Doctoral Psychology Internship Program

Transcription

1 Doctoral Psychology Internship Program Handbook 2015

2 Mission: The Mission of The University of Texas Health Science Center at Tyler, Psychology Internship Program (UT Health Northeast PIP) is to prepare psychologists- in- training to provide clinically and culturally competent behavioral health services to traditionally underserved populations and geographical areas. 2 Program Overview The University of Texas Health Science Center at Tyler Psychology Internship Program (UT Health Northeast PIP) provides training in human development, psychopathology, assessment, psychotherapy, and ethics and provides interns with the necessary skills to practice as competent and ethical entry- level professional psychologists. UT Health Northeast is the only academic health science center in northeast Texas and sponsors three graduate medical education training programs in family medicine, internal medicine, and occupational medicine. A psychiatry residency is planned in the future. UT Health Northeast provides a rich training experience through opportunities to work with highly- experienced psychologists in serving a wide variety of patients, including historically underserved and underfunded persons, across a number of treatment settings within the organization. UT Health Northeast includes a hospital, Emergency Department, and various outpatient clinics including Family Medicine, Internal Medicine, Center for Healthy Aging, Palliative Care and Oncology, and cardiopulmonary clinics. Further, UT Health Northeast houses three inpatient psychiatric units and an intensive outpatient program, as well as a post- acute neurorehabilitation center. UT Health Northeast is the regional anchor for Medicaid DSRIP projects for innovative health care. Among the many projects is the Behavioral Health Integration Project, which focuses on integrating mental health care in primary care settings. Northeast Texas is a rural state region characterized by 1) low income and below state average education level, 2) older average age, 3) high rates of chronic illness, 4) high rates of mental health problems, and 5) underutilization/limited access to mental health resources. UT Health Northeast PIP Structure UT Health Northeast PIP offers four one- year, full- time internship positions beginning July 1 and ending June 30 of each year. This is a 2,000 hour program. The Program provides comprehensive clinical and didactic experiences to support future professional practice. Three different tracks are available: 1) Psychology in a Medical Setting, 2) Neuropsychology, and 3) Combined Psychology in a Medical Setting and Neuropsychology. Training Model UT Health Northeast PIP training is based in the Practitioner- Scholar model. UT Health Northeast PIP trains doctoral psychology interns to become effective consumers of research who utilize scholarly inquiry to inform their practice. Accreditation Status

3 UT Health Northeast PIP is not currently accredited by the American Psychological Association. APPIC Membership Status UT Health Northeast PIP plans to apply for membership of APPIC in September Program Goals Goal 1: Interns will achieve competence appropriate to their professional developmental level in the area of Behavioral Health Intervention. Objectives related to this goal include the achievement of competence in the following: Case conceptualization and treatment planning Implementation of therapeutic interventions Crisis intervention Therapeutic skills Goal 2: Interns will achieve competence appropriate to their professional developmental level in the area of Assessment and Diagnosis. Objectives related to this goal include the achievement of competence in the following: Diagnostic skill Instrument selection, administration, and scoring Test interpretation Clinical formulation Report writing Communicating results Goal 3: Interns will achieve competence appropriate to their professional developmental level in the area of Interdisciplinary Consultation and Collaboration. Objectives related to this goal include the achievement of competence in the following: Multidisciplinary collaboration Theories and methods of consultation Goal 4: Interns will achieve competence appropriate to their professional developmental level in the area of Supervision. Objectives related to this goal include the achievement of competence in the following: Theories and methods of supervision Effective use of supervision Goal 5: Interns will achieve competence appropriate to their professional developmental level in the area of Cultural and Individual Diversity. Objectives related to this goal include the achievement of competence in the following: Cultural awareness Effects of cultural considerations on clinical activities Evidence- informed approach to cultural considerations Goal 6: Interns will achieve competence appropriate to their professional developmental level in the area of Science and Practice Integration. Objectives related to this goal include the achievement of competence in the following: Application of scientific knowledge to practice Program evaluation

4 Goal 7: Interns will achieve competence appropriate to their professional developmental level in the area of Ethical Conduct. Objectives related to this goal include the achievement of competence in the following: Knowledge of ethical, legal, and professional standards Adherence to ethical principles and guidelines Goal 8: Interns will achieve competence appropriate to their professional developmental level in the area of Professionalism. Objectives related to this goal include the achievement of competence in the following: Professional awareness Interpersonal relationships Self- awareness Clinical documentation Case management Major Training Emphases Each of the three training tracks addresses the Program goals and offer training in the following areas: Behavioral Health Intervention: Interns will work in clinical settings to provide behavioral health intervention for people from diverse backgrounds. Intervention may include individual, group, family and/or couples treatment, and may be provided for children, adolescents and/or adults. Psychological Assessment: Interns will be expected to administer, interpret, and provide written synthesis of psychological test batteries. Assessments may include intellectual, achievement, personality, and competency- based measures. Interns will have opportunities to write reports and make recommendations that convey meaningful information to clients/patients and referral sources. Interdisciplinary Collaboration and Consultation: Interns will have experience working across systems and disciplines as a major component of their training program. Collaboration and consultation are important skills for success as a psychologist in underserved areas. Experiences may involve collaboration and consultation with various agencies, systems of care, and providers within multiple care disciplines and settings. Supervision: Interns will be provided supervision, as well as will have the experience of supervising Master s level practicum students from the University of Texas Tyler. Didactics on and supervision of this experience are also provided. Didactics At a minimum, an average of two hours of weekly didactic training will be provided by Program faculty, physicians, and other professionals. Supervision All interns will receive a total minimum of 4 hours per week of supervision from a licensed psychologist. Interns receive a minimum of two (2) hours of individual supervision each week from a licensed psychologist. Interns will additionally meet for Professional Development meeting led by the Training Director. 4

