The Haymount Institute for Psychological Services Pre-Doctoral Internship

Transcription

1 The Haymount Institute for Psychological Services Pre-Doctoral Internship This agreement is hereby made between The Haymount Institute, hereinafter referred to interchangeably as Pre-Doctoral Internship Agency, and the undersigned Pre-Doctoral Intern, set forth below according to the following terms, conditions, and provisions: 1. The Pre-Doctoral Intern is identified as follows: Name: Address: Type of Entity: Home Phone: Cell Phone: Social Security Number: Dates of Internship: 9/5/2011 9/4/2011 Hours per Week: 40 Total Hours: 2,000 Paid Personal Leave: 10 days per calendar year Paid Holidays: New Year s Day, Good Friday, Memorial Day, July 4, Labor Day, Thanksgiving (1 day), Christmas (1 day) Compensation: $15,080.00/year 2. The Haymount Institute desires that the Pre-Doctoral Intern agrees to perform work outlined in the internship brochure. Pre-Doctoral Interns are required to maintain Professional Liability insurance at all times and provide proof of same to The Haymount Institute prior to beginning his or her association with same. 3. The pre-doctoral internship meets the following criteria: i. The psychology internship is an organized training program, which in contrast to supervised experience or on-the-job training, is designed to provide the intern with a planned, programmed sequence of training experiences. The primary focus and purpose of this internship is to assure breadth and quality of training. ii. The internship agency has a clearly designated doctoral level staff psychologist who is responsible for the integrity and quality of the training program. This person is actively licensed, certified, or registered by the State Board of Examiners, in the jurisdiction where the program exists, and is present at the training facility for a minimum of 20 hours a week. 1

2 iii. iv. The internship agency training staff consists of at least two full time equivalent doctoral level psychologists who are actively licensed, certified, or registered as a psychologist by the Board of Examiners in the jurisdiction where the program exits, who serve as primary supervisors. Intern supervision is provided by staff members of the internship agency who carry clinical responsibility for the clients being supervised. At least 2 hours per week of regularly scheduled individual, face-to-face supervision is provided with at least one hour per week being individual supervision provided by one or more doctoral level licensed psychologists. Supervision is provided with the specific intent of dealing with psychological services rendered directly by the intern. v. The internship provides training in a range of psychological assessment and intervention activities conducted directly with recipients of psychological services. vi. vii. viii. ix. At least 25% of the trainee s time is in face-to-face psychological services with clients. The internship provides at least two hours per week in didactic activities such as case conferences, seminars, and in-service training. Internship training is at post-clerkship, post-practicum, and post-externship level, and precedes the granting of the doctoral degree. The internship agency has a minimum of two full-time equivalent interns at the internship level of training during any period of training. x. The internship level psychology trainees have the title of Intern to designate trainee status. xi. xii. The internship agency has a written statement that provides a clear description of the nature of the training program, including the goal and content of the internship and clear expectations for quantity and quality of the trainee s work. It is made available to perspective interns via or hard copy upon written request. The internship program has documented due process procedures, including notice, hearing, and appeal for interns. These procedures are given to interns the beginning of the training period. xiii. The internship experience is for a minimum of 2,000 hours, completed within 24 months. 2

3 xiv. xv. xvi. The internship includes a minimum of 4 hours in structural learning activities on issues related to racial/ethnic bases of behavior with a focus on people of color as required. The internship program will conduct formal written evaluation of the intern s performance at least twice a year. The internship training at Haymount Institute of Psychological Assessment is a formal training program that will be conducted within the range and spirit of the APA and APPIC. The Director of Training is Christopher J. Ketchman, Psy.D., ABPP, who is a licensed psychologist in North Carolina. 5. It is understood that as an Pre-Doctoral Intern, you will be providing clinical and therapeutic services to individuals and families of The Haymount Institute, and as such, will hold a position of trust and confidence and come into possession of confidential and proprietary information of such individuals and families as well as such information relating to the general operations of The Haymount Institute. 6. It is also understood that The Haymount Institute desires to protect its confidential information from unauthorized disclosure to and/or use by others and that The Haymount Institute has invested substantial money and effort to develop client relationships as well as relationships with its employees and associates, which it similarly desires to protect. Accordingly, the Pre-Doctoral Intern shall not, during his or her association with The Haymount Institute, or anytime thereafter, directly or indirectly use, disseminate, disclose, publish or otherwise make available any confidential information or any portion thereof to any entity or person other than the principals of The Haymount Institute with the need to know such information or as otherwise directed by Alida S. Mason or Christopher J. Ketchman. That the confidential information referenced above shall include, but is not necessarily limited to: (i) any of the names, addresses, telephone numbers, and clinical and/or therapeutic details of any of the individuals or families treated by the Pre-Doctoral Intern; (ii) any writings, photographs, drawings, blueprints, reproductions, recordings, software or other materials of any kind, including materials created using other confidential information, belonging to The Haymount Institute in particular, any intellectual property (i.e. templates for written reports); (iii) any confidential business methods, practices, operations, marketing strategies or plans of The Haymount Institute; (iv) any financial information, profit margins, discounts, rebates or pricing 3

