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Goals & Objectives

It is the objective of the training program to have practicum students meet, by the end of the year, expected skills and competencies necessary to claim knowledge and/or expertise in the area of professional training to enter an internship with a focus on clinical health psychology; the following are identified as standards for Clinical Health Psychology which were first articulated at the National Working Conference on Education and Training in Health Psychology (Stone, 1983), re-stated in terms of expectations for post-doctoral training in Health Psychology (Sheridan et al., 1988), and updated in 1995 (Belar & Deardorff, 1995). The definitions for the APA Specialty in Clinical Health Psychology (established August, 1997) draw on these documents and are integrated in the skills, competencies, and values of the UTMB psychology training program.

The objectives, activities, expected competencies and outcomes for each goal is described for practicum students as follows:

Goals & Objectives page list

Goal 1: To develop advanced skills in the practice of professional psychology through training activities that are primarily advanced clinical experience and research activities through sequential, cumulative, and graduated in complexity training experiences.

Objective: Trainees are required to participate in 50% of their time in delivery and management of psychological services to patients at UTMB through intervention and assessment. Trainees will consider a research-focused project, in an area relevant to health care service delivery in their specialty area, by the end of the training year.

Activities: Advanced practice in patient care skills including interviewing, assessment, consultation, and treatment. Competencies are evaluated on a continuous basis during the training period and must meet minimal criteria which is graduated in complexity as the year progresses. Competencies in clinical care are obtained and practiced in at least two of the following services: 1) anesthesiology pain clinic; 2) outpatient care in Wellness; 2) outpatient and inpatient care at the Shriners Burns Hospital; 3) orthopedic surgery spine clinic.

Competencies & Outcome: Psychology trainees will achieve a minimum level of 2 during the first quarterly evaluation; and a level of 3 or above for all subsequent evaluations for the training year on the following domain:

  • Individual Intervention;
  • Crisis Intervention/Problem Solving;
  • And Psychological Evaluation Skills Section of the Fellow Evaluation Form and Quarterly Competencies Evaluation Form.

Goal 2: To develop techniques and skills to develop and improve grant writing skills and to participate in seeking grant funding from federal agencies as related to the practice of clinical health psychology including the presentation of research in a public forum or as a publication.

Objective: Trainees will be a mentee to faculty who are actively writing grants and can choose to be an active member of a research team that produces a minimum of two publications (submissions) by the end of their practical training.
Activities: Participation in psychology didactic seminar;  participation in at least 2 hours additional time per week in related didactics and documented in the UTMB Monthly Activity Form.

Competencies & Outcome: Psychology trainees will achieve a level of 2 during the first quarterly evaluation and a level of 3 by the second evaluation and a level of 4 for the last quarterly evaluation for the Domain: Research/Consultation/Teaching Skills Section of the Psychology Trainee Evaluation Form and Quarterly Competencies Evaluation Form.

Goal 3: To provide clinical services to a diverse population and continue to improve and gain new skills as a clinical health psychologist through a graduated and complex training program.

Objective: Trainees will gain experience in providing clinical services to patients from under represented populations for approximately 50% of their clinical time.

Activities: They will receive individual and group supervision at a rate of not less than 2 hours per week individual face to face supervision (per 40 hours per week) while using empirically supported (best practices) treatments and/or literature to support their treatment modalities. Provide clinical care in one of the above named clinical experiences (Objective 1 Activities) and focus on issues and concerns of underserved populations. Read the literature regarding special issues related to underserved populations.

Competencies & Outcome: The Psychology Trainee will achieve a minimum level of 2 at the end of the first quarterly evaluation; 3 at the second quarterly evaluation and a 4 for the last quarterly evaluation for the Domain: Use of Supervision Skills section of the Psychology Trainee Evaluation Form and the Quarterly Competencies Evaluation Form.

Goal 4: To prepare for a career in a medical or academic setting as a clinical health psychologist.

Objective: Fellows will participate in activities that will prepare them for a career in a medical center by emulating the activities expected of advanced practitioners of clinical health psychology for new and emerging professionals.

