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Determine the (a) training, experience, and attitudes and (b) current practices and self-reported competence of a nationwide sample of Veterans Health Administration clinical psychologists; and (c) whether these vary by region and age. An anonymous online survey was distributed via email link to 2,294 Veterans Administration psychologists that had 52 quantitative questions (categories: demographic, training, experience, current practice, self-reported competence, attitudes/knowledge, and need/interest for training) and yielded 384 respondents. We separated participants into younger and older groups as well as regional groups (more progressive vs. more conservative). Analyses were descriptive, correlational, and tests of mean differences. Overall, psychologists had minimal training in areas of sexual orientation and gender identity and limited experience delivering services to these populations. As a group, older psychologists had less graduate training in issues of sexual orientation and gender identity. Younger psychologists had more LGBT-affirmative attitudes, though less lifetime training. Progressive regions had more LGBT-affirmative attitudes, more sexual orientation training, and were more interested in further training. Training in areas of sexual orientation and gender identity during graduate school correlated significantly with later practice. Self-rated competence was not aligned with levels of training and experience. Additional training is indicated and should be tailored to regional needs. Graduate school/internship may be a training opportunity that has a lifetime practice impact. More research is needed to understand the relationship of self-rated competence to training and experience and how to better align these variables.

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Higher clinical costs associated with longer lengths of stay in colder climates have implications for budget planning. Climate factors must also be recognized for their potential effect on performance monitoring systems focused on hospital utilization. Researchers must continue to consider broader contextual variables such as climate if they are to fully understand the determinants of health care utilization and psychiatric hospitalization costs.

Problem gambling is a common, highly destructive disorder which is often overlooked by clinicians. Levels of clinical training, clinical experience, and professional competence for providing clinical services for problem gambling were examined in a survey of 181 clinical psychologists working in the Veterans Healthcare Administration (VHA). The results suggest that the majority of clinical psychologists have little or no formal training and little or no past or current clinical experience in the treatment of disordered gambling, nor do they see themselves as competent to evaluate or treat patients with disordered gambling. Most have not referred patients for treatment of problem gambling and do not know of a competent provider to whom they can refer. There is an identifiable subgroup, representing 9% of respondents, who do have more training, provide services, and see themselves as competent to provide care for patients with problem gambling. The amount of formal training is positively correlated with care provided and self-ratings of competence. Despite the lack of training and experience, most respondents expressed interest in receiving additional training. These data suggest that to improve rates of diagnosis and treatment of patients with problem gambling in mental health settings, additional training needs to be made available for mental health providers as a group, with specialized training for clinicians interested in specializing in this area.