Psychiatric Institute of Washington

Psychiatric Institute of Washington 2012-2013 Psychology Predoctoral Internship Handbook 1

TABLE OF CONTENTS GREETINGS... 4 HISTORY OF PIW... 5 HOSPITAL MISSION STATEMENT... 7 DEPARTMENT OF PSYCHOLOGY MISSION STATEMENT... 8 PROGRAM PHILOSOPHY AND TRAINING MODEL... 8 PSYCHOLOGY TRAINING PROGRAM GOAL... 8 INTERNSHIP PROGRAM DESCRIPTION... 9 Program Components... 9 Individual Psychotherapy... 9 Group Psychotherapy... 9 Psychological Assessment...10 Intake Services...10 Unit Responsibilities...10 Seminars...10 Supervision...11 Evaluation Procedures...11 Clinical Placements...11 GENERAL INFORMATION...12 Work Hours...12 Stipend...12 Benefits & Leave...12 Number of Positions...12 Regularly Scheduled Meetings...12 Psychology Department Testing Supplies - PIW...13 RIGHTS AND RESPONSIBILITIES...14 Overview...14 Program Responsibilities...14 Intern Rights and Responsibilities...15 TRAINING GOALS, OBJECTIVES, AND COMPETENCIES...17 Objective 1: Psychological Interventions...17 Objective 2: Psychological Assessments...17 Objective 3: Ethics and Professional Behavior...18 Objective 4: Supervision...18 Objective 5: Cultural Competence...19 Objective 6: Program Development...19 SUMMARY AND SCHEDULE OF INTERN EVALUATION PROCEDURES...21 IDENTIFICATION OF DEFICIENCIES OR PROBLEMATIC ASPECTS IN PERFORMANCE AND DUE PROCESS...22 Remediation...23 Due Process...24 Procedures for an Intern Appeal...26 Grievances Procedures...28 Complaints Regarding Training Issues:...28 Complaints Regarding Non-Training Issues:...29 2

PSYCHOLOGY DEPARTMENT STAFF...30 INTERN ELIGIBILITY...31 Application Procedures...31 Interview Dates and Locations...32 Training Position Offers...32 3

GREETINGS ~ We at the Psychiatric Institute of Washington are delighted to welcome you to our pre-doctoral internship in clinical psychology. Our internship program has a long-standing history and many of our interns go on to work in postdoctoral positions in hospitals, schools, community clinics, and university counseling centers. Our program offers the opportunity to develop clinical skills while working with both acute and chronic mentally ill urban populations. Overall, the program is designed to prepare you for your career as a psychologist in the mental health workplace. Our faculty is composed of excellent clinicians who are role models for psychologists in the provision of mental health services to severely mentally ill populations. They have a wide range of clinical experiences and training that they draw upon in educating you in how to work with mentally ill children, adolescents, and adults in an inpatient setting. We believe that we offer a challenging and varied educational experience that exposes you to the many different roles that psychologists play in the provision of inpatient mental health services and to the different stages of psychopathology as patients undergo treatment. We believe your time with us will help you grow in your professional development and prepare you for your future career as a professional psychologist. This handbook includes information about the program as well as the hospital. Its purpose is to provide you with information that will help you to understand the program, the hospital, and its policies and procedures. 4

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PSYCHIATRIC INSTITUTE OF WASHINGTON For four decades, the Psychiatric Institute of Washington (PIW) has been making a difference in metropolitan Washington. PIW has become a nationally recognized treatment facility and an innovator in inpatient treatment programs. It has served as a model for many private, freestanding, psychiatric hospitals throughout the nation. In its forty years, PIW has touched the lives of more than 75,000 patients, and has grown to be an integral and vital part of the healthcare continuum in the District of Columbia. The hospital currently employs approximately 250 people. In the Beginning PIW was founded when two National Institute of Mental Health research psychiatrists, Jack Durell, MD and Howard Hoffman, MD, were asked by a group of psychiatrists at the George Washington University, Drs. Ed Fleming, Jesse Rubin, and Leon Yochelson, to help establish the clinical program for a new, private psychiatric hospital based on a model therapeutic community developed at NIMH. The hospital offered an alternative to the two existing modes of treatment, i.e., very short-term EXCT, and long-term psychoanalytically based inpatient care. During the summer of 1967, PIW welcomed its first patient to 2141 K Street, NW, located on the top 2 ½ floors of a medical office building, which itself was unique in the nation. By the mid 1970 s, the hospital had grown from its original 75 beds to 235 beds and moved to a second location. Making a Change, Meeting a Challenge In 1982, the organization founded by PIW was sold to a national healthcare chain. After rapid expansion, that organization began having serious difficulties, and by 1993, needed to divest or close their psychiatric hospitals. In 1995, Dr. Hoffman, along with Charles Baumgardner and Ken Courage, saw an opportunity to rebuild the hospital and restore the reputation of the once proud and productive hospital. They purchased the hospital and instilled a new and broader vision and created a new mission that produced a dramatic turnaround leading to PIW s current success. PIW made a commitment to the city of Washington by becoming a key component of DC s mental health delivery system. The Child and Adolescent Program was updated to meet the needs of inner-city youth. The hospital also became a major center for the city s substance abuse population. The Center, a program to treat trauma survivors was started and developed an outstanding reputation, such that it draws patients nationwide. A Leader in the Field 6

