predictive value for the trainees' ability to operate effectively in the inner city. Such aspects of behavior as making and keeping appointments, talking about one's feelings, and the ability to relate to a white middle-class morality, reflected a high degree of cultural differences between the clients and the counselors in the CDC program. It is strongly recommended that where such cultural differences are to be encountered, they be made explicit and included in the fabric of the training program. The problems faced are quite reminiscent of similar problems reported by Peace Corps volunteers. Not unexpectedly, even language patterns and attitudes toward care-givers were
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not shared by the counselors and the recipient in the inner city of the District of Columbia. While the CDC trainees did not seek gratitude, they often expected it. The client, on the other hand, may take the position that there has to be "something in it" for the care-giver. If there is not some reward, then the client can have little respect for the care-giver. If there is, then clearly there is no need for gratitude, however much it may be expected. Such'interactions may be outside the domain of the trainee's experience and be a source of much confusion or anxiety. The training format used in planning for cultural differences is important. In the CDC program, training included a strong field component, but there was some question as to the relationship between the early aspects of field training and subsequent placement. As a result, many of the CDCs were not prepared to cope with the problems that confronted them. Thus they tended not to get involved in many issues of primary relevance to the clients. They avoided home visits, and they limited their contacts to the clinic at specified appointment times, thus intensifying the effect of cultural differences. Those trainees who were able to remain more comfortable with their clients' culture, even when markedly dissimilar from their own, seemed more successful in their efforts. REFERENCES Albee, G. W. American psychology in the sixties. American Psychologist, I963, I8, 90-95. Eisdorfer, C.; Altrocchi, J.; and Young, R. F. Principles of community mental health in a rural setting: the Halifax County Program. Community Mental Health Journal, 1968, 4, 2 2 1 - 2 2 0 .
Golann, S. E. Initial findings of the follow-up study of child development counselors. A ~'" .~. . . Journal ~ I ~ , ~~vz, 57, 1759-1766. .~m~,zc . . . . . . . . . . .of . . . D.,~.I~. . Golann, S. E., Breiter, D. E., and Magoon, T. M. A filmed interview applied to the evaluation of mental health counselors. Psychotherapy: Theory, Research, and Practice, I966, 3, 21-24. Lourie, R. S., Rioch, M. J., and Schwartz, S. The concept of a training program for child development counselors. American Journal of Public Health, I967, 57, 1754I758. Magoon, T. M., and Golann, S. E. Non-traditionally trained women as mental health counselors/psychotherapists.Personnel and Guidance Journal, I966, 44, 788-792. Magoon, T. M., Golann, S. E., and Freeman, R. W. Mental health counselors at work. New York: Pergamon Press, 2969. Riessman, F. Strategies and suggestions for training nonprofessionals. Community Mental Health Journal, 1967, 3, Io3-Ilo. Rioch, M. Implications of two pilot projects in training mental health counselors. Paper presented at the American PsychologicalAssociation Convention, Chicago, i965 . Rioch, M., Elkes, C., and Flint, A. A. Pilot project in training mental health counselors. USPHS Pub. No. 1254. Washington, D.C.: Government Printing Office, 2965. Webster's New International Dictionary of the English Language (3rd ed., unabridged). Springfield, Mass.: G. & C. Merriam, I964.