5 Weekly group supervision will also be provided. Group supervision may focus on legal/ethical issues and clinical topics. While supervising, interns will also receive weekly supervision of supervision by a licensed psychologist. Research Research opportunities will vary. Interns may also pursue projects of their own, with faculty oversight. Stipend, Benefits, and Resources UT Health Northeast PIP interns are employees. The annual stipend for all interns will be $20,000 as well as the other benefits of employment, including health insurance. Health insurance is not available for the first days during the pre- enrollment period. However, interns will be reimbursed for maintaining their current health insurance during this period up to $700. per month. Diversity and Non- Discrimination Policy UT Health Northeast PIP strongly values diversity and believes in creating an equitable, hospitable, appreciative, safe, and inclusive learning environment for its interns. Diversity among interns and supervisors enriches the educational experience, promotes personal growth, and strengthens communities and the workplace. Every effort is made by UT Health Northeast PIP to create a climate in which all staff and interns feel respected. UT Health Northeast PIP s training program includes an expected competency in individual and cultural diversity, and multiple experiences are provided to be sure that interns are both personally supported and well- trained in this area. UT Health Northeast PIP welcomes applicants from diverse backgrounds. UT Health Northeast PIP provides equal opportunity to all prospective interns and does not discriminate because of a person s race, color, religion, sex, national origin, age, disability, or any other factor that is irrelevant to success as a psychology intern. Applicants are individually evaluated in terms of quality of previous training, practicum experiences, and fit with the internship. Intern Expectations and Experiences UT Health Northeast PIP is a one year- long, full- time doctoral internship experience. Interns are expected to complete 2000 hours of training during the year.interns are also expected to achieve the goals and objectives of the internship program, as stated above and to abide by the APA Code of Ethics, the requirements of the UT Health Northeast PIP, and the policies, procedures, rules and regulations of UT Health Northeast. Throughout the year, interns will participate together in didactics and group supervision. Interns will complete an average of hours per week of face- to- face direct service delivery. Interns are expected to maintain a daily log of direct service and indirect activities related to the internship program (e.g., client sessions, clinical preparation, case documentation, supervision, etc.). 5 UT Health Northeast PIP has a due process procedure for addressing concerns about intern performance, as well as intern concerns about training. These procedures are provided in hard copy during orientation (see below).

6 The training emphases of UT Health Northeast PIP are emphasized through intern participation in longitudinal experiences in an interdisciplinary environment. There are two major tracks of experience, Psychology in a Medical Setting, and Neuropsychology. These tracks can also be combined to form a third track. Each track offers the following experiences, with more emphasis and time spent on the experiences appropriate to the track: Integrated Health Care Experience: The Integrated Health Care experience emphasizes the biopsychosocial approach to medicine while integrating research with a collaborative approach in a teaching hospital. This model places an emphasis on a collaborative versus prescriptive patient relationship and interaction in order to foster improvements in health and wellness in a medical environment. The Integrated Health Care experience consists of working in various clinics within the hospital on both an inpatient and outpatient basis. Interns see patients in Center for Healthy Aging and the Family Health Clinic. The Family Health Center is a family medicine clinic, where the interns work closely with medical residents. Interns see patients as needed based on referral in the clinic and provide consultation as well as therapy services within a variety of therapeutic modalities. In these settings, there may be long- term or shorter term psychotherapy experiences. Interns are also expected to field warm- handoffs from faculty and resident physicians as needed. A warm- handoff consists of the intern coming into a medical appointment to address psychological symptoms that a patient may be experiencing. This can consist of addressing acute symptoms directly with brief intervention or conducting a meet and greet to facilitate a future therapy appointment. Interns may also work with Master s level practicum students from the University of Texas at Tyler, and there are some opportunities for the Interns to supervise these students. Neuropsychology/Neuro- Rehabilitation Experience: The Neuropsychology/Neuro- Rehabilitation experience occurs within the neurorehabilitation unit of the hospital, owned and operated by NeuroRestorative Texas. NeuroRestorative is a post- acute brain injury rehabilitation floor that provides services on an inpatient and outpatient basis, as well as long term supported living options in a nearby residence. Interns have the opportunity to conduct neuropsychological assessments and to produce integrated neuropsychological reports with a variety of instruments. Interns are also afforded the opportunity to conduct therapy sessions with clients and their families as needed. Interns work with a multi- disciplinary rehabilitation team consisting of a Licensed Psychological Associate, a Speech/Language Pathologist, Occupational Therapists, Physical Therapists, Nursing staff, Medical Director, consulting Physiatrist, consulting Psychiatrists, and Case Manager. Interns also work with Master s level practicum students from the University of Texas at Tyler, and there are some opportunities for the Interns to supervise these students. Psychological Assessment Experience: The Psychological Assessment Experience consists of Interns working in Internal Medicine clinics to conduct various personality, cognitive, and neuropsychological assessments based on consultations from Internal Medicine physicians in the hospital. Interns also conduct various Outpatient Evaluations from sources such as the V.A. and Department of Assistive and Rehabilitative Services (DARS). 6