Since then, PIW has distinguished itself by instituting a variety of needed and innovative programs. PIW has been chosen by other hospitals to manage their psychiatric units. At both Greater Southeast Community Hospital and Laurel Regional Hospital, PIW lends its expertise in treating adults for serious mental illness and substance abuse. Another unique collaboration in the New Directions program, an intensive outpatient and residential treatment program for substance abusers operated in partnership with the Salvation Army Harbor Light Center. The hospital also operates a clinical trials research program that provides free inpatient care for the city s neediest chronically mentally ill adults with schizophrenia. PIW offers a competitive internship training site for medical, nursing, psychology, and social work students. PIW has prevailed against a number of challenges. Changes in the insurance industry and the move away from institutionalization have led to shorter lengths of stay for individuals in care, while levels of acuity, crisis admissions, and costs have increased. Many small private psychiatric hospitals have succumbed to the clinical challenges and financial pressures. PIW, however, remains a vital and vibrant contributor to the mental health community and is standing tall. 7

Psychiatric Institute of Washington HOSPITAL MISSION STATEMENT PIW is PEOPLE with INTEGRITY and WILLINGNESS to share in the healing process and guide those we serve on the path to health. We are advocates for your cause, trustees of your resources, and respecters of your dignity. With professionalism and compassion, we commit to your endeavor to find balance and meaning. Vision Statement PIW is committed to improving the behavioral health care within our community by going beyond the traditional. We will continue to develop diverse and dynamic treatment programs and establish partnerships with others to understand and serve people where they live. Together we will build upon our strengths and human spirit to create a different future. Values (PIW's Guiding Principles) We will deliver the highest quality behavioral health services to clients at PIW in a responsible, reliable and cost-effective manner. We will be responsive, sensitive and professional in all of our relationships. We will be a leader in providing a continuum of behavioral health care services in the Washington Metropolitan Area. We will practice good corporate citizenship within our community. We will pursue growth while being mindful of the economic realities necessitated by being an independent organization. We will treat all employees and staff of PIW fairly. 8

DEPARTMENT OF PSYCHOLOGY MISSION STATEMENT The Department of Psychology assists the Psychiatric Institute of Washington in providing quality mental health services for the citizens of the District of Columbia, Maryland, and Virginia who require inpatient services. We accomplish this mission in part by active participation on treatment teams and the provision of specific psychological services such as assessments, psychotherapy and training. PROGRAM PHILOSOPHY AND TRAINING MODEL Psychology staff members maintain a strong commitment to the training of predoctoral interns and make every effort to provide as an enriching experience as possible within an atmosphere of mutual respect and professionalism. The training program uses the scholar-practitioner model, which emphasizes the application of scholarly knowledge to the practice of psychology based on the scientific foundations of the profession. Training consists of both didactic and experiential learning. Theory, research, and scholarly inquiry are utilized to guide the delivery and application of psychological services. Experiential learning and the development of professional skills are guided and enriched through seminars, consultations, and staff development activities. Faculty supervisors serve as role models and professional mentors. The overarching aim of the program is to facilitate the development of interns, to build upon knowledge and skills acquired during earlier doctoral training, and to serve as preparation for entry level positions as generalist psychologists. Training goals include the development of strong general clinical skills as a psychologist, and to integrate attitudes and behaviors associated with the ability to work with the severely mentally ill in a public or private health setting. Interns develop and refine skills in the areas of individual psychotherapy, group psychotherapy, assessment and diagnostic evaluation, and crisis intervention. The internship program also provides interns with the opportunity to develop supervision skills through work with externs. We endeavor to achieve a good balance between serving the clinical needs of the patient population and keeping the training mission paramount. We are committed to helping interns develop their own professional identities as they expand and refine their clinical competencies. PSYCHOLOGY TRAINING PROGRAM GOAL The primary goal of the Psychology Internship Program is to produce culturallyaware graduates who have the knowledge and skills necessary for the practice of professional psychology, with particular experience and skills in working with the severely mentally ill in a public health setting. Program graduates will be equipped to deliver a range of psychological services and should be able to 9

function in a variety of clinical settings. After successfully completing the training program, graduates will be ready for entry-level doctoral positions that make use of their general and specialized clinical skills. Our training program focuses on the development of our interns professional skills in the following areas: Psychological Assessment Psychological Interventions Ethical & Professional Behavior Supervision Consultation Cultural Competency Evaluation INTERNSHIP PROGRAM DESCRIPTION The internship is a twelve-month, full-time experience beginning on or about August 15 of each year and ending on or about August 14 of the following year. The internship is a 2000-hour internship program in professional psychology. An application will be submitted in March 2012 pursuing APPIC membership. The internship program offers an array of training experiences including direct clinical services, clinical supervision, and seminars. The type of direct clinical services which interns provide varies slightly depending upon the clinical track. Interns spend approximately 15-20 hours of their time involved in service delivery. Interns are required to participate in didactic seminars (2 hours per week) and supervision (minimum 4 hours per week). The internship is structured into major and minor placements for the duration of the year. Trainees spend about 16-20 hours per week at their major rotation(s) and approximately 5 hours per week at their minor rotation(s). The training and services will be completed on site at PIW, unless attending additional and optional off-site workshops. Program Components The following are components of the internship program. The schedule is based on a 40 hours per week, one year internship. The total number of hours completed at end of internship should equal 2000 hours: Individual Psychotherapy Interns typically carry an individual caseload of 4 individual therapy patients seen in therapy twice weekly with an age range of 6 through adulthood, depending on their rotation. Interns may elect to develop experience with one age group during their training year. However, interns will be expected to have a range within their overall caseload in an effort to develop familiarity with 10

