Meier Clinics Neuropsychology Internship and Advanced Practicum Placement Program

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1 MEIER CLINICS NEUROPSYCHOLOGY INTERNSHIP AND ADVANCED PRACTICUM PROGRAM Kymberly F. Larson, Psy.D., Clinical Neuropsychologist Meier Clinics February PURPOSE: The Meier Clinics Neuropsychology Internship and Advanced Practicum Program document establishes the description, policies and procedures for the Clinical Neuropsychology Track Training within the Meier Clinics Internship and Advanced Practicum Program in Clinical Psychology. 2. MISSION: Neuropsychology is the study of brain-behavior relationships. The Meier Clinics Neuropsychology Internship and Advanced Practicum Program is designed to provide a comprehensive and intensive one-year training program in the specialty area of clinical neuropsychology, focusing on learning to conduct comprehensive integrated evaluations of clients across the age range from childhood through elderly adult, with recommendations for ongoing treatment, rehabilitation, work and educational accommodations and placements. Emphasis is placed on a scientist-practitioner model which is competency-based, within the Meier Clinics mission to provide Christian counseling services. 3. RESPONSIBILITIES: A. Dr. Brad Kahle is the Director of Clinical Training for Meier Clinics, and has overall responsibility for the Internship and Practicum Training Program in Clinical Psychology. Dr. Kahle establishes and supervises the training of interns and practicum students that develops their competence as clinical psychology trainees based on sound scientific and professional practice foundations. Training includes core seminars, lectures and case conferences which will be attended by all graduate students. The core education includes the following content areas: psychological assessment and consultation; organization, management and administration issues pertinent to psychological service delivery and practice, training and research; professional conduct, ethics and law; integration of Christian ethical principles in psychological services; and issues of cultural and individual diversity. B. Dr. Kymberly Larson is the Director of Training for the Clinical Neuropsychology Specialty Track, and is responsible for developing the content of the program, day-to-day administration and activities of the program, and the documentation of training. This includes coordinating with the other Meier Clinic staff, and staff of other institutions to establish training opportunities for Clinical Neuropsychology interns and practicum students. The content of the Clinical Neuropsychology Specialty Track is detailed under Objectives and Content, in this document. The Director of Training for the Clinical Neuropsychology Specialty Track reports directly to Dr. Brad Kahle, Director of Clinical Training for Meier Clinics. 1

2 C. Neuropsychology interns and advanced practicum students have as their primary responsibility the acquisition of a knowledge base and clinical skills to developed advanced competence in the practice of Clinical Psychology and the practice of Clinical Neuropsychology. Specific objectives and processes are detailed in Appendix 2: Objectives and Processes for the Clinical Neuropsychology Specialty Track. 4. GOALS: The Clinical Neuropsychology Specialty Track is structured to ensure the development of advanced professional and technical expertise in the practice of Clinical Neuropsychology of each graduate student based upon sound scientific and professional practice foundations. The primary goal of the Clinical Neuropsychology Specialty Track is to use the scientist-practitioner approach to train clinical psychology graduate students to be prepared to work in a variety of neuropsychology-related clinical, research, and academic settings. The long-term goal of the internship and advanced practicum program is to train psychologists who are interested in pursuing careers in clinical neuropsychology and make significant contributions in clinical, research, or teaching activities. The specific goals and objections of the specialty area are listed in Appendix 2. The following are integral to the achievement of this goal: A. The primary training method is supervised service delivery with direct patient care. Each graduate student receives 3 to 4 hours of supervision per week, with a minimum of at least 1 hour involving individual, face-to-face supervision with Dr. Kymberly Larson; one hour clinical group supervision with Dr. Brad Kahle; and one hour clinical neuropsychological group supervision with Dr. Kymberly Larson. Advanced Practicum students will have additional supervision by the Neuropsychology Interns. In addition, graduate students always have access to supervisor consultation and intervention in emergencies. B. Educational and training activities also comprise a large portion of the graduate students training and are designed to be cumulative, graduated in complexity and structured (See Appendix 4 for listing of educational and training activities during the internship and practicum, and Appendix 5 for list of recommended readings). 5. COMPETENCY REQUIREMENTS: During the first week of the program the Director of Training for the Clinical Neuropsychology Specialty Track, Dr. Kymberly Larson, meets with each graduate student and reviews the list of required competencies for the specialty training experience (See list of competencies at Appendix 3). The competency list specifies training requirements in terms of assessment competencies, treatment competencies, knowledge required, and research activities. Each graduate student works with Dr. Larson to develop an initial training plan based on the graduate student s previous training and experience related to the competencies as well as the graduate student s areas of interest. Training activities are listed in Appendix FACILITATING TRAINING AND EDUCATIONAL EXPERIENCE OF INTERNS AND PRACTICUM STUDENTS: A. The model of integrated education and training in Clinical Neuropsychology is acknowledged. Each graduate student presents with different degrees of specialty knowledge and skills acquired at various levels of their training throughout their doctoral studies. At the conclusion of each quarter, each graduate student is provided feedback on his/her strengths and weaknesses. To the degree possible, supervision and training for each graduate student is tailored to their individual needs and interests. In 2

