WELLSPAN BEHAVIORAL HEALTH DOCTORAL INTERNSHIP PROGRAM IN CLINICAL PSYCHOLOGY

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1 WELLSPAN BEHAVIORAL HEALTH DOCTORAL INTERNSHIP PROGRAM IN CLINICAL PSYCHOLOGY Site Training Manual WellSpan Behavioral Health 1600 South George Street York, PA Tel.:

2 WellSpan Health Doctoral Internship Program In Clinical Psychology Site Training Manual WellSpan Health Mission WellSpan Health is an integrated health system serving central Pennsylvania. It is a community-based, not-for-profit organization. WellSpan Health s Mission Statement reads as follows: Working as one to improve health through exceptional care for all, lifelong wellness and healthy communities. Statement of Non-Discrimination WellSpan Health values the diversity of the communities that we serve. It is the policy of WellSpan Health to not discriminate in providing access to or delivery of healthcare services on the basis of any legally protected category. WellSpan Health offers healthcare services to patients without regard to their: - age - sex - religion, creed - race, ethnicity, national origin, color, limited English proficiency - mental or physical disability - medical condition, medical history, genetic information - evidence of insurability, claims experience, source of payment, income status - sexual orientation, gender identity - any other legally protected category This policy applies to all entities that are part of the WellSpan Health system. WellSpan Health facilities are available to patients, visitors and customers without discrimination on the basis of any legally protected category. WellSpan Health expects all persons and organizations that do business with WellSpan Health, or that refer or recommend patients for WellSpan Health services, to do so without discrimination on the basis of any legally protected category. Persons who experience or become aware of discriminatory behavior toward patients, visitors or customers are encouraged to notify the WellSpan Health Compliance Officer. Reports of discriminatory behavior will be investigated and corrective action taken, as appropriate. 2

3 A Commitment to Training As an extension of our mission statement, WellSpan strives to provide a planned, sequential training program that contributes to ongoing excellence in the field of psychology and is committed to the following core values: 1. We are committed to the practitioner-scholar model with training based upon applying sound scientific knowledge and scholarly practice to clinical work. 2. We are committed to a broad range of skill development encompassing a variety of skill sets that practitioner-scholars have found useful. We seek to provide a varied range of experiences aimed at producing well-rounded clinicians with the skills to function in a variety of settings including clinical service, community consultation, and education. 3. We are committed to an understanding of human diversity as it affects the delivery of clinical services to diverse client groups. Training includes the opportunity to work with clients from diverse ethnic, cultural, and socioeconomic groups in a variety of settings. 4. We are committed to the facilitation of the development of professional identity and ethical professional practice. Training offers the opportunity to engage in a variety of professional roles and to do so with the expectation of a high level of professionalism and ethical standards. 5. We are committed to flexibility in training and practice. We strive to identify and embrace the different areas of strength and interest of each intern and within the structure of activities that provide the core skill set for a clinician, interns are encouraged to develop unique interests and activities that will further their development as scholar practitioners. WellSpan Behavioral Health The doctoral internship at WellSpan Health is contained within a community-based, notfor-profit integrated health system serving central Pennsylvania. WellSpan Health is: 3