developmental differences across the age ranges. Individual therapy patients vary diagnostically and the training year is designed to aid the intern in developing advanced clinical skills in psychotherapeutic work with a variety of diagnostic groups. Individual therapy cases are typically short-term and may involve a variety of theoretical orientations. Group Psychotherapy Interns co-lead eight groups, of varying age groups, depending on their rotation. Group therapy is offered on all of PIW s units, serving patients with severe emotional illnesses. The range of group experiences includes play therapy, structured groups (e.g. ACT), psycho education, and process groups. Interns are encouraged to develop groups in which they have special interest or expertise. We also encourage interns to work with groups that they have little previous experience with to facilitate the development of new skills. Psychological Assessment Interns are required to complete six full batteries during the training year. Incoming interns are expected to have had sufficient prior experience in testing to enable them at the beginning of the training year to administer, score, and provide basic written interpretations to intelligence testing (e.g. WAIS-IV, WISC-IV), objective personality measures (e.g. MMPI-2, MMPI-A, SCL-90), and projective personality measures (e.g. Rorschach, TAT, House Tree Person). Our goal is to help the trainee use multiple sources of data to provide an integrated and coherent understanding of the individual and the difficulties s/he are struggling with. Possible data sources include patient-examiner relationship, assessment data, early history, medical records, school records, legal records, and collateral interviews. Familiarity and experience with other instruments is helpful. Students will gain increased understanding of the uses and implementation of a fully battery of testing with an emphasis on diagnostic thinking and integration of test data. In addition, interns are expected to provide supervision to three externs in their provision of psychological assessment. This supervision includes checking in with externs regarding assessment progression, answering questions, reviewing test data for inaccuracies, and editing the initial written report. The assessment reports are always edited by the intern s assessment supervisor after the intern s edits are made. The supervisor makes final corrections and signs off on the reports. This process ensures the quality of the reports, as well as enables the intern s supervisor to provide feedback to the intern on the quality of his/her supervision of the extern s assessment. 11

Intake Services Initial diagnostic assessments in the Clinical Assessment Center represent a core training experience and receive supervision from the Director of the Clinical Assessment Center. The intern will develop and enhance his/her skills in observation, history taking, and critical thinking through this experience. This rotation also will sharpen the intern s crisis intervention skills, as well as his/her clinical and ethical decision making skills. Unit Responsibilities Interns are considered part of the unit s multidisciplinary teams. As such, interns are expected to attend rounds on his/her main unit at least once a week. He/she is also expected to attend family meetings and/or behavior planning meetings whenever possible. In addition, interns will check in with other team members on a regular basis in regard to patient treatment. These team members include the treating psychiatrist, the appointed social worker, unit nurses and psychiatric technicians. Seminars Approximately 2 hours per week are devoted to didactic seminars. All interns are required to attend the didactic seminars. The following seminars are offered to interns: Assessment Seminar Individual Psychotherapy Seminar Supervision Seminar Interns are also encouraged to attend PIW-sponsored educational opportunities such as Grand Rounds, Continuing Education Courses, and those offered by other PIW training departments such as Psychiatry Training. In addition, interns have the opportunity to attend workshops sponsored by local associations such as The District of Columbia Psychological Association and the Walter Reed National Military Medical Center Department of Psychology. Supervision Intensive clinical supervision is an integral aspect of the internship. Each intern receives a minimum of three hours of supervision per week, at least two of which are individual supervision with licensed clinical psychologists. Interns will work with at least two supervisors over the course of the year. Each intern is assigned a supervisor for: psychological assessment, individual psychotherapy, and minor placement supervisors. Group therapy will be supervised in group supervision facilitated by two licensed psychologists. In addition to seminars and supervision, trainees with participate in a weekly intern meeting with training faculty. 12

Interns will also take on a supervisory role. They are responsible for helping psychology externs engage in psychological assessment. Interns may help with test selection, case conceptualization, and provide written feedback on report drafts. Evaluation Procedures Supervisors formally evaluate interns three times per year according to the training program s required competency goals. Evaluations are discussed with the trainee and signed by both the trainee and supervisor. In addition, weekly meetings of the training faculty allow for ongoing monitoring of trainees' performance. Clinical Placements Students will rotate between three units: Adult Psychological Services (APS), Adolescent, and Child units. The assigned unit serves as the intern s home base, so that the intern becomes an integral part of the unit treatment teams. As much as possible, interns will do writing and supervision for the work on these wards during the time allotment for the unit placement. Interns will also participate in minor rotations, consisting of approximately five hours per week. The minor rotations are located in specialty services within the hospital and allow interns the opportunity to gain focused training within a specific specialty. Examples of minor rotations include the Clinical Assessment Center, the Center (trauma services), and the Outpatient Department. If a trainee has a specific interest (e.g. staff development, program evaluation, etc.), the possibility exists to create a minor rotation to address the interest. GENERAL INFORMATION Work Hours At the Psychiatric Institute of Washington hours are generally from 8:30 am to 5:00 pm. Monday through Friday for a total of 40 hours per week. Lunch is 30 minutes. Stipend The current stipend for interns is $20,000 per year based on a 40 hour week. Interns are paid as contractors. Interns submit an invoice at the end of the month and are paid the following month. Interns may choose to pick up their check from Human Resources or have it mailed to their home. 13