7 Additional Training Experiences: UT Health Northeast PIP Interns will also train at one of the local State hospitals (Rusk and Terrell). This experience may include provision of group psychotherapy, attendance at treatment team meetings, and conducting psychological assessments. Opportunities for experience on three inpatient psychiatric units on campus are also available. Further, interns may elect to be involved in working with the Palliative/Supportive Care team. There has also been the opportunity to attend a once- per- month I Can Cope cancer support group that is led by a licensed social worker, a nurse- practitioner specializing in oncology, and an oncology nurse liaison. Interns have the option of facilitating discussion in this group and presenting psycho- educational presentations. Additional Didactics and Training: In addition to the weekly minimum didactic training required by the Program, interns are encouraged to access the many other opportunities for didactic training throughout the hospital. A sample of these opportunities includes attending Grand Rounds on various medical, psychological, and professional topics and attending Tumor board, Journal Article presentations, and interdisciplinary treatment team meetings. Psychology Intern Duty Hours and the Working Environment 1. Professionalism, Personal Responsibility, and Patient Safety a. Programs and sponsoring institutions must educate Psychology Interns and faculty members concerning the professional responsibilities of psychology faculty to appear for duty appropriately rested and fit to provide the services required by their patients. b. The program must be committed to and responsible for promoting patient safety and psychology intern well- being in a supportive educational environment. c. The training director and institution must ensure a culture of professionalism that supports patient safety and personal responsibility. d. Psychology interns and faculty members must demonstrate an understanding and acceptance of their personal role in the following: i. assurance of the safety and welfare of patients entrusted to their care; ii. provision of patient- and family- centered care; iii. assurance of their fitness for duty; iv. management of their time before, during, and after clinical assignments; v. recognition of impairment, including illness and fatigue, in themselves and in their peers; vi. attention to lifelong learning; vii. the monitoring of their patient care performance improvement indicators; and, viii. honest and accurate reporting of duty hours, patient outcomes, and clinical experience data. f. All psychology interns and faculty members must demonstrate responsiveness to patient needs that supersedes self- interest. They must recognize that under certain circumstances, the best interests of the patient may be served by transitioning that patient s care to another qualified and rested provider. 7

8 2. Transitions of Care a. Programs must design clinical assignments to minimize the number of transitions in patient care. b. Each program must have a process to ensure continuity of patient care in the event that a psychology intern may be unable to perform his/her patient care duties. 4. Supervision of Psychology Interns a. In the clinical learning environment, each patient must have an identifiable, licensed, appropriately- credentialed and privileged supervising psychologist who is ultimately responsible for that patient s care. i. This information should be available to Psychology interns, faculty members, and patients. ii. Psychology Interns and faculty members should inform patients of their respective roles in each patient s care. b. The program must demonstrate that the appropriate level of supervision is in place for all Psychology Interns who care for patients. i. A licensed psychologist must be physically on site wherever a Psychology intern is delivering services. ii. Each psychology intern will receive a minimum of 2 hours individual supervision, and 1 hour group supervision by a licensed psychologist, as well as an additional hour of supervision, yielding a minimum of 4 hours of supervision per week. iii. Each psychology intern will receive a minimum of 2 hours of didactics per week pertinent to the field of psychology. Evaluations A Psychology Intern will be evaluated at least twice each year with regard to his or her performance, knowledge, skills, satisfactory progressive scholarship, and professional growth. To progress in the program and to successfully complete the program, a Psychology Intern must demonstrate his or her ability to assume increased responsibility for patient care. The evaluations and the Psychology Intern s responses to the evaluations, if any, will be maintained in the Program or department office and will be accessible to the Psychology Intern for review. It is the responsibility of the Psychology Intern to follow up with any questions that he or she may have regarding an evaluation. UT Health PIP requires that interns demonstrate minimum levels of achievement across all training competencies, as outlined in the Competency Grid. Interns are formally evaluated by their primary supervisor twice annually: 1) at the midpoint; and 2) at the end of the internship year. Evaluations are conducted using a standard rating form, which includes comment spaces where supervisors include specific written feedback regarding intern performance and progress. The evaluation form includes information about intern performance regarding all of UT Health Northeast PIP expected training competencies and the related objectives. Supervisors are expected to review these evaluations with the intern and provide an opportunity for discussion if the intern has questions or concerns about the feedback. Evaluations will be communicated to the Psychology Intern in a timely manner. A minimum level of achievement on each evaluation is defined as a rating of 3 for each competency. 8

9 The rating scale for each evaluation is a 5- point Likert scale, with the following rating values: 1= Significant Development Needed, 2= Development Needed, 3= Meets Expectations, 4= Exceeds Expectations, 5= Significantly Exceeds Expectations. If an intern receives a score less than 3 on any component of any evaluation, or if supervisors have reason to be concerned about the intern s performance or progress, the due process procedures will be initiated. Additionally, all UT Health Northeast PIP interns are expected to complete 2000 hours of training during the internship year. Meeting the hours requirement and obtaining sufficient ratings on all evaluations demonstrates that the intern has progressed satisfactorily through and completed the internship program. Feedback to the intern s home doctoral program is provided at the culmination of the internship year. Doctoral programs are contacted within one month following the end of the internship year and informed that the intern has successfully completed the program. If successful completion of the program comes into question at any point during the internship year, or if an intern enters into the formal review step of the due process procedures due to a grievance by a supervisor or an inadequate rating on an evaluation, the home doctoral program will also be contacted. This contact is intended to ensure that the home doctoral program, which also has a vested interest in the intern s progress, is kept engaged in order to support an intern who may be having difficulties during the internship year. The home doctoral program is notified of any further action that may be taken by UT Health Northeast PIP as a result of the due process procedures, up to and including termination from the Program. In addition to the evaluations described above, interns must complete a self- evaluation form at the beginning and end of the internship. Additionally, interns will complete an evaluation of their supervisor and a program evaluation at the mid- point and end of the internship year, in order to provide feedback that will inform any changes or improvements in the training program. Psychology Intern Impairment Impaired function may be due to mental or emotional illness, personality disorder, substance abuse; and includes evidence of lying or cheating. The institutional policy regarding substance abuse among Psychology Interns recognizes the importance of prevention through education, recognition of the impaired Psychology Intern, and the counseling and rehabilitation of the impaired Psychology Intern. Impaired Psychology Interns and related allegations will be handled in accordance with the GME Committee s Impairment Policy (web site %20Section% Medical%20Staff/09_54%20Provider%20Impairment%20Professional%20Conduct% pdf ). Psychology Intern Impairment Policy 1. Statement of Policy Overview The University of Texas Health Science Center at Tyler (UTHSCT) is committed to maintaining a drug free environment for Psychology Interns. The primary goal related to substance abuse in the Psychology Intern community is prevention. UTHSCT recognizes that substance abuse is a treatable medical condition, and as an institution dedicated to health, facilitates the treatment and rehabilitation of this condition for both patients and healthcare providers. 9