4 Four respected hospitals: WellSpan York Hospital, WellSpan Gettysburg Hospital, Ephrata Community Hospital and the WellSpan Surgery and Rehabilitation Hospital Regional referral services that include in heart and vascular care, oncology, women and children services, orthopedics and spine care, neurosciences and behavioral health More than 90 locations in Adams and York counties and northern Maryland, providing a full range of care for all members of our communities, regardless of their ability to pay. 11,000 physicians, employees, volunteers, board members and auxilians - all committed to providing patients with the very best in health and wellness care. A community teaching hospital with six residency programs, 123 residents, 400 medical students and a research center. 6 retail pharmacies, which fill more than 400,000 prescriptions each year. 10 outpatient health centers offering a variety of physician and diagnostic testing services 47 primary care and specialty physician practices 1 home health and hospice provider - VNA Home Health - which serves more than 5,000 people each year. 2.managed care plans, South Central Preferred and Quest Behavioral Health, with more than 40,000 covered lives. Services for businesses, including WorkFirst, WellSpan Employee Assistance Program. A non-profit community resource that provides more than $175 million each year in uncompensated medical and outreach services, supplies and physician care. Behavior Health services are offered in a variety of settings including the inpatient Adult Behavioral Health Unit of the York Hospital, the WellSpan Surgery and Rehabilitation Hospital and five outpatient locations serving the full range of mental health needs of the community from children to geriatric patients. Interns perform a variety of clinical functions, including individual, marital, family, and group psychotherapy, diagnosis and assessment, psychological testing, in-service training, and consultation with medical staff. Clinical services include: Psychotherapy Services: Individual Psychotherapy Marital Psychotherapy Family Therapy Group Therapy Dialectical Behavioral Therapy Cognitive Behavioral Therapy Psychological Assessment and Consultation Services: It should be noted that formal psychological testing is NOT emphasized in our internship. Rather, most assessment occurs in the context of using structured interviews and instruments designed for focal assessment to answer specific referral questions. That said, the following services are offered by WellSpan on a limited basis and interns may gain some experience in these areas if time and interest permit: Intelligence and Educational Testing 4

5 Testing for Attention Deficit Hyperactivity Disorder Evaluation of Psychological Effects of Medical Disorders Behavioral and Personality Assessment Neuropsychological Testing Consultation-Liaison Services to a wide variety of medical specialties and services including: The WellSpan Pain Management Clinic, The WellSpan Surgery and Rehabilitation Hospital, and the Ambulatory Intensive Care Unit The Doctoral Internship at WellSpan Behavioral Health The doctoral internship in clinical psychology at WellSpan Behavioral Health is designed to train future psychologists to work in health care settings, especially large, integrated health systems such as ours, as providers of comprehensive psychological services with an emphasis on multidisciplinary collaboration. Accordingly we are aggressively recruiting a diverse group of interns with a passion for integrating cognitive behaviorally oriented psychology into a health system and to developing the necessary competencies for conducting cognitive behavioral psychotherapy, performing diagnostic screenings and more comprehensive evaluations, serving as consultants in collaborating with multidisciplinary treatment teams, performing staff trainings in areas such as Motivational Interviewing, and who are capable of a close reading of the relevant research literature and of presenting this clearly and succinctly to a professional audience in the true tradition of the scholar-practitioner. WellSpan Behavioral Health offers a full spectrum of psychological services to virtually all diagnostic categories and all ages in inpatient, crisis intervention, intensive outpatient, outpatient, and medical-surgical settings. In each of these settings, interns interact with medical and allied mental health professionals as fully participatory members of the total health care team. The internship has a strong cognitive behavioral orientation and much of the didactic training is provided at our Center for Cognitive Therapy. The Doctoral Internship Training program is accredited by the Commission on Accreditation of the American Psychological Association (APA) and is a member of the Association of Psychology Post-doctoral and Internship Centers (APPIC). Questions related to the program s accredited status should be directed to the Commission on Accreditation: Office of Program Consultation and Accreditation American Psychological Association st Street, NE, Washington, DC Phone: (202) / Web: Interns are expected to complete 2000 psychological service hours over the course of the internship. At least 50% of an intern s time is spent in direct clinical service delivery in an outpatient setting involving face-to-face client contact. Interns are expected to see a 5