Benefits & Leave As interns are considered temporary full-time employees, they are not eligible for benefits. Interns are not scheduled to work on Federal holidays. In addition, the psychology department will be closed to students from December 24 through January 2, 2013. Two weeks leave time is allotted to each intern to be scheduled with at least two weeks advanced notice when possible. The two weeks leave is referred to as PDL (paid leave days) and can be used for sick and/or vacation days. Interns also are allotted four additional days to attend conferences and workshops off-site. Number of Positions Two full-time psychology intern positions are anticipated for the upcoming training year. Regularly Scheduled Meetings Rounds TBD Weekly Seminars o Individual Therapy Seminar (August April) o Supervision Seminar (April August) 12:00-12:50 p.m. Mondays o Inpatient Group Therapy Seminar/Supervision 10:00-10:50 a.m. Wednesdays o Assessment Seminar 11:00 11:50 a.m. Wednesdays Intern Meeting - 12:00-12:30 p.m. Wednesdays Psychology Department Testing Supplies - PIW Our supplies are shared among all of the psychology staff. It is important to sign out and return manuals and kits promptly so that we can maintain workflow as much as possible. The Psychology Department has a wide variety of psychological assessment measures, computer scoring programs, play therapy toys, and a large library on psychology-related subjects. Testing materials are located: o Second Floor - Psychology Department Manuals and kits are kept in a metal cabinet. Protocols are alphabetically organized. Please sign out your supplies on the sign-out sheet on the table next to the testing cabinet. Do not keep the materials out overnight. 14

o Computerized scoring programs are available Second Floor - Intern office 15

RIGHTS AND RESPONSIBILITIES Overview s Department of Psychology is committed to maintaining an internship program that facilitates learning and professional growth for interns. The training staff places a high premium on creating a work environment that is professionally stimulating and sufficiently flexible to accommodate individual needs and requirements. Fundamental to a successful training experience is the provision of ongoing feedback to interns that facilitates professional and personal growth. This section outlines the rights and responsibilities both of the program and of the interns in the training process. It also outlines the evaluation, due process, and grievances procedures. Program Responsibilities The Department of Psychology's internship program has the responsibility to provide appropriate training toward developing competence according to our training goals and objectives, as well as assess the progress of each intern throughout his/her training. In order to maximize intern growth and clinical development, it is important that such assessment be done on a continuing basis at timely intervals. It is also important that an intern's expected performance be explained in advance along with the provisions for interns' feedback if dilemmas or problems arise. Our training staff recognize that developmental stressors are inherent both in the interns' transition from graduate school to the internship setting, as well as during the internship itself. For example, when entering the internship, the rapidity with which interns must assimilate into a new environment and the expectation of competency in diverse clinical activities may be a source of considerable stress. Furthermore, supervision of their performance in these activities is typically more intense, concentrated, and frequent than trainees may have previously received in their graduate programs. As interns confront significant developmental transitions, they may need special kinds of assistance. In order to provide pertinent information and to derive supportive measures or appropriate remediation, it is necessary for the internship program, in concert with the individual intern, to have an accurate sense of how the intern is progressing in relation to standardized criteria or normative behaviors for our setting. Recognizing that evaluations and measures of intern performance are susceptible to bias and subjectivity, every effort is made to insure that interns understand the program's expectations about goals, objectives, and levels of competencies of performance. Further, because interns receive ongoing feedback from the training staff, an intern should not be surprised by the more formal evaluation feedback. Thus, this document lists the training program's expectations of 16

interns' performance followed by a discussion of issues related to intern impairment and the procedures designed to deal with such situations if they arise. 17

Intern Rights and Responsibilities 1. The right to a clear statement of general rights and responsibilities upon entry into the internship, including a clear statement of goals and parameters of the training experience. 2. The right to be trained by competent professionals who behave in accordance with the APA ethical guidelines. 3. The right to be treated with professional respect, that recognizes the training and experience the intern brings with him/her. 4. The right to ongoing evaluation that is specific, respectful, and pertinent. 5. The right to engage in an ongoing evaluation of the training program experience. 6. The right to initiate an informal resolution of problems that might arise in the training experience through discussion or written request to the staff member concerned and/or to the Director of Psychology Training. 7. The right to due process and appeal to APPIC to deal with problems after informal resolution has failed (either with supervisor and/or Director of Psychology Training) or to determine when rights have been infringed upon. 8. The right to one's personal privacy. 9. The responsibility to read, understand and clarify, if necessary, the statement of rights and responsibilities. It is assumed that these responsibilities will be exercised and their implementation is viewed as a function of competence. 10. The responsibility to maintain behavior within the scope of the APA ethical guidelines. 11. The responsibility to behave within the principles set forth by the statutes and regulations of the American Psychological Association. These Principles are set forth in the American Psychological Association's pamphlet entitled "Ethical Principles of Psychologists and Code of Conduct. 12. The responsibility to be open to professionally appropriate feedback from supervisors, professional staff and agency personnel. 13. The responsibility to behave in a manner that promotes professional 18

interactions and is in accordance with the standards and expectations of the Department of Psychology and PIW. 14. The responsibility to give constructive feedback that evaluates the training experience or other experiences at the Psychiatric Institute of Washington 15. The responsibility to conduct oneself in a professionally appropriate manner if due process is initiated. 16. The responsibility to actively participate in the training, clinical services and the overall activities of the Department of Psychology. 17. The responsibility to meet training expectations by developing competency in (1) psychological assessment skills, (2) psychotherapy skills, (3) treatment planning and consultation skills, and (4) other areas as delineated in the evaluation forms. 19