10 Although UTHSCT is concerned with helping Psychology Interns who have substance abuse or dependency problems, in cases in which a Psychology Intern endangers or causes harm to him/herself or others, the Psychology Intern will be subject to corrective action. Also, if a Psychology Intern is convicted of a criminal drug statute violation, UTHSCT s main priority will be in addressing the legal implications of the Psychology Intern s dependency. 2. Policy The unlawful purchase, manufacture, distribution, possession, sale, storage, or use of any controlled substance or medication by Psychology Interns while on duty, or while in or on premises or property owned or controlled by UTHSCT or any of its affiliated institutions is prohibited. The unauthorized use or possession of alcohol by Psychology Interns while on duty is prohibited. State law will be enforced at all times in or on all premises or property owned or controlled by UTHSCT or any of its affiliated institutions. Any use of alcohol or any other substance by Psychology Interns that adversely affects job performance or that may adversely affect the safety of other Psychology Interns, students, visitors or patients in any facility owned or controlled by UTHSCT or its affiliated institutions is prohibited, regardless of whether such use occurs during duty hours. Use of alcohol by Psychology Interns at an authorized, official function of UTHSCT or any of its affiliated institutions that may adversely affect job performance or the safety of any other person is prohibited. Prescription and over- the- counter medications that may induce impairment are included in this policy. A Training Director's advice and assistance may be necessary when duty adjustments are required to ensure a Psychology Intern's ability to perform assigned work in a safe manner because of the use of such medications. Distribution to others of a drug or controlled substance obtained by prescription while on duty or while in or on premises or property owned by UTHSCT or any of its affiliated institutions is prohibited, except by duly licensed and certified persons. Failure to comply with this published policy by any Psychology Intern will constitute grounds for corrective action, including termination. At the discretion of UTHSCT, the Psychology Intern may be referred to the Employee Assistance Program (EAP) and be required to participate in and satisfactorily complete an approved treatment and follow- up program. 3. Procedure Because substance abuse has a potential for serious adverse effects upon the Psychology Intern, patients, colleagues and the institution, it is necessary to have a comprehensive program that: educates both Psychology Interns and Faculty about the hazards of substance abuse and trains them to recognize signs of alcohol or drug abuse, if possible; provides a means for immediate evaluation and appropriate referral for diagnosis, treatment and follow- up, including monitoring; and, complies with state and federal law as well as policies included in The University of Texas Health Science Center at Tyler Handbook of Operating Procedures Educational Efforts

11 UTHSCT relies on the observations and judgment of training directors, teaching faculty, and peers to evaluate the behavior of Psychology Interns, to identify suspected impaired behavior, and to refer Psychology Interns exhibiting such behavior to the EAP for evaluation. The EAP is a benefit available to all Psychology Interns. The EAP also provides assessment and referral for assistance with personal problems such as difficulty with a marital, family or other significant relationship, stress/burnout, depression, or grief as well as alcohol and drug dependency or abuse. Training director and faculty awareness of EAP services and the issues and implications of substance abuse will be facilitated through educational efforts. To this end, UTHSCT will provide instruction and disseminate educational materials to all Psychology Interns concerning the following: The institutional prohibition against the unlawful purchase, manufacture, distribution, possession, sale, storage, or use of any controlled substance or medication by Psychology Interns while on duty or while in or on premises or property owned by UTHSCT or any of its affiliated institutions; The identification of the types of behavior that give rise to a "reasonable suspicion" of drug- related impairment; The risks inherent in substance abuse, for both the individual and the institution; The available referral resources within UTHSCT that can provide confidential, affordable assistance for individuals with substance abuse or chemical dependency problems; and The policies of UTHSCT regarding drug abuse and corrective actions against offending individuals. 5. EAP Referral and Treatment a. Course of Action: Reasonable Suspicion of Use Any Psychology Intern, whose behavior or performance gives rise to a reasonable suspicion of impairment based on documented observations by faculty or staff, will be immediately relieved of clinical duties and be asked by the Training Director to submit to blood and/or urine screening for substances of abuse utilizing an appropriate chain of custody with lab results reviewed by a Medical Review Officer (MRO). The Chair of the Department will also be notified of the allegation of impairment. The Psychology Intern will be immediately referred to an EAP counselor, who will assess the Psychology Intern's condition and determine the likelihood that the observed behavior might be caused by drug or alcohol use. The Psychology Intern will be expected to comply with the EAP counselor's recommendations. These corrective actions, including back- to- work restrictions, if any, and regular blood and/or urine test monitoring (utilizing an appropriate chain of custody with lab results reviewed by a Medical Review Officer or MRO), regular follow- up, or other consequences of the identified problem will be decided upon by the Training Director or Chair following consideration of all pertinent information, including the evaluation and treatment recommendations and the requirements of the signed contract. The EAP will coordinate necessary follow- up and monitoring on behalf of UTHSCT by informing the Psychology Intern's Training Director as to whether or not the Psychology Intern has cooperated. Regular reports of the Psychology Intern s progress will be provided twice annually to the Training Director/Department Chair by the EAP. In addition, failure to comply with treatment and/or positive body fluid tests for disallowed substances will also be reported. The EAP will also participate in a return- to- duty meeting in all cases when the treatment and monitoring plan are fully in place. The assessment and referral function of the EAP provides a measure of protection for the Psychology Intern who has made a good faith effort towards recovery, codified by the signed contract. 11