6 minimum of 20 outpatients per week which typically requires scheduling 25 patienthours per week. Another 8-9 hours each week is divided among programs depending upon the intern s needs and interests. The options include such programs as our inpatient mental health unit, our Pain Management Clinic, our Surgery and Rehabilitation Hospital, our Ambulatory Intensive Care Unit, etc. Interns attend individual, face-to-face supervision with at least two different doctoral level psychologists on our staff for a combined two hours each week, two hours of group supervision with a doctoral level staff psychologist, and attend didactic intern seminars with the intern cohort, and other supervised training experiences such as case conferences, multidisciplinary team meetings, educational seminars and Grand Rounds for the equivalent of at least four hours per week of supervision and 2 hours per week of didactic training. Interns receive training and supervision in as broad a range of professional activities as possible and perform a variety of clinical functions including individual and group psychotherapy, assessment and diagnosis, intake evaluations, psychological testing, and consultation to medical inpatients. Specifically, interns are expected to perform at least one full-battery diagnostic testing evaluation during the internship year. Interns are also asked to choose a special area of interest for the year to demonstrate their scholarly research skills and to do a close reading of the research and to present for an hour at our Behavioral Health Service Line Education Series. INTERN STIPEND The annual stipend for interns for is $25,000 US to be paid in 26 installments minus all deductions required by law or authorized by the Intern. Interns are entitled to 80 hours of paid time off and receive health, dental, and vision benefits. Administrative Assistance Interns have access to the full range of clerical and technical support available to all employees at WellSpan, including secretarial services for scheduling appointments, support through information services for technical assistance with computer based information systems, and access to our medical library and the Emig Research Center, among other services. Support staff assistance is provided for patient scheduling, billing, coordination and assurance of adequate supervision time, training time, equity in assessment and therapy assignments, and access to psychological tests, supplies, forms, and materials. WellSpan provides extensive orientation training and monthly didactic 6

7 seminars as well as customer service training every year. This customer service training addresses cultural competence. Doctoral Internship Training Goals The overarching goals for the internship year are to refine and extend proficiency, knowledge, skills and attitudes in the following areas of professional psychology such that the intern will have developed an advanced to proficient level of competence: INTERVENTION: Interviewing patients, developing case formulations, and implementing treatment strategies based on empirically supported treatment paradigms for a diverse array of clients. Our program places a strong emphasis on training in cognitive behavioral approaches. ASSESSMENT: clarification of the referral question, diagnostic interviewing and hypothesis formulation, selection and utilization of appropriate instruments, competent administration, scoring and interpretation, and presenting findings concisely in written form. CONSULTATION AND COLLABORATION with interdisciplinary treatment team members, including experience with patients who have complex medical as well as psychological problems INTEGRATION of complex interactions of biological, psychological, social, cultural, and spiritual influences in psychopathology and psychological well-being. PROFESSIONAL DEVELOPMENT: Understanding the role of the clinical psychologist as a clinician, researcher, educator, and administrator in medical and mental health settings and support and model the development of that role. ETHICS involving familiarity with and the practice of the Ethics and Standards of Professional Practice in Pennsylvania as well as with other standards of care and conduct, including HIPAA regulations. INDIVIDUAL-CULTURAL DIVERSITY: including sensitivity to, respect for, and knowledge and understanding of issues of individual differences and cultural diversity in terms of the following areas: culture, race, gender, religion, and individual identity and how these impact on the assessment/evaluation, intervention, consultation, and administrative functions of psychologists INTERNSHIP GOALS, OBJECTIVES, AND COMPETENCIES Goal #1: To prepare the psychology intern as an entry-level practitioner by refining and extending proficiency, knowledge, and skills in psychotherapeutic intervention to an advanced to proficient level. 7