TRAINING GOALS, OBJECTIVES, AND COMPETENCIES The internship program functions with the following goals, objectives, and competencies in mind and expects the intern to achieve the following competencies: Goal: To produce culturally aware graduates within the scholar-practioner model who have the knowledge and skills necessary for the practice of professional psychology, with particular experience and skills in working with the severely mentally ill in a public health setting. Interns will be able to utilize theory and research in their provision of psychological services. Our training program focuses on the development of our interns professional skills in the following areas: Objective 1: Psychological Interventions: Intern is able to treat diverse individuals in individual and group therapy settings. Competency 1: Intern is able to establish rapport with patients. Competency 2: Intern demonstrates the ability to appropriately apply group therapy knowledge and skills to the hospital s clinical population. Competency 3: Intern demonstrates the ability to utilize theoretical orientation to conceptualize individual therapy cases. Competency 4: Intern is able to demonstrate the ability to conceptualize treatment of a group and follow evidence-based interventions when possible. Competency 5: Intern is able to effectively work with co-leader in various group therapy settings to facilitate change. Objective 2: Psychological Assessment: Intern is able to conduct all aspects of psychological assessment. Competency 1: Intern is able to conduct diagnostic and clinical interviews in an organized manner that gathers information efficiently and thoroughly, identifying problematic areas for the patient and recognizing diversity issues in the interview process. Competency 2: Intern is able to score psychological tests accurately with no major errors. 20

Competency 3: Intern is able to report psychological interview and test data accurately, interprets findings accurately according to professional standards for tests utilized, and is able to make an integrated conceptualization of the interview and test data gathered to produce a comprehensive review of the patient. Competency 4: Intern is able to apply DSM-IV-TR criteria appropriately with consideration for rule-out diagnoses. Competency 5: Intern is able to produce professional written documents with proper grammar, coherence, organization, and clarity at the appropriate comprehension level for his or her consumers. Competency 6: Intern demonstrates ability to choose psychological tests appropriate to the referral questions, uses proper judgment regarding the psychometric properties of the tests in making test selection and interpretations, and is able to articulate the psychometric strengths and weaknesses of the selected tests. Competency 7: Intern demonstrates ability to summarize and provide verbal feedback to patients, family members, and/or members of the treatment team. Objective 3: Ethics and Professional Behavior: Intern displays appropriate professional conduct and demeanor that is consistent with APA s Ethical Principles and Codes of Conduct, local licensing standards, and hospital standards. Competency 1: Intern demonstrates awareness of ethical issues, displays appropriate ethical behavior, and seeks supervision when uncertain about any of these issues. Competency 2: Intern attends their scheduled activities and gives proper notification of absences or lateness. Competency 3: Clinical documentation (e.g. test reports, group therapy notes, incident reports) is completed within appropriate timeframes and according to hospital standards. Competency 4: Intern demonstrates the ability to manage personal feelings, issues, and boundaries while maintaining work performance. Competency 5: Intern displays poise and confidence appropriate to their training level. 21

Objective 4: Supervision: Intern is able to demonstrate the ability to utilize supervision in an appropriate manner. Intern will demonstrate understanding of supervision theories and will identify a supervision style by end of training year. Competency 1: Intern is prepared for supervision and actively participates by asking questions, bringing in appropriate materials, and incorporating feedback. Competency 2: Intern demonstrates the ability to receive feedback about their behavior in an appropriate manner and uses it constructively to improve their performance in the future (Note: this competency is relevant to written work in the use of supervisory feedback to limit the number of drafts required to reach final draft status). Competency 3: Intern uses supervision as a guide to treatment/assessment and a place to conceptualize relevant data. Competency 4: Intern is able to self-reflect in supervision, and demonstrates an understanding of how their thinking, emotions, and behavior affect their clinical work. Competency 5: If systematic or programmatic issues arise, intern is able to raise these issues in supervision and seek consultation to on how to best address these issues. Competency 6: Interns will, under the supervision of licensed psychologists, provide basic-level supervision in area of psychological assessment to externs. Objective 5: Cultural Awareness: Intern is able to demonstrate the importance of cultural knowledge and skills in their delivery of their clinical services and their professional conduct. Competency 1: Intern demonstrates awareness of patient s diversity of background and is able to adapt assessment results, interpretations, and recommendations accordingly. Competency 2: Intern is able to discuss impact of issues of diversity in their clinical work and professional interactions with their peers and supervisors. 22

Competency 3: Intern recognizes limits of cultural awareness and seeks additional training, consultation, and literature to enhance their cultural awareness. Competency 4: Interns seek out relevant literature and research regarding assessment, treatment, and cultural awareness to further their education and improve their clinical skills. Objective 6: Program Development: Intern demonstrates ability to research and apply empirically validated treatment interventions through group therapy with varying populations. Competency 1: Interns demonstrate the ability to research empirically validated treatment interventions for use with seriously mentally ill adults and adolescents. Competency 2: Interns demonstrate the ability to apply, under supervision, empirically validated treatment interventions for use with seriously mentally ill adults and adolescents. Competency 3: Interns are able to evaluate, via pre- and post-test data collection, efficacy of applied interventions. 23