12 b. Course of Action: Self- referral Psychology Interns who wish to obtain assistance for the treatment of a drug- related problem are encouraged to seek assistance from the EAP. Psychology Interns may use health insurance to defray the cost of many drug and alcohol treatment programs, although certain restrictions may apply, depending on the type of treatment recommended. The EAP will assist in determining how a Psychology Intern's insurance coverage may be applied most efficiently. In addition, medical leaves of absence may be granted to accommodate outpatient and/or extended hospital care. Seeking help through the EAP will not jeopardize the Psychology Intern's current position or potential in the training program. Involvement with the EAP will not grant special privileges or exceptions from normal performance standards. Confidentiality between the Psychology Intern, Training Director and Chairperson, and the EAP will be respected in all cases unless the Psychology Intern authorizes disclosure or as otherwise required by law Sanctions Corrective actions or other consequences of the reported behavior will be determined exclusively by the Training Director or Chair following their consideration of all pertinent information. Any Psychology Intern who is convicted under a criminal statute for a drug- related offense occurring while on duty is required by law and UTHSCT policy to notify the Training Director no later than five days after such conviction. In turn, the Training Director is required to notify the UTHSCT Chief of Staff immediately after receiving notice of such conviction to provide for the Institution's compliance with the law. A felony conviction of a violation of any criminal drug statute for use, possession, dispersion, distribution, or manufacture of an illegal drug while the Psychology Intern is on duty will result in termination of the Psychology Intern's appointment. Due Process Procedures In the event a Psychology Intern encounters difficulty meeting and/or maintaining performance or professional standards, the Psychology Intern should seek out the advice and guidance of the Training Director. Likewise, if the Training Director knows that a Psychology Intern s performance is unsatisfactory; or that the intern has a problem behavior, he or she must contact the Psychology Intern and provide adequate verbal and/or written notice and guidance to the Psychology Intern about his or her performance and possible corrective action. Grievances by Faculty For situations in which the Training Director, a supervisor, or other faculty member raises a grievance about the behavior of a psychology intern: Definition of Problem Behavior For purposes of this handbook, intern problem behavior is defined as an interference in professional functioning which is reflected in one or more of the following ways: 1) an inability and/or unwillingness to acquire and integrate professional standards into one's repertoire of professional behavior, 2) an

13 inability to acquire professional skills in order to reach an acceptable level of competency, and/or 3) an inability to control personal stress, psychological challenges, and/or excessive emotional reactions which interfere with professional functioning. It is a professional judgment as to when an intern's behavior becomes problematic, rather than of concern. Interns may exhibit behaviors, attitudes or characteristics that, while of concern and requiring remediation, are not unexpected or excessive for professionals in training. Problems typically become identified as impairments when they include one or more of the following characteristics: 1) the intern does not acknowledge, understand, or address the problem when it is identified, 2) the problem is not merely a reflection of a skill deficit which can be rectified by academic or didactic training, 3) the quality of services delivered by the intern is sufficiently negatively affected, 4) the problem is not restricted to one area of professional functioning, 5) a disproportionate amount of attention by training personnel is required, 6) the intern's behavior does not change as a function of feedback, remediation efforts, and/or time, 7) the problematic behavior has potential for ethical or legal ramifications if not addressed, 8) the intern's behavior negatively impacts the public view of the agency, 9) the problematic behavior negatively impacts the intern class Under any circumstances in which the Training Director determines that the unsatisfactory performance of the Psychology Intern may constitute a threat to patient safety, he or she may immediately suspend or reassign the Psychology Intern pending a final decision by the Training Director regarding the ability of the Psychology Intern to continue in the Program. Informal Review When a faculty member or supervisor believes that an intern s behavior is becoming problematic, the first step in addressing the issue should be to raise the issue with the intern directly and as soon as feasible in an attempt to informally resolve the problem. This process should be documented in writing, but will not become part of the intern s professional file. Formal Review If an intern s problem behavior persists following an attempt to resolve the issue informally, or if an intern receives a rating below a 3 on a broad domain within a supervisory evaluation, the following process is initiated: A. The supervisor will meet with the Training Director, and intern within 10 working days to discuss the problem and determine what action needs to be taken to address the issue. B. The intern will have the opportunity to provide a written statement related to his/her response to the problem. C. After discussing the problem and the intern's response, the supervisor and Training Director may: 1) Issue an "Acknowledgement Notice" which formally acknowledges a) that the faculty is aware of and concerned with the problem, b) that the problem has been brought to the attention of the intern, c) that the faculty will work with the intern to specify the steps 13

14 necessary to rectify the problem or skill deficits addressed by the inadequate evaluation rating, and d) that the problem is not significant enough to warrant further remedial action at this time. This notice will be issued within 5 working days of the meeting. 2) Place the intern on "Remediation" status which defines a relationship such that the faculty, through the supervisors and Training Director, actively and systematically monitor, for a specific length of time, the degree to which the intern addresses, changes and/or otherwise improves the problematic behavior or skill deficit. The length of the Remediation period will depend upon the nature of the problem and will be determined by the intern s supervisors and Training Director. Remediation will include a written statement to the intern and the Director of Clinical Training at the trainee s graduate institution and includes: a) the actual behaviors or skills associated with the problem, b) the specific recommendations for rectifying the problem, c) the time frame for the probation during which the problem is expected to be ameliorated, and d) the procedures designed to ascertain whether the problem has been appropriately rectified. This statement will be issued within 5 working days of the decision. If the Training Director has notified the Psychology Intern about his or her unsatisfactory performance, offered advice and guidance and, if appropriate, corrective action and the Psychology Intern continues his or her unsatisfactory performance, it is the prerogative of the Training Director to take what he or she considers to be appropriate academic corrective action. Corrective action may include, but is not limited to: remedial assignments, probation (formal or informal), suspension, failure to graduate, or dismissal from the Program. The GMEC, or a subcommittee of the GMEC, is available to the Psychology Intern to review those instances of failure to graduate, suspension or dismissal in which the Psychology Intern believes that this academic corrective action was levied against him or her without the requisite notice and guidance of the Training Director. The review by the GMEC or a subcommittee of the GMEC is restricted solely to the determination of whether the requisite notice and guidance was received by the Psychology Intern. The Psychology Intern must make a request for a review by the GMEC within fourteen (14) days of the date the academic corrective action in question is levied against the Psychology Intern. 2. Other/Additional Corrective Actions In the event allegations of scholastic dishonesty, theft, or allegations of conduct that is prohibited by UTHSCT, The University of Texas System, or by federal, state, or local law, are levied against a Psychology Intern, UTHSCT may seek to terminate the appointment of the Psychology Intern prior to the end of the appointment term. In any event in which it is determined that a Psychology Intern constitutes a threat to patient safety, the Psychology Intern may be immediately suspended or reassigned pending an inquiry by the Training Director. If allegations are levied against the Psychology Intern that may be subject to such action, the Training Director will conduct an investigation into the allegations. If the investigation reveals that the allegations appear to be substantiated, notice of the allegations will be sent to the Psychology Intern via certified mail with a copy to the GME office. 14

