CAMERON FOUNDATION CHEMICAL DEPENDENCY FELLOWSHIP PROGRAM Counselor Intern Training Program Information For Applicants Memorial Hermann Prevention and Recovery Center 3043 Gessner Houston, Texas 77080 P 713-329-7547 F 713-329-7403 Revised 8/25/2015 Page 1 of 5
MEMORIAL HERMANN PREVENTION AND RECOVERY CENTER Cameron Foundation Chemical Dependency Fellowship Training Sponsored by the Cameron Foundation and supported by the Memorial Hermann Prevention and Recovery center, this Fellowship Program offers healthcare professionals an opportunity to learn about substance use disorders and gain experience in the assessment and management of patients with problems resulting from patterns of disordered substance use. Upon successful completion of the program, the participant should have the knowledge and skills necessary to assess, identify, and treat patients with substance use disorder. Milieu Memorial Hermann Prevention and Recovery Center is an Alcohol and Drug Treatment facility licensed by the Texas Department of State Health Services. Our services include inpatient detoxification, residential, and outpatient treatment for treatment and recovery from substance use disorders. We also treat co-occurring mental health disorders in patients with a primary substance use disorder. Patients include adult men and women with primary substance use disorders. Depending on the patient population, at least half of the patients have co-occurring psychiatric disorders. The most common psychiatric diagnoses include mood disorders and anxiety disorders. Treatment approaches include individual and group therapy, CD-education, 12-step meetings, psychopharmacology, recreation activities, and family programs. This program will work with various educational institutions in the community, including University of Texas, Houston Baptist University, Memorial Hermann Family Practice Residency program, Baylor College of Medicine, Lone Star College, University of Houston, Houston Community College Counselor Program and various other colleges. Fellowship Program for Counselors The Memorial Hermann Chemical Dependency Fellowship will provide counselors an opportunity to gain knowledge and experience in the best practices in treating addictive disorders and diseases. The duration of the Addiction Counselor Fellowship Program is from six to twenty-four months, based on experience and qualifications. The counselor intern will receive supervision from a MHPaRC staff clinical supervisor credentialed to provide supervision to LCDC, LPC, and LMFT counselor interns. The intern will attain their work experience at the main campus of MHPaRC at 3043 Gessner on a full-time 40 hour week basis from 8am 5pm Monday through Friday. Supervision will be provided in accordance with the applicable Texas Department of State Health Services licensing board requirements. Fellowship Objectives Develop a comprehensive knowledge base of addiction as a disease and treatment of patients addicted to drugs and alcohol. Learn counselors role in providing comprehensive care to patients addicted to drugs and alcohol in collaboration with other clinical staff. Learn about Assessment and Treatment Process. Learn how to develop an individualized Treatment Plan. Receive a scholarship to assist with expenses during the program. Admission Requirements Must meet all Texas Department of State Health Services Counselor Intern requirements Services: 18 years of age or older; Intern is registered with Department of State Health Service as an LCDC Intern, LPC Intern, or LMFT Associate Intern is currently enrolled in or has completed an associates, bachelors or masters program with an accredited college; Intern signs and adheres to the DSHS LCDC Code of Ethics Agreement; Intern agrees to comply with Memorial Hermann Prevention and Recovery Center s Behavioral Expectations; Revised 8/25/2015 Page 2 of 5
Intern demonstrates a satisfactory level of professional skills when interacting with patients and staff; Intern demonstrates willingness to follow supervisor s instructions with regards to patient interactions, assignments and schedule; works a minimum of 40 hours per week; The initial 13 weeks will be working an orientation training schedule in a variety of work settings at the Prevention and Recovery Center. If in recovery, must be two years clean and sober Clearance from the Memorial Hermann Human Resource department and Occupational Health department pre-employment screening which includes criminal background check, license verification and a urine drug screen for addictive substances including nicotine. Disciplinary action up to and including termination from the Counselor Internship Program can and will occur for any Code of Ethics violation Application Process