Abstract
Background: Substance Use Disorders (SUD) has been an increasing public health problem. Puerto Rico (PR) is facing difficulties in the health system, including limited access to health services. Still, this problem is even more present in disadvantaged groups like people living with SUD. Many of the available services for SUD in PR have systematic constraints, which limits the opportunities for clinical psychology dcotoral students to receive training in integrated care models and address the SUD epidemic. Academic programs must focus on developing strategies to help students overcome the system barriers by providing resources to facilitate appropriate training on integrated care and SUD. Objective: This work aims to examine clinical psychology doctoral students' challenges while providing integrated care to people with SUD and discuss the strategies our program has implanted to support our students in overcoming those barriers. Method: Using qualitative and quantitative techniques, we documented the challenges reported by students in an accelerated track in SUD and Integrated Care that use strategies to support students to overcome the barriers. Also, three current students are co-authors in this work. Results: Some of the challenges identified by the students are security problems in the training centers, inadequate supervision, insufficient resources and materials, deficient facilities, poor programmatic structure, limited clinical hours due to site limitations, and personnel without appropriate training in SUD and integrated care. The strategies implemented to reduce these barriers include providing a specialized secondary supervisor, discussing difficulties in group supervision and receiving feedback focused on problem-solving, being able to meet with program staff to discuss the barriers and solve difficulties, special rotations to increase clinical hours, and facilitation of specialized training for students and supervisors. Discussion: Many limitations are documented in the literature regarding treatments in integrated health settings with people with SUD. Due to stigma, in many scenarios in PR the treatment for SUD is separated and not integrated with other medical care. The few programs providing effective integrated care have funding limitations. Through our program with the specialized training and practicums components, we have supported the development of competencies in integrated care and SUD of ten (10) students each year. Students have faced many challenges and barriers in their practicum scenarios. Training programs must implement strategies for students to report and discuss challenges and provide options to support students in navigating the complex systemic difficulties faced when working with integrated care and SUD in PR.