15 If the Psychology Intern does not dispute the allegations he or she will be asked to sign a Waiver of Hearing and a penalty will be assessed by the Training Director or department Chairperson. If the Psychology Intern disputes the allegations, or if the Psychology Intern admits the allegations but contests the penalty assessed, he or she may request a hearing before an Arbitration Committee appointed by the Faculty Senate. The Arbitration Committee will consist of three (3) members, one of whom will be a Psychology Intern member from the Psychology Doctoral Internship. The Arbitration Committee will select its presiding Chairperson. The Psychology Intern will be given at least ten (10) days notice of the date, time, and place for such hearing and the name of the members of the Arbitration Committee. The notice will include a written statement of the allegations and a summary statement of evidence supporting such allegations. The notice shall be delivered in person or by certified mail to the Psychology Intern at the address appearing in the Program records. Upon a hearing of the allegations, the UTHSCT institutional representative has the burden of going forward with the evidence and the burden of proving the allegations by the greater weight of the credible evidence. The hearing will be conducted to assure that both parties (UTHSCT and the Psychology Intern) are afforded the following minimal rights: a. Each party will provide to the GME office a complete list of all witnesses, a brief summary of the testimony to be given by each, and a copy of all documents to be introduced at the hearing. Each party will be provided copies of the above by the GME office prior to the hearing. Deadlines concerning the submission of materials will be set and communicated by the GME office. b. Each party will have the right to appear and present evidence in person. The Psychology Intern may have legal counsel present outside of the hearing room; however, no attorneys will actually appear as an advocate for either party. c. Each party will have the right to cross- examine witnesses. d. The hearing will be recorded. If either party wishes to appeal the findings, the record will be transcribed and both parties will be allowed to purchase a copy of the transcript. The Psychology Intern may challenge the impartiality of any member(s) of the Arbitration Committee up to three (3) working days prior to the hearing. The challenged member of the Arbitration Committee shall be the sole judge of whether he or she can serve with fairness and objectivity. In the event a member disqualifies himself or herself, a substitute will be chosen. The Arbitration Committee will render and send to both parties a written decision, which will contain findings of facts and conclusions and will assess a penalty or penalties. Either or both parties may appeal an action taken by the Arbitration Committee in accordance with the following procedures: Within fourteen (14) days after the parties have been notified of the decision, either or both parties may give notice of appeal to the Physician- in- Chief. If the decision is sent by mail, the date the decision is mailed initiates the fourteen (14) day period. The decision will be reviewed on the basis of the transcript, if any, and evidence considered at the hearing. In order for the appeal to be considered, all the necessary documentation to be filed by the appealing party(s), including written argument must be 15

16 filed with the Physician- in- Chief within fourteen (14) days after notice of appeal is given and the transcript, if any, is available. Both parties, at the discretion of the Physician- in- Chief, may present oral argument. The Physician- in- Chief may approve, reject, or modify the decision in question or may require that the original hearing be reopened for the presentation of additional evidence and reconsideration of the decision. The action of the Physician- in- Chief shall be communicated in writing to the Psychology Intern and Training Director no more than thirty (30) days after the appeal and related documents have been received. The decision of the Physician- in- Chief is the final appellate review. Grievances by Interns It is the policy of UTHSCT to encourage fair, efficient, and equitable solutions for problems that arise out of the appointment of the Psychology Intern. Grievances may involve payroll, hours of work, working conditions, clinical assignments, and issues related to the program or faculty, or the interpretation of a rule, regulation, or policy. If a Psychology Intern has a grievance, he or she should first attempt to resolve it by consulting with (1) the Training Director; or, (3) the Department/Section Chairperson. If after twenty- one (21) days the matter has not been resolved in a satisfactory manner, the Psychology Intern should then present the grievance in written form to the GMEC through the Medical Education office. 16 A grievance subcommittee of the GMEC appointed by the GMEC Chairperson will be assigned to review the grievance. The Psychology Intern may be invited or permitted to appear before the subcommittee at the discretion of the subcommittee. After the grievance subcommittee has reviewed all information submitted in writing or in person by the Psychology Intern, a decision will be communicated in writing to the Psychology Intern and other appropriate, involved persons. Complaints of Sexual Harassment or Unlawful Discrimination Complaints of sexual harassment and/or other forms of unlawful discrimination are to be addressed in accordance with the regulations of UTHSCT as set out in its Handbook of Operating Procedures. (web site: %20Section% Human%20Resources%20and%20Employment%20Related/08.0%20Rules%20and%20Regulations/06_08 _28%20Sexual%20Harassment%20and%20Sexual%20Misconduct.pdf ) Graduation/Completion of the Psychology Doctoral Internship Interns must receive a score of 3 or higher on all items of the final evaluation. Completion of 2,000 hours. Further criteria for graduation shall be based upon three parameters. The psychology intern must be judged as competent in each of the three parameters for graduation. The parameters of satisfactory performance are: 1. Clinical and Academic Competence - - fund of knowledge, education meeting attendance, clinical performance (rotation evaluations), clinical judgment, technical skills, including procedural competence and documentation, knowledge of limitations. 2. Professional Behavior - - working relationship with faculty, ancillary staff, intern and resident colleagues, and patients; acceptance of responsibility, including demonstrated ability to