3 order to facilitate this, goals and objectives for each quarter are developed collaboratively between the supervisor and graduate student. B. In order to maximize the quality and effectiveness of the graduate students' learning experiences, graduate student-supervisor relations are collegial and conducted in a manner consistent with ethical principles and professional conduct standards. C. The Director of Clinical Training will meet with all graduate students weekly during group supervision, in order to obtain feedback about the program, any concerns the graduate student may have, and information on specific changes that would facilitate further development and learning. 7. EVALUATIONS AND FEEDBACK: A. At the conclusion of each quarter, the Director of Training for the Clinical Neuropsychology Specialty Track evaluates the graduate student's attainment of standards for that quarter, as well as the graduate student's strengths and weaknesses. These evaluations are recorded and signed by both the Director of Training for the Clinical Neuropsychology Specialty Track and the graduate student. The results are utilized to develop individual goals for the graduate student in subsequent quarters. B. At the conclusion of the internship or advanced practicum, a formal evaluation of the graduate student s competency in all of the exit criteria will be conducted. If there is any question that the graduate student may not meet the exit criteria at the end of his/her internship/practicum, this will be specifically addressed at the end of quarterly evaluations and the graduate student will be provided timely written notification of all shortcomings, the opportunity to discuss them and guidance regarding steps to remedy them (if remediable). Additionally, written feedback on the extent to which corrective actions are or are not successful will be provided. C. The Director of Training for the Clinical Neuropsychology Specialty Track will keep evaluations which will not be released to any agency outside Meier Clinics without written permission of the graduate student. Upon satisfactory completion of the internship/practicum, an appropriate certificate will be issued to each graduate student attesting to his/her completion of an Internship or Advanced Practicum in Clinical Psychology, with a specialization in Clinical Neuropsychology. Dr. Kymberly Larson, Psy.D. Clinical Neuropsychologist Director, Clinical Neuropsychology Specialty Track 3

4 APPENDIX 1: Exit Criteria The following exit criteria will be included in a formal evaluation of the graduate student's competency in the Clinical Neuropsychology specialty area: 1. Develop interviewing and assessment skills to be able to provide a comprehensive neuropsychological evaluation, sufficient to practice on an independent basis for interns; sufficient to qualify for a neuropsychology internship for advanced practicum students. 2. Develop comprehensive knowledge of neurobehavioral syndromes, neuroanatomy, neuropathology and demonstrate the ability to use that knowledge in neuropsychological settings. 3. Develop the ability to provide consultation to patients and professionals sufficient to practice on an independent basis for interns; sufficient to qualify for a neuropsychology internship for advanced practicum students. 4. Develop an advanced understanding of brain-behavior relationships; 5. For interns, complete a scholarly activity that demonstrates individual competence of independent and systematic psychological research of publishable quality. This scholarly activity may be dissertation research. While publication/presentation of the research project is not required, it is highly encouraged. 4