SUMMARY AND SCHEDULE OF INTERN EVALUATION PROCEDURES Evaluation Schedule Supervisors formally evaluate interns every four months. The goals, objectives, and competencies are assessed with our program s trainee evaluation form. See the Appendix for a copy of this form. Evaluations are discussed with the trainee and signed by both the trainee and supervisor. Weekly meetings of clinical supervisors allow for ongoing monitoring of trainees' performance. August Initial Orientation and Meeting with Director of Psychology Training & Clinical Supervisors Assign interns to clinical supervisors Assess current competencies and plan goals for internship. December End of 1 st Period 1 st Period Evaluation Clinical Supervisors & Intern Assess clinical work and progress on competency training goals. Provide feedback to intern s graduate program April End of 2 nd Period 2 nd Period Evaluation Clinical Supervisors & Intern Assess clinical work and progress on training goals. August End of 3rd Period Final Evaluation Clinical Supervisors & Intern Assess clinical work and progress on competency training goals. Beginning to mid August Exit Process Clinical Supervisors & Intern Review of intern training file to determine if internship was satisfactorily completed. The Director of Psychology Training communicates with the intern's Director of Clinical Training at his/her doctoral program regarding the intern's performance. Once all internship requirements have been met, a letter of completion will be issued by the intern's Director of Clinical Training and a Certificate of Completion will be issued to the trainee. 24

IDENTIFICATION OF DEFICIENCIES OR PROBLEMATIC ASPECTS IN PERFORMANCE OR TRAINING The Department of Psychology follows the procedures set forth by the Association of Psychology Postdoctoral and Internship Centers (APPIC) and The Psychiatric Institute of Washington (PIW). The following is a description of internal Department of Psychology procedures for dealing with deficiencies or problematic aspects in performance and due process prior to final action. For the purposes of procedural policy, intern deficiencies or problematic aspects in performance are defined broadly 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 behaviors and ethical standards, (2) an inability to acquire the level of professional skills necessary to reach an acceptable level of competency, (3) an inability to control personal stress, psychological problems, and/or excessive emotional reactions which interfere with professional functioning. Criteria which link this definition of deficiencies or problematic aspects in performance to particular professional behaviors and attitudes are incorporated into the program's evaluation procedures. Ultimately, it is a matter of professional judgment as to when an intern's performance is deficient or problematic. However, problems typically become identified as deficiencies or problematic aspects in performance 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; the problem is not merely a reflection of a skill deficit which can be rectified by further supervision, academic or didactic training; the quality of the intern's service delivery is negatively affected and may be considered to be unhelpful or detrimental to clients; the problem is not restricted to one area of professional functioning; a disproportionate amount of attention by training faculty is required, compared to other interns in the group; the trainee's behavior does not change as a function of feedback, remediation efforts, and/or time; 2. multiple and similar observations are made by more than one supervisor. 25

Remediation Several possible concurrent courses of action to remediate identified deficiencies or problematic aspects in performance include, but are not limited to: 1. Increased supervision with one or more supervisors; 2. Change in format, emphasis and/or focus of supervision or training; 3. Informing the intern s academic department/program of the intern s problematic performance, probation status/temporary suspension and the remediation procedure; 4. Recommendation/requirement of personal therapy when the problems are psychological in nature; 5. Reduction of the intern's clinical or other professional duties; 6. Addition of special academic coursework or other remedial activity; 7. Recommendation, when appropriate, of a leave of absence and/or a second internship at another setting. After an agreed-upon time period, when a combination of the above interventions does not rectify the deficiencies or problematic aspects in performance, or when the trainee seems unable or unwilling to alter her/his behavior, the training program may need to take more formal action, including, but not limited to: 1. Giving the intern a limited endorsement for employment or letters of reference, specifying those settings in which she/he could function adequately; 2. Dismissal from the internship; 3. Communicating to the intern and academic department/program that the intern has not successfully completed the internship; 4. Recommending a career shift for the intern; All the above steps need to be adequately and appropriately documented in ways that are consistent with due process procedures. 26

Due Process Clinical supervisors meet monthly in order to monitor intern progress and share experiences of supervision with interns and their progress in learning, skill development and performance. In December, April, and August, comprehensive written reviews of each intern's progress are conducted by the training supervisors. Any unacceptable ratings or deficits in expected levels of competency are discussed during these meetings, and a consensus is reached as to whether or not a problem is serious enough to be considered a deficiency, or whether continued individual supervision (with specific recommendations) is sufficient to remedy the situation. If, by consensus of the clinical supervisors, individual supervision is considered sufficient, the intern is informed of the difficulty by his/her primary supervisor and special attention is focused on the problem until the next evaluation period. If, by consensus of the clinical supervisors, the problem is considered a deficiency or problematic aspect in performance, the intern is placed on probation and a remediation plan is devised. Once deficiencies or problematic aspects in performance are defined, and a remediation plan is outlined, the following steps are taken: 1. The Director of Psychology Training issues a statement of "Probation, which defines a process by which the clinical supervisors or other identified persons actively and systematically monitor, for a specific length of time, the degree to which the intern addresses, changes and/or otherwise improves the behavior associated with the inadequate rating. The probation is a written statement to the intern which includes: a) the fact of probationary status; b) the actual behaviors associated with the inadequate rating; c) the specific recommendations for rectifying the problem; d) the timeframe for the probation (not to exceed six weeks) during which the problem is expected to be ameliorated; and e) the procedures designed to ascertain whether the problem has been appropriately rectified. 2. The Director of Psychology Training may decide to issue a "Temporary Suspension. If an intern is charged with violating the APA Code of Ethics, he/she may be temporarily suspended from engaging in any or all clinical or direct services. All temporary suspensions become effective immediately upon notifying the intern of the suspension (in writing and orally). The written notification (including the reasons) for the suspension is expected to be in the hands of the intern within one working day. A date will be set for a special review meeting at which time the Director of Psychology Training will review the special conditions imposed and progress made toward 27

remediating the violation. In the event that a problem arises between the intern and the Director of Psychology Training, the review will be conducted by a clinical supervisor (psychologist), the Chief of Clinical Operations (CCO), or a designated representative from APPIC. 28