17 supervise others, punctuality and reliability, willingness/openness to do brief consults ( warm handoffs ), including the willingness to participate in emergency coverage due to illness, etc., as needed; and fulfillment of administrative duties, including timely and thorough records completion, completion of all evaluations, logs, and administrative meeting attendance; timely attention to clinical duties (quality measures, returning messages.) 3. Impairment - - absence of impaired function due to mental or emotional illness, personality disorder, substance abuse; absence of lying or cheating on examinations. 17 OVERVIEW OF PRIVACY POLICIES HIPAA: Federal regulations protect the privacy of patient health information. The Health Insurance Portability and Accountability Act (HIPAA) is a set of federal rules that defines what information is protected, sets limits on how that information may be used or shared, and provides patients with certain rights regarding their information. These rules protect information that is collected or maintained (verbally, in paper, or electronic format), that can be linked back to an individual patient and is related to his/ her health, the provision of health care services, or the payment for health care services. This includes, but is not limited to, clinical information, billing and financial information, and demographic/scheduling information. Even the fact that an individual has received care through UT Health PIP training site is protected. HIPAA regulations limit the use or sharing of protected patient information to the following purposes: providing treatment, obtaining payment for services, certain health care administrative functions and when required or permitted by law. Any other use or disclosure of protected information requires written authorization from the patient. For all uses or disclosures other than treatment, only the minimum amount of information necessary will be shared on a need to basis. The Notice of Privacy Practices describes to patients how we may use or disclose their health information and patient rights regarding their protected health information. UT Health Northeast Privacy and Acceptable Use Policies: otfolder=%2fsites%2futpolicy%2fhandbook%20of%20operating%20procedures%2f04%20%2d%20secti on%204%2d%2dinstitutional%20compliance%20related&folderctid=&view=%7b65a60bb9%2d1bec% 2d4200%2d9271%2d87852E83ED5D%7d and 14%20UTHSCT.pdf Additional policies on privacy include, but are not limited to: Information technology,

18 Technology/Website Privacy and Security.doc and Behavioral Health Services Health Services/Patients right to privacy 2.pdf ADDITIONAL GMEC INFORMATION A. General Information Doctoral psychology students pursuing their doctoral internship graduate training at The University of Texas Health Science Center at Tyler are appointed by The University of Texas Health Science Center at Tyler. The Graduate Medical Education Committee ( GMEC ) provides academic oversight for the Psychology Internship Training Program. The GMEC reports to the Physician-in-Chief who reports to the President. The President reports to the Vice-Chancellor for Health Affairs of the University of Texas System. The Graduate Medical Education Office provides administrative services for all residency and fellowship programs: Graduate Medical Education Office US Highway 271 Tyler, TX, Phone: 903/ Fax: 903/ B. Affiliated Hospitals Hospitals affiliated with The University of Texas Health Science Center at Tyler ( UTHSCT ) for the purpose of the Residency Training Programs are: Good Shepherd Medical Center, Trinity Mother Frances Hospital, and East Texas Medical Center. Other hospitals may either affiliate with or leave the Program after the Agreement is signed. C. Level of Training Psychology interns are doctoral level students who receive one year internship training. II. CONDITIONS OF APPOINTMENT A. Parties to the Agreement and Their Responsibilities The parties to the appointment Agreement (Agreement) are the individual in training (Psychology Intern) and UTHSCT. The Psychology Intern agrees: to serve at the affiliated hospitals; to accept the duties, responsibilities, and rotations assigned by the Training Director; to meet the training program's standards for learning and advancement including objective demonstration of the acquisition of knowledge and skills; to abide by the Rules and Regulations of the Board of Regents of The University of Texas System, the regulations of The University of Texas Health Science Center at Tyler as set out in its Handbook of Operating Procedures (web-site: ) and the regulations of the hospitals to which assigned; to conduct himself or herself ethically and morally in keeping with his or her position as a psychology intern; and, to meet the conditions outlined in this Doctoral Internship in Psychology Handbook (Handbook). 2. UTHSCT agrees to perform a series of administrative and educational functions for the benefit of both the Psychology Intern and the Program. These functions include: issuance of paychecks; provision of personnel services; provision of an office and personnel for the administration of the Program; maintenance of records; procurement and administration of the fringe benefits outlined in the Handbook; provision of mechanisms for effective coordination of the Program among the hospitals. B. Appointment Agreement The Agreement is signed by the Psychology Intern and the Training Director, on behalf of UTHSCT. C. Appointment and Reappointment 18