8 Objective(s) for Goal #1: Objective A: Ability to form an effective working alliance with patients and their families Objective B: Competent at handling emergency and crisis situations Objective C: Ability to develop an effective treatment plan Objective D: Ability to implement an effective treatment plan with well-timed, effective, and empirically supported treatments Objective E: Effective use of cognitive interventions Objective F: Effective use of behavioral interventions Objective G: Effective use of supervision and continuing education Objective H: Effective use of reflective practice and self-assessment: Using emotional reactions in therapy Competencies Expected: A.1. Ability to take a respectful, helpful professional approach to interacting with patients/clients/families. A.2. Effective use of empathy and active listening skills A.3. Effective at creating a warm, non-judgmental stance A.4. Relationship building skills A.5. Interpersonal effectiveness A.6. Non-specific response skills (reflections, interpretations, open-ended questions, summary statements) A.7. Ability to understand and maintain appropriate professional boundaries B.1 Knowledgeable regarding the specific protocol to follow if immediate action is necessary (e.g. involuntary commitment, making reports to Childline) C.1. Effective at efficiently developing a comprehensive cognitive case conceptualization C.2. Ability to set well-defined goals and objectives C.3 Proficiency in psycho-education D.1. Motivational Interviewing Skills D.2. Ability to pace and use time efficiently D.3. Effective at setting an agenda D.4. Effective at using active collaboration and guided discovery D.5. Ability to elicit and respond effectively to verbal and non-verbal feedback D.6. Effective intervention implementation D.7 Clinical practice is informed by scientifically derived knowledge and empirically supported practice D.8 Assessment of treatment progress and outcomes D.9 Effective at termination of treatment E.1. Knowledge of CBT E.2. Proficiency in cognitive techniques F.1. Proficiency in behavioral techniques F.2. Proficiency in relaxation-based techniques G.1 Ability to prepare for supervision G.2 Ability/willingness to accept supervisory input and direction, ability to follow through on recommendations, and ability to negotiate needs for autonomy from and dependency on supervisors 8

9 G.3. Ability to work collaboratively with supervisors H.1 Manages personal stress, psychological concerns, and emotional reactions so they do not adversely affect clinical work or interactions with supervisors and other professionals H.2. Ability to self-reflect and self-evaluate regarding clinical skills and use of supervision H.3. Commitment to quality improvement through self-identified areas in need of further growth and development H.4 Effective use of emotional reactions in therapy Goal #2: Refine and extend proficiency, knowledge, and skills in psychological assessment, diagnosis, and case conceptualization to an advanced to proficient level Objective(s) for Goal #2: Objective A: Competent at conducting clinical interviews and intake evaluations Objective B: Competent at risk assessment and management Objective C: Competent at assessment and psycho-diagnosis Objective D: Competent at case formulation and conceptualization Objective E: Competent at assessment writing skills Objective F: Competent at providing feedback to the patient Competencies Expected: A.1. Ability to formulate and conceptualize cases and to present findings clearly and concisely in written form A.2. Ability to utilize systematic approaches to gathering data to inform clinical decision making. B.1 Ability to conduct screenings to determine risk for self-harm, other-harm, childmaltreatment, or psychosis C.1. Ability to select and implement multiple methods and means of evaluation in ways that are responsive to and respectful of diverse individuals, couples, families, and groups. C.2. Ability to formulate a realistic diagnostic impression based on clinical interview and historical information and that considers diversity issues C.3.Knowledge of evidence-based assessment C.4. Ability to present assessment findings clearly and concisely in written form D.1. Ability to obtain information from multiple sources and integrate results into case formulation and treatment planning D.2. Effective at efficiently developing a comprehensive cognitive case conceptualization E.1 Effective at writing a well-organized report that integrates information from multiple sources and answers the referral question clearly and concisely and provides specific recommendations F.1 Effective at explaining evaluation results to a patient, provides suitable recommendations, and responds to issues raised by the patient and family 9

10 Goal #3: Refine and extend proficiency, knowledge and skills in consultation and collaboration in interdisciplinary health care to an advanced to proficient level Objective(s) for Goal #3: Objective A: Develop productive and professional relationships in the practice of psychology. Objective B: Work effectively in a multidisciplinary setting with provision of supervision: knowledgeable of the treatment roles of other disciplines Objective C: Conduct appropriate consultative guidance Competencies Expected: A.1. Ability to take a respectful, helpful professional approach to interacting with patients/clients/families. A.2. Ability to deal with conflict and negotiate differences A.3. Ability to understand and maintain appropriate professional boundaries. A.4. Ability to work collegially with fellow professionals. A.5. Ability to effective relate to other professionals in accordance with their unique patient care roles A.6. Ability to provide helpful feedback to peers and receive feedback non-defensively from peers. A.7. Ability to be respectful of support staff roles and persons A.8. Ability to contribute in ways that will enrich the site as a clinical experience for future students. B.1. Ability to support others and their work and to gain support for one s own work B.2. Ability to participate fully in the team s work. B.3. Ability to understand and observe the team s operating procedures B.4. Ability to communicate professionally and work collaboratively with community professionals. B.5. Ability to understand and observe the agency s operating procedures B.6. Ability to participate in furthering the work and mission of the clinical site. C.1. Understanding of the consultant s role C.2. Understanding the supervisor s role C.3. Knowledge of issues related to integration of different data sources. C.4. Knowledge of the unique patient care roles of other professionals C.5. Understanding of the consultant s role as an information provider to another professional who will ultimately be the patient care decision maker C.6. Ability to choose an appropriate means of assessment to answer referral questions C.7. Ability to implement a systematic approach to data collection in a consultative role. C.8. Consultative reports are well organized, succinct, and provide useful and relevant recommendations to other professionals C.9. Capacity for dialoguing with other professionals, which avoids use of psychological jargon. C.10. Demonstrates awareness and knowledge of key issues and concepts about related disciplines. 10