5 APPENDIX 2: Objectives and Processes for the Clinical Neuropsychology Specialty Track Objective #1. Obtain substantial experience and develop a high level of expertise in broad stateof-the art Clinical Neuropsychological assessment techniques and be familiar with psychometric properties of each of the tests and assessment techniques. Processes 1. (A). Each graduate student will become highly skilled in selecting, implementing, scoring, interpreting, and communicating findings from a broad array of psychological assessment instruments, including experience in each of the following assessment domains: Mental Status Screening Tests: MMSE, Cognistat, NAB Screener, Mattis Dementia Rating Scale, CNS Vital Signs, etc. Cognitive/Intellectual and Achievement/Academic Assessment: Wechsler Adult Intelligence Scale -IV, Wechsler Intelligence Scale for Children-IV, WRAT- 4, Wechsler Individual Achievement Test II, Wechsler Memory Scale-IV, Children s Memory Scale, WASI, KBIT-2, PPVT-4, NART, etc. Standard Neuropsychological Assessment Instruments: Repeatable Battery for the Assessment of Neuropsychological Symptoms, ANAM, Wechsler Memory Scale-IV, Halstead-Reitan Battery tests, Houston Battery tests, California Verbal Learning Test-II, Boston Diagnostic Aphasia Examination 3 rd edition, Booklet Categories Test, Beery Tests, Judgment of Line Orientation, etc. Computerized Neuropsychological Assessment Instruments Wisconsin Card Sorting Test, Connors Continuous Performance Test-II, Test of Variable Attention(TOVA)-8, CNS Vital Signs, etc. Assessment of Effort and Motivation Victoria Symptom Validity Test, Rey Fifteen-Item Test, Portland Digit Recognition Test 5

6 Personality Assessment Minnesota Multiphasic Personality Inventory-2, Millon Clinical Multiaxial Inventory-III, MMPI-A, M-PACI, Thematic Apperception Test, Children s Apperception Test, Personality Assessment Inventory, Geriatric Depression Scale, Beck Inventories, Beck Youth Inventory, Conners Inventories, Brown Inventories, Clinician Administered PTSD Scale (CAPS), Gilliam Asperger s Disorder Scale (GADS), Gilliam Autism Spectrum Disorder Scale, etc. (B). Each graduate student will receive individual supervision on psychological assessment with a licensed clinical psychologist. This supervision will occur before the evaluation report is finalized and feedback is given to the patient and family, if appropriate. (C). Each graduate student will be familiar with test construction, psychometric properties and other characteristics of common neuropsychological tests. (D). Each graduate student will be familiar with non-standardized procedures, computerized measures and special assessment techniques such as qualitative screening measures. Objective #2. Ensure acquisition of the knowledge required for advanced training in Clinical Neuropsychology. These knowledge based prerequisites are as follows: (a) general neuropsychological principles, (b) developmental principles, (c) clinical syndromes, (d) treatment and rehabilitation (e), neuroanatomy/neurophysiology, (f) neuropathology (g) clinical neurology/ neuroimaging (h) and military application of neuropsychology. Processes 2. (A). Basic knowledge will be acquired through didactic events, to include training in assessment of ADHD; learning disabilities; traumatic brain injury; dementias; epilepsy; cerebrovascular disorders, etc. Weekly reading seminars will be reviewed in group neuropsychology supervision, in relevant topics such as attention/concentration disorders; language problems and assessment; memory and learning; deficits in visuospatial/visuoconstructional skills; frontal lobe/executive functioning; affect, emotions and mood; aphasia syndromes; cerebrovascular disease and stroke; military neuropsychology and other clinical syndromes. A list of readings appears in Appendix 5. 6