Activities: Psychology Trainees will participate in clinical services, publications of scholarly activity, writing grants, teaching, and providing supervision and consultation to other health care professionals such as medical residents, psychology residents, physician assistant students, occupational and physical therapy students.

Competencies & Outcome: The Psychology Trainee will achieve a minimum level of 2 at the end of the first quarterly evaluation; a level of 3 at the end of the second quarterly evaluation and a level of 4 at the end of the last quarterly evaluation on the Domains:

Administrative/Organizational Skills and the Personal Issues Skills Section of the Psychology Trainee Evaluation Form and the Quarterly Competencies Evaluation Form.
In order to accomplish these goals and objectives, each Fellow participates in a year-long training plan that includes monitoring goals and objectives with the research and clinical supervisors and the Program Director. There is typically a primary and secondary clinical supervisor as well as a research supervisor. The training goals and objectives are a specific plan of sequential, cumulative and graduated in complexity skills developed to ensure attainment of a full range of competencies in the specialty area by the end of the year and to meet the specialty guidelines for the professional practice of psychology at the advanced level of clinical health psychology.

Additional Clarification of Competencies and Activities:

  • Supervised experience with clinical rotations: Trainees will receive a minimum of 2 hours of individual supervision from licensed psychologists (per 40 hours per week of clinical services). Supervision is face to face. Direct service on the clinical rotation includes: direct patient contact, service delivery, group supervision, team meetings, review of written clinical reports, consultations, etc.
  • Taking on supervisory and teaching roles appropriate to the Fellow’s competence and level of training, including providing integrated in-service training, teaching/lecturing in one of the formal classes and/or providing supervision for first year practicum students if the trainees is in their 2nd or 3rd year of practical training. Direct supervision and training on these experiences are provided by either the primary or secondary supervisory both of whom are licensed psychologists.
  • Research mentoring will be provided by a Psychology staff member with whom the Trainee is collaborating on research usually for 1-2 hours per week; with at least half of that provided as face-to-face individual supervision and other supervision offered in participation in meetings of the research group. This is in addition to the 2 hours per week in clinical supervision.
  • Didactic training plans that include campus wide seminars, departmental seminars and grand rounds and active participation in clinical services that are directly related to the advanced practice of clinical health psychology such as peer consultation with medical personnel, collaboration with primary care providers, obtaining informed consent for treatment or research protocols, navigating the IRB for translational research projects, etc.
  • Trainees will consult with medical, nursing, or other interdisciplinary personnel, conjointly interview patients with other professionals, and participate in medical resident preceptorship. It is expected the training director will assist with the assimilation of the medical culture, facilitate and support interdisciplinary in-service training, and to provide feedback on the “fit” between the Trainees liaison and teaching skills and the needs of medical professionals and a “how-to” consultation role for clinical health psychology especially if the trainee has little or no formal experience in clinical health psychology in medical settings. A similar role will be taken by the attending physician at each of the training sites selected by the trainee as it is expected the trainee will work closely with the medical director of each unit/clinic.
  • Fellows will have opportunities for co-therapy, observation of other trainees, or role-modeling in most training settings. Second year trainees will also be offered the opportunity to provide supervision to first year practicum trainees but all trainees will be exposed to the different models of supervision. They will be expected to observe supervisory staff as role models and therapists in these same settings.

Competencies that guide our model of training are related to assessment, treatment, consultation, teaching, and program evaluation. Fellows participate in didactic learning that expands their information and knowledge in effective methods of psychological assessment, diagnosis and intervention. These are provided in the psychology training didactic seminars as well as experiential learning with clinical activities. These are further addressed in clinical supervision and observation by the supervisor. In each of the clinical settings, the process of learning and doing is the primary model. Trainees are assigned an appropriate case load that allows for learning and learning by observation. Cases are supervised by a licensed staff member. Clinical supervision is provided to meet with the Trainee for at least one hour for every 10 hours of time spent in training or a minimum of 2 hours per week or as much as needed and this is negotiated between the supervisee and the supervisor. More supervision is not necessarily a skills deficit but may reflect the complexity of the case load. Consultation and additional supervision varies depending on case load and issues and concerns. The Supervising Psychologist is available 24/7 by email and cell phone.