11 Goal #4: Refine and extend proficiency, knowledge and skills in professional development: understand and develop administrative, management, and supervision skills while understanding personal boundaries of competence as a provider of health care. Objective(s) for Goal #4: Objective A: Understanding the role of the clinical psychologist as a clinician, researcher, educator, and administrator in medical and mental health settings and support and model the development of that role. Objective B: Management and administrative leadership skills: Efficiency and time management Objective C: Professional responsibility and documentation Objective D: Reflective practice and self-assessment: uses positive coping strategies to deal with personal challenges Objective E: Interns will be able to provide competent supervision in a clinical setting Competencies Expected: A.1. Seek out and use leadership mentors to assist with one s personal development, knowledge acquisition, and skill development. A.2. Knowledge of clinic procedures; A.3. Commitment to engaging in activities that support and extend knowledge, skills and attitudes in professional psychology, including awareness of current research and how that informs practice; A.4. Ability to participate in furthering the work and mission of the clinical site. A.5. Ability to contribute in ways that will enrich the site as a clinical experience for future students. B.1. Timeliness: completing professional tasks in allotted/appropriate time (e.g., evaluations, notes, reports); arriving promptly at meetings and appointments. B.2. Developing an organized, disciplined approach to writing and maintaining notes and records. B.3. Understand the relationship between roles of supervisor, manager, and executive. B.4. Ability to identify leadership, business, and management skills. B.5. Demonstrates an understanding of Management-Administration of direct delivery of services. B.6. Understand the basics of financial management as it pertains to clinical service delivery. B.7. Understand the purpose and structure of meetings and how to run them well C.1 Maintains required patient records C.2 Notes are clear, concise and timely C.3 Records always include crucial information D.1. Knowing the extent and the limits of one s own skills; learning the habit of and skills for self-evaluation of clinical skills. 11

12 D.2. The ability to use supervision, consultation, and other resources to improve and extend skills (note the related relationship competence to work collegially and responsively with supervisors). D.3. Knowledge of the process for extending current skills into new areas. D.4. Commitment to life-long learning and quality improvement. D.5. Awareness of one s identity as a psychologist, i.e. knowing what one knows and can do (and should do) as a psychologist. D.6. Management of personal issues in a professional manner D.7. How to self-identify personal distress, particularly as it relates to clinical work. D.8. How to seek and use resources that support healthy functioning when experiencing personal distress. D.9. Organizing one s day, including time for notes and records, rest and recovery, etc. D.10..Demonstrates motivation to work hard and develop as a future mental health professional; D.11. Knowledge of methods and issues related to evaluating professional work, including delivering formative and summative feedback; D.12. Create, regularly assess, and revise a personal plan to provide direction for one s continuing professional development. E.1. Knowledge of literature on supervision (e.g., models, theories, & research). E.2. Knowledge concerning how clinicians develop to be skilled professionals. E.3. Knowledge of how supervision/teaching responds appropriately to individual and cultural differences. E.4. Knowledge of methods and issues related to evaluating professional work, including delivering formative and summative feedback. E.5. Knowledge of limits of one s supervisory skills and teaching competencies. Goal #5: Refine and extend proficiency, knowledge and skills in ethical practice Objective(s) for Goal #5: Objective A: Knowledge of ethical/professional codes, standards, and guidelines; knowledge of statutes, rules, regulations, and case law relevant to the practice of psychology. Objective B: Interns will recognize ethical aspects of their work and demonstrate the ability to practice ethical, legal, and professional conduct. Competencies Expected: A.1. Knowledge of ethical/professional codes, standards, and guidelines; knowledge of statutes, rules, regulations, and case law relevant to the practice of psychology B.1. Recognize and analyze ethical and legal issues across the range of professional activities in the clinical setting. 12