7 (B). In areas where greater experience or knowledge is believed to be necessary prior to more advanced and autonomous training experiences, opportunities will be provided for the graduate student to (1) read key references in designated areas, (2) attend relevant seminars or courses. Objective #3. Obtain experience and develop a high level of professional expertise in the conduct of Clinical Neuropsychological evaluations, in differential diagnosis, clinical interviewing and in case formulation based on contemporary clinical practice. Develop a philosophy of neuropsychological assessment, brain organization and professional ethics. Develop professional consultation skills and the ability to provide lectures and information on neuropsychological issues. Processes 3. (A). Each graduate student will be scheduled for Clinical Neuropsychological evaluations with a broad age range of patients, from children to elderly adults, with a broad range of neuropsychological disorders. (B). Each intern will be scheduled for a minimum of 2 weekly evaluations in the Neuropsychology Specialty Track. Expectation is that the intern will typically do 2 weekly evaluations. Each advanced practicum student will be scheduled for a minimum of one weekly evaluation, and the expectation is that the advanced practicum student will typically do one weekly evaluation. (C). Each graduate student will receive cases for evaluation that include a variety of diagnostic possibilities, including attention deficit disorder, learning disabilities, Asperger s disorder, head injury, stroke, dementia, epilepsy and other medical conditions. Fellows will participate in assessing patients and discussing cases with supervision attending faculty. (D). Graduate students will discuss interviews and initial case formulations with a clinical supervisor prior to completing the case formulation, written report, and feedback to the patient and family if appropriate. This discussion will initially occur immediately following the interview, allowing for follow-up questions, clarifications, or direct supervisor involvement with the patient. Test selection will also be discussed with the supervisor prior to testing the patient. As interns and practicum students demonstrate increased clinical sophistication, initial case formulation and report writing may occur before formal case supervision. 7

8 (E). Graduate students will write reports of their evaluations in a timely manner, obtaining written or verbal feedback on the evaluation reports from the supervising psychologist. (F). Graduate students will attend weekly case conferences and present evaluation data and case formulations in this setting several times during each training year. This will enable consultation, case discussion, or recommendations for patient care as appropriate. (G). Each intern will provide at least one lecture to fellow interns and advanced practicum students, as well as other interested Meier Clinics staff. Objective #4. Obtain skills in supervision of junior trainees and provide input in the development of training curriculum for those trainees Processes 4. (A). Each intern will provide supervision to a psychology practicum student on at least 5 clinical cases, with the intent of developing the supervisee s clinical skills to provide assessment and evaluation. (B). Each intern will provide input into the development of training activities for the trainees. (C). Each intern will receive didactic training in supervision. Objective #5. Become highly competent and capable of independent and systematic neuropsychological research and/or a scholarly activity within this specialization. 8

9 Processes 5. (A). Each graduate student may participate in ongoing research projects within their research specialization track, including accepting of responsibility for managing research databases and collecting data. Interns are expected to complete a scholarly activity that demonstrates individual competence of independent and systematic psychological research of publishable quality, which in most cases will be their dissertation. While publication/presentation of the research project is not required, it is highly encouraged. 9

10 APPENDIX 3: Clinical Neuropsychology Specialty Area Competence/Knowledge Checklist Intern/Advanced Practicum Student Training Year (N/A = experience not available) Objective 1: Assessment techniques Completed 1. Cognitive/ Intellectual assessment (WAIS-IV, WRAT-4, WIAT-II, etc) 2. Personality Assessment (MMPI, PAI, GADS, etc) 3. Standard Assessment Batteries (RBANS, BDAE,CVLT-II, etc) 4. Computerized Assessment Instruments (CPT-II, WCST, etc) 5. Psychometric construction and properties of tests assessed 6. Supervised Instruction on test administration and scoring Objective 2: Foundational Knowledge of Neuropsychological Principles Completed 1. Readings in Neuropsychological Principles 2. Readings in Clinical Syndromes 3. Readings in Military Neuropsychology COD Class (12 weeks) 4. Readings in Ethical Principles 10

11 Objective 3: Clinical Neuropsychological Evaluations Completed Neuropsychological evaluations weekly 2. Clinical Neuropsychological Interviews 3. 5 Learning disability evaluations ADHD Evaluations 5. TBI Evaluations 6. Stroke, CVA evaluations Geriatric/ Dementia evaluations 8. Independent case conceptualization and formulation 9. Consultation to patients and family 10. Consultation to medical providers 11. Case conference presentations 12. Integrated Neuropsychological Reports 13. Lectures/Presentations Objective 4: Supervision Completed 1. Number of Case Supervisions of intern or practicum students 2. Provide input to curriculum for practicum student 11

