A certain type of educational ecosystem supports a successful Clinical Health Psychology PhD program. Having received an initial seven-year accreditation from the American Psychological Association (the most extended accreditation possible) just last month, the program at CU Denver feels justified in making a case for having just such an ecosystem. The "connective tissues" that make for the perfect ecosystem include a supportive and engaged faculty, a dedicated leadership team ready to mentor students to success, and a campus community in need of and receptive to mental health support. But perhaps as important as any of these factors, a successful Clinical Health Psychology PhD program must have access to plentiful training and research opportunities, as there are here in Denver—a major, regional medical hub. Being the only PhD program of its kind in the city, and fully embracing the opportunities provided by consolidation with the Anschutz Medical Campus, the CU Denver program has a major advantage in recruiting, retaining, and producing psychologists of the highest caliber. The program now receives more than one hundred applications a year, for less than ten spots per cohort. "Our goal is to train scientist-practitioners to be leaders in the field of behavioral medicine or behavioral health, because so many of the major physical illnesses people face have important behavioral or lifestyle components," says Department Chair and Psychology Professor Peter Kaplan. "The students who have come to our program are very bright and extraordinarily hard-working. I know they will have a huge impact on the community and the profession."

Taking advantage of the vast experiential learning opportunities for students also means that, with each new connection made, the nascent program develops roots in the established networks of the city's health and mental health communities, roots that will keep the ecosystem here fresh and relevant. These connections are critical to students, as competition in the field is fierce and employment after graduation will rely on the variety of skills and networks developed during students' internship and externship experiences. Externships are completed after intense coursework and rigorous training in the on-campus Psychological Services Center takes place during students' first two to four years in the program. During the final year of clinical health psychology PhD training, students nationwide enter and apply for an intensive, one-year clinical internship using a computer matching process similar to medical school residency. The internships and externships pursued by students in CU Denver's program reflect the scope of the field of clinical health psychology itself.

Take for example the experiences of Ava Roxanne Drennen, now in her sixth year of the program, who worked last year at the Salud Family Health Center in Frederick, Colorado. Drennen was on an external practicum placement as a behavioral health provider, serving patients across the lifespan in an integrated primary care setting with other professionals across health care disciplines. Says Drennen of the experience, "The goal was to provide care for the 'whole person' including both physical and mental health, because both are so inextricably linked." At Salud, Drennen worked closely with other providers as a consultant on potential diagnoses, suggesting modified health behaviors and general stress management techniques, weighing in on parenting concerns, and providing suicide or homicide safety assessments. Patients at Salud are able to engage in psychotherapy in their primary care office for concerns that require a certain level of care, with referrals made to more intensive treatments as necessary. Explains Drennen, "Salud serves a primarily underrepresented patient population, and many of them have a history of multiple traumas and complex mental health needs, and nowhere else to turn for services. Integrated behavioral healthcare, as practiced at Salud, increases access to behavioral and mental health services that the clinic population likely would not have had access to otherwise." Drennen provided services in both English and Spanish, to further increase access, and says the experience solidified her desire to spend her career working with underserved populations," I truly enjoyed the clinical aspect at Salud where I got to actually provide the services and see the difference I was making in peoples' lives every single day. I hope to do the same at Denver Health."

Now in her residency at Denver Health, Drennen will be on the health psychology and adult outpatient major rotations, but will also have the opportunity to gain experience in many different clinics throughout the hospital. In the health psychology rotation, Drennen will expand her experience in integrated primary care working with underserved adults, and also provide health coaching over the telephone to help patients make behavioral changes to prevent and/or manage chronic health conditions like diabetes, heart failure, or depression. Over-the-phone coaching further improves access for underserved populations, and says Drennen, "One of my main goals has always been to reduce health disparities. My graduate research has focused on the same overall topic." Her passion originates in a personal place, and she says, "Coming from an underserved background myself, it has always been very important to me to find a way to help underserved populations and I feel that providing integrated behavioral healthcare is a great way to achieve that goal."

Similarly, Ryan Asherin chose an experiential learning opportunity close to his heart. In his fourth year in the program, Asherin is one of five doctoral students in the greater Denver area that was accepted to take part in the Therapy and Assessment Externship in the Department of Psychiatry at Children's Hospital Colorado (CHCO). Children's Hospital is a special place for Asherin, as he spent time at CHCO as an infant inpatient and then, much later, became a research assistant in the Department of Psychiatry, an experience that helped prepare him to become a doctoral student. Asherin has a great deal of admiration for the clinical care and research conducted at CHCO and feels fortunate to be able to continue his psychological training there as an extern. Through this externship, Asherin provides direct clinical care to children, adolescents, and families under the supervision of a licensed psychologist. Direct clinical care includes conducting an intake evaluation every one to three weeks to determine the appropriate level of care, carrying a caseload of six weekly outpatients, and assisting with inpatient psychological assessments over the course of a year. Additionally, licensed psychologists from Children's provide individual and group supervision to all of the externs, and the externs participate in two hours per week of didactics, training in issues relevant to clinical and pediatric psychology.

Asherin says, "I applied to the Therapy and Assessment Externship at CHCO because of the unique opportunity to receive complimentary training in pediatric psychology from one of the top pediatric hospitals in the country." Asherin is interested in specializing in pediatrics because he believes that providing care for the youngest patients afflicted with illness can provide the most significant gains for their overall health and quality of life. "The most positive aspect of this externship has been the breadth of the experience working in pediatric psychology," says Asherin. "The training program's emphasis on providing evidence based treatments for a variety of childhood mental health disorders has given me valuable experience in conceptualizing the difficulties shared by patients and then planning, implementing, and documenting a treatment intervention." Asherin believes these experiences are preparing him to be a competitive applicant for internships in pediatric psychology, and ultimately a competent pediatric psychologist.