3. The Review Committee may consist of one or more of the following: Director of Psychology Training, clinical supervisors, or CCO. The intern may choose to accept the status and conditions or may choose to appeal the action. The intern may consult with an APPIC representative to discuss the issue if desired. The procedures for appealing the action are presented in the next section. 4. If either the Probation or the Temporary Suspension Action occurs, the Director of Psychology Training, or other appointed person, will inform the intern's graduate psychology program, indicating the nature of the inadequate rating, the rationale for the decision, and the action taken by the Director of Psychology Training. Feedback and suggestions from the intern's graduate school training director are sought. The intern shall receive a copy of the letter sent to the sponsoring university. Another copy of the letter will be placed in the intern's permanent file maintained at the Office of Psychology Training by the Director of Psychology Training, or other appointed person. APPIC also will be consulted at this time. 5. The status of a probation or temporary suspension rating will be reviewed no later than the limits identified in the probation or temporary suspension statement, usually within four to six weeks. 6. If the deficiencies or problematic aspects in performance have been rectified to the satisfaction of the Director of Psychology Training, the intern, the graduate psychology program and other appropriate individuals will be informed, no further action will be taken, and the probationary or suspended status will be removed. If the Training Committee determines that there has not been sufficient improvement in the intern's behavior to remove the inadequate rating under the conditions stipulated in the Probation or Temporary Suspension, the Review Committee will communicate, in writing, to the intern that the conditions for lifting the Probation or Temporary suspension have not been met. The Review Committee may then adopt any one of the following methods or take any other appropriate action. It may issue a: 1. continuation of the Probation for a specified time period, with subsequent reevaluation by training staff; 2. suspension whereby the intern is not allowed to continue engaging in certain specified professional activities until there is evidence that the behavior in question has improved; 3. communication which informs the intern that the Training Committee is recommending to the Review Committee and to the intern s academic 29

department/program that the intern will not successfully complete the internship if the behavior does not change; and/or 4. communication which informs the intern that the Training Committee is recommending to the Review Committee that the intern be terminated immediately from the internship program and that the intern s academic department/program, as well as APPIC, will be informed of the intern s dismissal. Procedures for an Intern Appeal An intern may, within ten days of the communication of a Probation or Temporary Suspension, submit a letter to the Review Committee requesting an appeal. An appeal may be requested on the following grounds: 1. Denial of the described due process granted to the intern in any part of the evaluation procedure; 2. Denial of the opportunity to fairly present data to refute conclusions drawn in the evaluation; 3. Inadequate conditions that contribute to an intern s probationary or temporary suspension status; 4. Any breach by PIW of the contract with the intern, including but not limited to: adequate training supervision, direct/indirect client hours, confidentiality of student information, being fully informed of the hospital s and internship program s rules and policies, receiving immediate and necessary medical treatment, ensuring the individual s personal safety. Within five working days of the receipt of the appeal request the Review Committee will convene to review and discuss the intern s appeal. The procedures invoked for a special fact-finding review by this Committee are as follows: The intern and his/her supervisor or the staff member involved will be notified that a special review meeting will be held. 1. The Review Committee may request the presence of, or written statement from, individuals as deemed appropriate. 2. The intern may submit to the Review Committee any written statements he/she believes to be appropriate, may request a personal interview, and/or may request that the Committee interview other individuals who 30

might have relevant information. The supervisor or staff member involved will also be afforded the same privilege. 3. Following the fact-finding review, the Review Committee or a designated member will communicate the summary of their findings and any recommendations to the Training Committee, within two working days of the end of the deliberation. Following the review by the Review Committee, the Training Committee takes actions deemed appropriate. Such action is not limited to, but may take the form of, any of the following: 1. Accept the supervisor's or staff member's report of problems and recommend a program of remediation. 2. Request a new report to be written to include specific changes in the statement of deficit(s) or recommendation(s) by the supervisor or staff member involved. 3. Ask the Training Committee to re-write the evaluation, or add an addendum to the report of the supervisor or staff member. 4. Place the intern on probation for a specified period of time, during which time changes in the intern's behavior according to an identified remediation program are to be expected. 5. Recommend to the Training Committee the dismissal of the intern from the training program. In the event that the Director of Psychology Training is the supervisor or the staff member involved in the appeal, the review will go to another clinical supervisor (licensed psychologist) or the Chief of Clinical Operations. If an intern is dissatisfied with the decision of the Review Committee, he/she may request a second and final review. This request must be submitted in writing within five working days after the intern has been notified of the Training Committee s decision, and the second review will be conducted by the Director of Human Resources. Also an intern may contact APPIC for a consultation if desired In the event that the designated clinical supervisor or the CCO is a staff member involved in the initial appeal, the review will go directly to Director of Human Resources. 31