13 B.2. Recognize and understand the ethical dimensions/features of his/her own attitudes and practice in the clinical setting. B.3. Decisions reflect consideration of and commitment to ethical principles in professional work and practice B.4. Readily identifies ethical implications in cases and understands the ethical elements in any present ethical dilemma B.5. Seek appropriate information and consultation when faced with ethical issues. B.6. Practice appropriate professional assertiveness related to ethical issues (e.g., by raising issues when they become apparent to the student). B.7. Evidence commitment to ethical practice, and advocate for the profession. B.8. Demonstrates the ability to effectively implement the following practices: informed consent, confidentiality, setting of appropriate boundaries and documentation of services Goal #6: To develop the ability to provide clinical services to diverse populations Objective(s) for Goal #6: Objective A: Interns will be aware of their own cultural values and how their particular culture s representation influences the therapeutic relationship and work with diverse clients. Objective B: Interns will be aware of normal psychological functioning and psychopathological functioning presentations and how these vary with culture and other dimensions of individual diversity and integrate this knowledge into patient care Competencies Expected: A.1. Knowledge of self in the context of diversity (one s own attitudes, stimulus value, and related strengths/limitations) as one operates in the clinical setting with diverse others (i.e., knowledge of self in the diverse world). A.2. Demonstrates an appreciation of one s own cultural identity in relation to others; B.1. Knowledge about the nature and impact of diversity in different clinical situations (e.g., clinical work with specific racial/ethnic populations). B.2. Ability to work effectively with diverse others in assessment, treatment, and consultation. B.3. Effectively integrates knowledge of the client s individual and cultural diversity into assessment, case formulation, and treatment; B.4. Shows an understanding and sensitivity to diversity issues and is aware of when and how to bring these up in therapy with a client B.5. Considers diversity issues when conceptualizing cases and creating a treatment plan 13

14 Goal #7: To integrate and apply scientific knowledge, methods, research, and evaluation into the clinical practice of psychology. Objective(s) for Goal #7: Objective A: Seeks current scientific knowledge and methods Objective B: Demonstrates an understanding of outcomes and evaluation research methods Competencies expected: A.1. Demonstrates consideration of biological, cognitive-affective, and developmental bases of human behavior. A.2. Clinical practice is informed by scientifically-derived knowledge and empiricallysupported practice. A.3. Demonstrates respect for scientifically-derived knowledge, data collection, and statistical analytic techniques. B.1. Demonstrates an awareness of research literature related to professional practice. B.2. Demonstrates basic skills necessary for conducting treatment outcome assessments. B.3. Understands the basic principles and methods of quality assurance and performance improvement activities. Internship Activities Clinical Problems Treated at WellSpan Behavioral Health At a minimum, interns spend 20 hours each week in face to face psychological services, assessing and treating clients with the full range of Axis I and Axis II disorders as well as marital and family issues. Patients come from a variety of referral sources including self-referral, Crisis Intervention, the Adult Behavioral Health Inpatient Unit, Managed Care Organizations, primary care physicians, and various medical specialties on both an inpatient and outpatient basis. Treatment Settings Training of interns occurs in various locations within our WellSpan System (all are within 20 minutes driving time of each other) including the following: 14

WELLSPAN BEHAVIORAL HEALTH DOCTORAL INTERNSHIP PROGRAM IN CLINICAL PSYCHOLOGY 2013-2014

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