Similarly, the experiential learning Kalie Ross is pursuing in her third year in the program is staying close to her heart. "As an avid runner, hiker, and snowshoe enthusiast, issues of leading a healthy lifestyle are near and dear to me. Through my graduate assistantship at the University of Colorado Anschutz Health and Wellness Center (AHWC) I get to tackle these health issues directly by finding ways to help people improve their nutrition, lose weight, and increase their physical activity." Ross has been working with Extreme Weight Loss contestants, a television program on ABC that aired its fourth season this past summer, and has found the experience immensely inspiring. Ross works with the contestants to build "Mental Muscle" as part of their yearlong weight loss journey. The "Mental Muscle Building" program, led by Ross along with another graduate student (Stephanie Hooker), teaches each contestant how to effectively handle stress, setbacks, and barriers to leading a healthy lifestyle.

Ross has also had the opportunity to reach people on a broader scale through a clinical research collaboration between the Clinical Health Psychology program and AHWC. In this program Ross is helping to develop an intervention that is being tested as a new approach to improving long-term maintenance of weight loss and physical activity. She says, "I really enjoy working on this project because it has such strong real-world implications—finding ways to improve weight loss and physical activity would mean saving lives by preventing diseases such as diabetes and cardiovascular disease."

In yet another project, Ross is collaborating with fellow CU Denver graduate student Lacey Clement, also in her third year of the program, at the A.F. Williams Family Medicine Center, on grant-funded work to develop health coaching in a primary care medical setting. Working with clinical leadership, Clement and Ross have researched various implementations of health coaching or self-management programs in primary care clinics around the country. They are now working with staff and faculty at A.F. Williams to develop a program unique to that clinic which would aid patients with or at-risk for cardiovascular disease in changing behaviors or managing and improving their health. Clement and Ross will deliver the intervention to patients at A.F. Williams while gathering both quantitative and qualitative data on how effective the program is. Says Clement, "Working at A.F. Williams has allowed me to become involved in program development in health care settings from the ground up. It also has allowed me, as a doctoral student, to work in multidisciplinary teams with health care professionals, which has strengthened my research, clinical, and networking skills." Emphasizing the importance of experiential learning, Clement enthuses, "This experience goes beyond a classroom in that it provides me an opportunity to apply the clinical skills and knowledge I've obtained in this program in a way that greatly prepares me for my work with health patients in the future. When I graduate, I hope to work with patients adjusting to chronic illnesses and develop programs and interventions designed to help them adjust. Working at A.F. Williams as a graduate student has been a dream come true for me."

Leading this program that is making so many student dreams come true, Kevin Masters, Professor and Program Director of Clinical Health Psychology program, came to CU Denver in 2010, and says, "We have an unbelievably great and motivated group of students, some of the finest in the country. Entry into the program is very competitive and these students must be able to excel in all areas including the classroom, research lab, and clinical practice. We are tremendously proud of the work they do"

Faculty in the program are proud of all their students, but none more so than the first graduate of the program, Christina (CJ) Bathgate (formerly Kalinka). Bathgate took a chance by registering to graduate before official word of the program's accreditation was received. In a strange Catch-22, a program must have students at least to the point of being ready to graduate in order to gain accreditation, but a student who earns a PhD from a program that is then denied accreditation is in a significantly disadvantaged position. Bathgate was as confident in her program as she was that the credentials she gained while at CU Denver would get her success. She conducted her internship through the prestigious University of Arizona Medical Center (UAMC), which she describes as, "An appealing site for me, because I was able to continue working in behavioral sleep medicine and sexual health, as well as expanding my skill set to other populations (e.g., young adults with first episode psychosis)." During her externship Bathgate had studied sleep disorders working with internationally-renowned sleep specialists at National Jewish Health in Denver. She appreciates how the externship expanded her horizons, remarking, "NJH provides constant continuing education on topics within the field; I've learned about sleep disorders from orofacial myologists, specialty surgery doctors, endocrinologists, psychologists, pediatricians, dentists, and nurse practitioners."

In Arizona, Bathgate worked closely with Dr. Nick Breitborde, a leader in the field of early psychosis research, to provide individual, group, and family therapy to young adults who had recently experienced their first episode of psychosis. The Early Psychosis Intervention Center, or EPICENTER for short, is the only center of its kind in the state of Arizona, and provides a much-needed service for residents. The experiences Bathgate had during her internship were crucial in facilitating a greater understanding of the interactions between psychiatric complaints and comorbid medical concerns, which is the basis for clinical health psychology. She also administered sleep assessments, used cognitive and behavioral techniques to improve insomnia, and developed individual plans to help adults become more comfortable using their CPAP (continuous positive airway pressure) machines to have more nights of restful, restorative sleep. "The mentoring was outstanding at this internship—whether I had a question about a patient or a statistics research question, there was always a colleague there to help or be a sounding board. They also introduced me to tons of great contacts for networking, which has been incredibly helpful as I enter my postdoctoral year," says Bathgate. Her postdoctoral year will be spent getting additional training in behavioral sleep medicine and accruing enough hours to obtain professional license after passing the state board exam. Bathgate would like to pursue a career as a health psychologist in a medical facility that supports translating meaningful research into clinical practice.

Ultimately, the goal of the Clinical Health Psychology program is to provide students the correct balance of scholarship, research and clinical practice to make them competitive in future pursuits, while supporting the individual dreams of a diverse array of future practitioners. As the experiential learning students gain through both their internship and externship programs prepares them to work in all facets of Clinical Health Psychology, the strong ecosystem at CU Denver will continue to grow and evolve, gaining strength through connections with the Denver health and mental health communities.