19 Selection of the Psychology Intern for appointment to the Program will be in accordance with APPIC guidelines, as well as with UTHSCT, departmental, and psychology section policies and procedures. An Agreement will be issued to the Psychology Intern no earlier than eight (8) months prior to the date the Psychology Intern agrees to accept the appointment. This Agreement will extend for a period not to exceed twelve (12) months. Graduation/Successful Completion of the Program will be determined at the discretion of the UTHSCT Departmental Chairperson and Training Director. The decision to complete will be based on performance evaluations and an assessment of the Psychology Intern s readiness to advance. In instances where a Psychology Intern will not successfully complete the program, the Training Director will provide the Psychology Interns with a written notice of intent not to graduate no later than four months prior to the end of the Intern s current appointment term. However, if the primary reason(s) for the failure to graduate occurs within the four months prior to the end of appointment term, the Intern will be provided with as much written notice of the action as possible. At a Psychology Intern s request, a Training Director s decision to not permit graduation may be reviewed pursuant to II.N.1 of this handbook. Psychology Interns are not required to enter into a non-compete or other restrictive covenant agreement with UTHSCT as a condition of appointment. D. Content of Program The Psychology Doctoral Internship will include: provision of inpatient and outpatient settings; provision of equipment and other facilities for the care of patients; provision of supervision and evaluation of the professional work of the Psychology Intern by UTHSCT or affiliated and cooperating institutions; and, provision of didactic experiences to supplement practical clinical experiences. The Psychology Intern will be expected to participate actively in the care of all patients of the facility to which he or she is assigned. The Psychology Intern will be assigned to a regular schedule. This schedule is largely hours per week on site. Additional reading, report writing, and lecture preparation may often occur after hours. The major objective of the Program is educational, and as such the educational needs of the Psychology Intern will be a major priority of the Training Director. The teaching staff will supervise the Psychology Intern in a manner designed to facilitate progressively increasing responsibility for patient care according to level of training, ability and experience. The level of responsibility accorded to each Psychology Intern will be determined by the Training Director and/or teaching staff. E. Stipends Stipends will be paid to the Psychology Intern by UTHSCT. F. Quality Assurance The Psychology Intern will be informed of the various hospitals' organizations for and methods of providing quality assurance. The Psychology Intern should participate in the quality assurance activities of the clinical services to which he or she is assigned. Medical%20Staff/09_45%20Medical%20Staff%20Guidelines%20-%20Medical%20Residents% pdf G. Medical Records The Psychology Intern is required to complete medical records in a timely manner. Failure to complete medical records promptly and accurately indicates failure to deliver adequate care of patients and is considered grounds for academic corrective action. H. Other Benefits and Services The benefit program outlined below applies to all eligible Psychology Interns. The benefits listed in this Paragraph H are administered through UTHSCT. 1. Vacation Psychology Interns are permitted the equivalent of 10 days of vacation each year in addition to State holidays. The Psychology Intern must coordinate vacation scheduling with the respective Program, as well as with other Psychology Interns to ensure adequate coverage. It is the responsibility of the other Interns to cover for one another (call schedule) during a Psychology Intern s absence. A Psychology Intern is not eligible to accumulate annual vacation. A Psychology Intern leaving the Program will not be compensated for unused vacation. 19

20 2. Dress Code An official identification badge should be worn while at work. Professional attire consistent with the UTHSCT dress code will be worn to work. 3. Group Insurance Health Insurance is provided to the Psychology Intern at 100% no cost for the Psychology Intern and 50% of the premiums for eligible dependents are provided by UTHSCT and the State of Texas through Premium Sharing. There is a 60 day waiting period before medical insurance will become effective for Psychology Interns and dependents. However, enrollment to elect coverage for any eligible dependents and/or elect Optional Coverage must be done within 31 days of hire or family status changes. Psychology Interns will be provided $700. compensation each month, paid out of MSRDP, to cover the cost of the intern s pre-existing insurance until the 60 day waiting period has lapsed. Dental Insurance is provided as an Optional Coverage for the Psychology Intern and dependents. However, the Psychology Intern ONLY will have his/her premiums paid at 100% from designated funds for the Residency Program. Dependent coverage is not paid, but is available at group rates. Vision Insurance is available Psychology Intern and eligible dependents at group rates. Life Insurance in the amount of $10,000 is provided at no cost to the Psychology Intern when the medical insurance becomes effective. Additional Optional Voluntary Group Term Life Insurance can be elected for Psychology Interns at group rates. Spouse and dependent children may be covered for $10,000 each and additional spouse coverage can be requested for $15,000 or $40,000 with approval at group rates. Accidental Death and Dismemberment (AD&D) Insurance in the amount of $10,000 is provided at no cost to the Psychology Intern when the medical insurance becomes effective. Additional Accidental Death and Dismemberment Insurance can be elected for Psychology Intern and dependents at group rates. Spouse can be covered for up to 50% of Psychology Intern s coverage and dependent children may be covered for $10,000 each at group rates. Short Term Disability Insurance and Long Term Disability Insurance is provided to the Psychology Intern at group rates. Weekly short term disability benefits would start after a thirty (30) day waiting period during a disability for a continuous period. Monthly long term disability benefits will not begin until a ninety (90) day waiting period has been satisfied. Dependent coverage is not available. Long Term Care Insurance is available to the Psychology Intern, spouse, adult children (25 years or older), parents, grandparents, and in-laws at group rates. Flexible Spending Accounts (FSAs) are available to provide a tax-advantages way to pay certain out-ofpocket health care and work-related day care expenses with pre-tax dollars before you file your tax return by not having to pay Federal income tax or Social Security taxes on the money budgeted in the plan year that will be used for these types of expenses. A Psychology Intern can set aside money on a pre-tax basis in the UT FLEX Medical Expense Reimbursement Account to pay for qualifying out-of-pocket medical, dental, vision or hearing expenses that are not covered under existing insurance plans. Additionally, the Day Care Reimbursement Account could be set up on a pre-tax basis to pay for qualifying work-related child or adult day care expenses incurred during the plan year. One or both FSA s could be used by budgeting as little as $15 per month or up to a maximum of $416 per month for a play year of 12 months commencing September 1 of each year and ending August 31 of the following year. Once a Psychology Intern or an eligible family member incurs an eligible medical or dependent day care expense, the Psychology Intern may request tax-free withdrawals from the account for reimbursement or use a UT FLEX Debit Card to pay for certain healthcare expenses. The UT FLEX account is a use it or lose it, so careful estimation of expected expenses for the plan year is advisable. UTHSCT will automatically use the UT FLEX Premium Redirection Plan to reduce salary by the amount of premium the Psychology Intern has elected to pay and UTHSCT contributes for group insurance premiums for which Psychology Intern is enrolled and qualified pursuant to the Internal Revenue Code. 20