The application process includes submission of completed applicant information sheet, a cover letter, resume, transcripts, copy of intern license and at least one letter of recommendation. The cover letter should specify the supervision and clinical experience requirements the licensed intern has for the internship. The transcripts can be photocopies or unofficial forms of the transcript. Please submit the complete application all together at once instead of sending parts of the application over a period of time. The Fellowship Committee will only accept applications when there is a current employment position opening for Counselor Intern. Counselor Intern position openings can be verified at http://www.memorialhermann.org/careers/select the qualified applicants for a face to face interview for admission to the program. Contact: Vaughn M. Bryant, III, PhD, LCDC- CCS, LPC-S, LMFT-S Phone: 713-329-7547 Fax: 713-329-7413 email: Vaughn.bryant@memorialhermann.org Mail: Memorial Hermann Prevention and Recovery Center 3043 Gessner Houston, Texas 77080 Revised 8/25/2015 Page 3 of 5
CAMERON FOUNDATION CHEMICAL DEPENDENCY FELLOWSHIP APPLICANT INFORMATION SHEET Personal Data: Today's Date: Name: Address: Date of Birth: City/Zip: Phone #: Home: Work: Cell: Email: Texas Drivers License# Social Security # Current work status: Unemployed Self Employed Employed Part Time Employed Full Time Educational History: Include degree program currently enrolled in as well as degrees completed to date Name of School Diploma / Degree Major / Focus Date (from to) Please submit copies of all transcripts and diplomas of all educational history. Behavioral Health Related Experience Place of Employment Position Dates (from to) Include volunteer and practicum experiences as well as paid employment experiences. Licensure - LCDC Intern, LPC Intern, LMFT Associate License and License Number Date Issued Expiration Date # Hours Completed Score on Board Exam Please print verification of current status from http://www.dshs.state.tx.us/lcdc/lcdc_search.shtm Unique Skills or Other Experiences References - Name Professional Relationship Contact Information: Phone / Email Please list three references who know you professionally. References can include a supervisor, academic advisor, or professor. Also ask at least one reference to write a letter of recommendation and mail, fax or emailall materials to: Vaughn Bryant / MHPaRC / 3043 Gessner / Houston, Texas 77080 Vaughn.bryant@memorialhermann.org fax: 713-329-7413 Revised 8/25/2015 Page 4 of 5
Background Check Consent and Waiver Release Form 1. Have you been convicted (past 10 years) of a felony? Yes No 2. Are you currently out on bail or your recognizance, pending trial for any felony offense? Yes No 3. Have you ever been convicted of a sex offense or are you registered in any database as a sex offender? Yes No If Yes to any above question, please explain: BACKGROUND SCREEN RELEASE: I hereby release and hold harmless Memorial Hermann, their employees and agents, from any liability resulting from a background check or drug screen, including the specifics listed below. I, (Applicant), authorize and give consent for the above named organization to obtain information regarding myself. This includes the following: Social Security Number Verification, Criminal background records/information, Drivers license check, and addresses. I the undersigned, authorize this information to be obtained either in writing, electronic transmission or via telephone in connection with my volunteer application. Any person, firm or organization providing information or records in accordance with this authorization is released from any and all claims of liability for compliance. Such information will be held in confidence in accordance with the organization s guidelines. Candidates for the internship program will be required to submit to urine drug screening and will be disqualified from consideration for use of addictive substances including; tobacco, nicotine, marijuana, opiates, stimulants, sedatives, benzodiazepines, etc. DRUG SCREENING CONSENT: I, (Applicant), do hereby voluntarily consent to the Memorial Hermann medical staff, assistants, and/or designees to perform drug screen testing at Memorial Hermann Prevention and Recovery Center. For this purpose, I consent to the examination of my urine for the presence of drugs. I also authorize the Memorial Hermann medical and/or clinical staff to provide the results of these tests to the selection committee evaluating my application for placement at Memorial Hermann Prevention and Recovery Center as a clinical intern. This form has been fully explained to me and I certify that I understand its content. Print Name: Signature Date Revised 8/25/2015 Page 5 of 5