Consultation, program evaluation, supervision, and/or teaching are covered in various parts of our model. Consultation is a required competency element and is an ongoing day-to-day activity on most all of the medical units. This is a teaching hospital and medical students rotate through the clinics every 2 weeks and residents rotate through every 2 months. The psychology trainee is typically on the service for at least 6 months and is expected to provide consultation in a variety of cases not only to the students but to the clinic physicians as well. Trainees are exposed to consultation through an experiential model and are provided input and supervision on their integration and viability of consultation throughout the rotation. Most trainees come with the basics of consultation but may not have worked on medical units before. This is an integral part of their role on the medical unit and is clearly a valued component both by the trainee and the medical staff. Program evaluation is specified as a skill and is also expected for the Clinical Health Psychologist. Trainees are involved in this to a large extent that is also re-occurring throughout the year. Though all will have experience in program evaluation it typically takes on a variety of levels of skill and continues to build throughout the year. It may start with simply addressing why patients show up and why they do not. They might be expected to design an evaluation system and it may culminate in an intervention program such as developing handouts or phoning patients the night before (this was an actual project of a former trainee). It might increase in skill level and in one case the trainee took on the project of evaluating the psychology pain management structured group program. This took a much higher level of skill but was highly successful and led to some refinement and redesigning the program.

Finally, supervision and teaching is included as a goal/objective for trainees. They are likely to have the opportunity to provide case supervision to practicum students, under the supervision of a licensed staff member but all trainees are exposed to the variety of models of supervision through didactics. In reality they are supervising (through consultation) medical students and residents and provide continuous feedback regarding basic skills of interviewing.

Strategies of scholarly inquiry are specified as a goal for our model (part of Goals 1 and 2). In addition, while on the fellowship, time is made available for clinical research, didactics on advanced research skills, attention to relevant literature, construed broadly to include general information on the specialty population(s) of interest, general knowledge concerning psychopathology and other mental health issues in those populations, and empirically supported assessment and treatment approaches. This goal is met clinical experience, supervision, and formal didactics; numerous opportunities throughout campus, reading and integrating empirically supported treatments in case conceptualization and treatment are an integral part of learning in the advanced practice of psychology. Trainees are expected to integrate science into their treatment sessions and provide literature citations for their treatment during case conference and supervision.

Organization, management, and administration experience are provided as a component of the training model. Formal training is limited but trainees are exposed to a wide variety of issues related to organization, management, and administrative issues.

Professional issues and conduct, including law and ethics and service provider standards, are emphasized in our direct clinical supervision. During case discussion, supervisors routinely raise issues of ethical and legal standards and encourage Trainees to be sensitive to the ethical implications of various assessment information and treatment decisions especially in underserved populations. Supervisors also emphasize these issues when providing supervision for the Trainees’ teaching and supervision. In addition, many didactic experiences are available as these are daily issues in the provision of health care.

Cultural and individual diversity are important issues throughout our medical center. UTMB has a long history of providing care to underserved populations. UTMB has an enrollment greater than 30% of students from underserved backgrounds. UTMB provides service to a wide array of groups representing multiple categories of individual difference. UTMB serves all age populations, different sexual orientation (gay, lesbian, bisexual, and transgendered), the full spectrum of socioeconomic status and educational levels, and many racial/cultural groups. Cultural groups of highest prevalence in the UTMB population which has a lengthy history of providing underserved populations in Texas include Caucasian, African-American, Hispanic and Latino, Vietnamese, Indian and Native-Americans. In addition, many clinical settings serve the families and caregivers of patients. The UTMB has a roster of translators available when the concerns of patients cannot be well-addressed using English.

UTMB generally holds at least one major conference per year emphasizing cultural or other individual difference variables, as they affect the provision of psychological services. Trainees will be encouraged to attend the annual training and any other relevant didactic experiences (e.g., at Psychiatry Grand Rounds). Trainees, as researchers, will be able to study the impact of cultural diversity and individual differences on the diagnosis and treatment of specific medical conditions. Finally, the topic of individual differences and compliance are continuously offered on the campus and are fully integrated into the case conference and patient treatment seminars.