4 information of The Haymount Institute; (v) any credit policies, credit procedures, payment policies or procedures, insurance or other billing procedures for any client or supplier of The Haymount Institute. 7. That the Pre-Doctoral Intern acknowledges and agrees that the types of activities which are delineated in this Agreement are narrow and reasonable in order to protect the interests of The Haymount Institute and the individuals and families seeking clinical and therapeutic services from them. 8. That the Pre-Doctoral Intern agrees that a breach of any of the provisions herein may result in material and irreparable injury to The Haymount Institute for which there is no adequate remedy at law and that it may not be possible to measure damages for such injuries precisely. In the event of a breach, The Haymount Institute shall be entitled to obtain a temporary restraining order and/or preliminary or permanent injunction restraining the Pre-Doctoral Intern from further violations. These remedies are in addition to those otherwise available in law and/or equity to The Haymount Institute, all of which are expressly reserved. 12. The Pre-Doctoral Intern shall specifically name The Haymount Institute for Psychological Services, Christopher J. Ketchman and Alida S. Mason as named insureds under any policy(ies) obtained by the Pre-Doctoral Intern pursuant to paragraph 2 above. 13. Restrictive Covenants: (a) For the duration of the Pre-Doctoral Intern s association with The Haymount Institute, the Pre-Doctoral Intern agrees not to: (i) Engage in any other employment, occupation or consulting activity for any direct or indirect remuneration without the express written consent of The Haymount Institute; (ii) Directly or indirectly compete with the business of The Haymount Institute in any manner and in any geographical location; or (iii) Engage in any aspect of the business carried on by The Haymount Institute except as an Pre-Doctoral Intern associated with The Haymount Institute; (b) For a period of two (2) years immediately following the effective date of the termination of the Pre-Doctoral Intern s association with The Haymount Institute for any reason (including the resignation of the Pre-Doctoral Intern), the 4

5 Pre-Doctoral Intern shall not, either directly or indirectly (whether as a sole proprietor, partner, venturer, stockholder, director, officer, employee, consultant, agent, Pre-Doctoral Intern, or in any other capacity): (i) Solicit or attempt to influence any customer or client of The Haymount Institute to alter or terminate their relationship with The Haymount Institute; (ii) Solicit for employment or employ any person employed by or who has a business relationship with The Haymount Institute; (iii) Attempt to influence any person from terminating his or her client or business relationship with The Haymount Institute; (iv) Offer psychological, therapeutic or other related professional services within a twenty-five (25) mile radius from offices of The Haymount Institute. 14. Pre-Doctoral Interns shall be bound by the stipulations outlined in the Intern Rating, Due Process and Grievance Procedures provided at the signing of this contract. Should the Pre-Doctoral Intern be considered for termination in accordance with Due Process guidelines indicated in the aforementioned document, the Pre-Doctoral Intern will be asked to sign an Exit Agreement, and payment of any monies due to the Pre-Doctoral Intern following termination and/or resignation are expressly conditioned upon the execution of such Exit Agreement. 15. With reasonable cause, either party may terminate this agreement effective immediately upon the giving of written notice of termination for cause. Reasonable cause shall include: (a) Material violation of this agreement; (b) Any act exposing the other party to liability to others for personal injury, property damage, or professional malpractice; 16. The failure of either party to exercise any of its rights under this agreement for breech thereof shall not be deemed to be a waiver of such rights or a waiver of any subsequent breach. 17. This Agreement shall be construed and enforced in accordance with the laws of the State of North Carolina and the Pre-Doctoral Intern submits and consents to personal jurisdiction in the State of North Carolina should such action be necessary. 5

6 THE HAYMOUNT INSTITUTE BY: Dated: Authorized Representative The Haymount Institute BY: Dated: Intern Signature EEO Statement The Haymount Institute has, and will continue to provide, all employees, applicants, and contractors equal opportunity in the manner provided in law in all aspects of employment and services regardless of their race, ethnicity, color, creed, national origin, age, sex, sexual orientation, marital status, physical or mental handicap, developmental disability, according to Title VII of the Civil Rights Act of 1964, political affiliation, any person with HIV or AIDS related complex, or other disability according to the Rehabilitation Act of 1973, and the Americans with Disability Act of These individuals will be recruited, referred for hiring considerations, and employed with regard to positive and appropriate utilization of their skills and capabilities. Qualified staff will be afforded non-discriminatory consideration for promotion and job advancement, and there will be no discrimination with regard to assignments, rates of pay, promotion, transfers, training, accessibility, working conditions, and benefits. 6