Grievance Procedure In order to protect the needs and rights of all interns, a formal complaint procedure has been developed. While it is hoped that any concerns or complaints can be discussed and resolved informally, a formal mechanism is appropriate in light of the power differential between supervisory staff and interns. In general, interns are encouraged to work actively to create training experiences that fit their needs and interests and to work with the Department of Psychology staff to ensure that their needs are met. Giving feedback (both positive and negative) to staff members/supervisors or the Director of Psychology Training is encouraged and welcomed. Procedures covered in this document may be initiated in the following situations: 1. When an intern disagrees with a standard evaluation by a supervisor (not an evaluation of deficiencies or problematic aspects in performance): 2. When an intern has a complaint concerning a staff member/supervisor regarding a situation other than evaluation; 3. When an intern has a complaint concerning another trainee; 4. When an intern disagrees with actions taken by the Director of Psychology Training. 5. When an intern has a complaint about an unlawful or problematic procedure adopted by the facility. Complaints Regarding Training Issues: 1. The intern is encouraged to first speak directly with the staff member/supervisor or other trainee involved for a resolution. 2. If the situation is not resolved, or if the intern prefers not to speak directly to the staff member/supervisor or other trainee, the intern may discuss the complaint with the director of the Director of Psychology Training, or the Chief of Clinical Operations, who will then facilitate a meeting between the intern and the staff member/supervisor. 3. In the case of a complaint concerning a support staff member, the 32

Primary Supervisor and/or Director of Psychology Training will consult with the Unit Manager, who may then delegate the facilitation of a meeting between the intern and that staff member. 4. If the complaint is not resolved in the meeting with the intern, staff member/supervisor, and the Director of Psychology Training, the Director of Psychology Training will convene an Ad Hoc Advisory Committee. The Ad Hoc Advisory Committee will include the Director of Psychology Training, the intern, the staff member/supervisor, a member selected by the Director of Psychology Training, and an intern advocate selected by the intern. 5. If the complaint remains unresolved, the Chief of Clinical Operations, will be asked to meet with the Ad Hoc Advisory Committee to review and act on the complaint. Complaints Regarding Non-Training Issues Interns are encouraged to initiate procedures 1-4 outlined above to resolve the complaint. In the event that the complaint is against the Director of Psychology Training and could not be resolved in direct discussion with him/her, the intern may discuss the complaint with the Chief of Clinical Operations. In the case of perceived harassment (sexual, racial, and other) which is not resolved through this procedure, the intern should refer to the Department of Human Resources or with the intern s sponsoring academic program/department and consider the possibility of filing a complaint with the Office of Affirmative Action. 33

PSYCHOLOGY DEPARTMENT STAFF Kendra Ward, Psy.D. Director of Psychology Licensed Clinical Psychologist and Supervisor 202-885-5632 Kristen Reese, Psy.D. Licensed Clinical Psychologist and Supervisor 202-243-2079 Markisha Bennett, Ph.D. Licensed Clinical Psychologist and Supervisor 202-885-5798 34

INTERN ELIGIBILITY Internship applicants must have completed 3 or 4 years of graduate work in a clinical or counseling psychology Ph.D. or Psy.D. program and have approval from their program director to go on internship. Those with psychology doctorates who have re-specialized in an APA-accredited clinical or counseling program and who have the approval of the program's director also may apply. Applications for internship will be rated in consideration of the following criteria: academic preparation, clinical experiences, and fit between the applicant's learning and career objectives and our program's offerings. Candidates with significant practicum training/clinical experience with psychological testing and the severely mentally ill are preferred. In accordance with the DC Human Rights Act of 1977, as amended, DC Code 1-2501, et seq., (The Act), PIW does not discriminate on the basis of race, color, religion, national origin, sex, marital status, personal appearance, sexual orientation, familial status, family responsibilities, matriculation, political affiliation, disability, source of income, or place of residence or business. Sexual harassment is a form of sexual discrimination which is also prohibited by the Act. Discrimination in violation of the act will not be tolerated. Violators will be subject to disciplinary action. Application Procedures It is the responsibility of the applicant to assemble all application documents (with the exception of the transcript which is to be sent directly by the registrar) and send as one packet. Applicants should submit: 1. APPIC Application 2. Letter of interest defining reasons for wanting to train at PIW and why the PIW internship fits your career goals 3. Curriculum vita 4. Official graduate school transcript(s) to be sent from registrar directly to address listed below 5. Three (3) letters of recommendations from persons familiar with your clinical work, 6. Sample of a full battery psychological evaluation (minus identifying information) that includes both intellectual and objective and/or projective personality test measures 35

We accept electronic versions of all documents except your transcript. Letters of recommendation can be scanned and send to us, but current phone number and email of the references must be provided for verification of authenticity of the letters. Electronic submissions should be made to kward@piw-dc.com in ONE email. Use the following address to mail completed application materials: Psychiatric Institute of Washington ATTN: Kendra Ward, Psy.D. 4228 Wisconsin Avenue, N.W. Washington, D.C. 20016 Phone: 202-885-5632 Fax: 202-966-7374 Email: kward@piw-dc.com Completed applications must be received by November 1. After the initial review of the application packages, selected applicants will be invited for interview. Internship applicants who are no longer under consideration will be informed via e-mail by December 15. Interview Dates and Location Persons invited for interviews will be contacted via phone or email. Internship interview appointments are to be determined. All interviews will be held at the Psychiatric Institute of Washington. The hospital is located at 4228 Wisconsin Avenue, N.W., Washington, D.C. 20016 Training Position Offers Internship position offers will be made through the APPIC Internship Matching Program and in compliance with APPIC Match Policies. This internship site agrees to abide by the APPIC policy that no person at this training facility will solicit, accept or use any ranking-related information from any internship applicant. Please note that appointment to internship positions is contingent upon satisfactory completion of pre-employment physical. The start date is the third Monday in August. 36

In accordance with PIW s hospital policies, we also require an employee physical examination with tuberculosis skin test and criminal background check to be completed prior to coming on board at the hospital. Program Changes will be posted on the website: and www.appic.org 37