12 Objective 5: Research or Project/Review Paper /Dissertation Completed 1. Project Title 2. Proposal Presentation/Dissertation 3. Faculty Update/ Approval (if applicable) 4. Faculty Update 5. Faculty Update 6. Project Completion Core Training Activities Completed 1. Clinical Psychology Case Conferences (Dr. Paul Sather) a. Attended 90% b. Presented 3 cases to trainees and staff APPENDIX 4: EDUCATIONAL AND TRAINING ACTIVITIES The following training activities specific to the Neuropsychology Specialty Track 1. Neuropsychology Didactic Seminar (1 hour weekly) a. Attended 90% b. Presented 3 cases to trainees and staff 2. Neuropsychology case presentations 3. Teaching Assistant for Veterans Counseling Certificate Program, College of DuPage 12

13 APPENDIX 5: List of Required Readings I. The Little Black Book of Neuropsychology: A Syndrome-Based Approach (2011), Schoenberg & Scott, Springer Publishing 1. The Neuropsychology Referral and Answering the Referral Question 1 2. Deconstructing the Medical Chart Neuroanatomy Primer: Structure and Function of the Human Nervous System Components of the Neuropsychological Evaluation Arousal: The Disoriented, Stuporous, Agitated or Somnolent Patient Attention/Concentration: The Distractible Patient Language Problems and Assessment: The Aphasic Patient Memory and Learning: The Forgetful Patient Deficits in Visuospatial/Visuoconstructional Skills and Motor Praxis Frontal Lobe/Executive Functioning Affect, Emotions and Mood Aphasia Syndromes Cerebrovascular Disease and Stroke Dementias and Mild Cognitive Impairment in Adults Episodic Neurologic Symptoms Epilepsy and Seizures Neuropsychology of Psychogenic Nonepileptic Seizures SomatoformDisorders, Factitious Disorder, and Malingering Parkinson s Disease and Other Movement Disorders Multiple Sclerosis and Other Demyelinating Disorders Moderate and Severe Traumatic Brain Injury Mild Traumatic Brain Injury Sport-Related Concussion Post-Concussion Syndrome Pediatric Traumatic Brain Injury (TBI): Overview Brain Tumors Neurotoxicity in Neuropsychology Cognitive Decline in Childhood or Young Adulthood Application of Motivational Interviewing to Neuropsychology Practice Reliability and Validity in Neuropsychology Psychometric Foundations for the Interpretation of Neuropsychological Test Results Improving Accuracy for Identifying Cognitive Impairment

14 II. PsychEssentials: A Pocket Resource for Mental Health Practitioners (2012), Sonne, American Psychological Association 1. Initial Clinical Assessment Interview Standardized Screening Measures Structured and Semistructured Interviews Mental Status Examination Psychological Assessment Measures Clinical Assessment of Self-Harm and Interpersonally Violent Thoughts and Behaviors Risk Evaluation and Management of Self-Harm and Interpersonal Violence Child Abuse Reporting Reporting Abuse of Elderly and Dependent, Vulnerable, or Disabled Adults Duty to Protect: Reporting Client threat of Harm to Another Diagnosis Evidence-Based Interventions Psychopharmacotherapies Termination Records and Record Keeping Resources for Clinicians I: Professional Standards Resources for Clinicians II: Strategies for Self-Care and Managing Adverse Events Resources for Clients and Their Significant Others In addition to the above required books, the following are recommended books: 1. Neuropsychological Assessment, 4 th edition Lezak, Howieson, & Loring 2. Principles of Behavioral and Cognitive Neurology (2000), Mesulam 3. A Compendium of Neuropsychological Tests, 3rd edition, Strauss, Sherman, & Spreen 4. The Mental Status Examination in Neurology, 3rd ed., Strub & Black 5. Neuroanatomy Through Clinical Cases (2002), Blumenfeld 6. Neuropsychiatry and Behavioral Neuroscience (2003) Cummings & Mega 7. Clinical Neuropsychology, 4 th edition Heilman & Valenstein 8. Clinical Neuropsychology, 2 nd edition, Snyder, Nussbaum, & Robins 9. Essentials of Neuropsychological Assessment (2002), Hebben & Milberg 10. Behavioral Neurology & Neuropsychology, 2 nd edition, Feinberg & Farah 11. Manter and Gatz s Essentials of Clinical Neuroanatomy and Neurophysiology, 10 th edition, Gilman & Newman 12. Clinicians Guide to Neuropsychological Assessment, 2 nd edition, Vanderploeg 13. Handbook Of Normative Data for Neuropsychological Assessment, 2 nd edition, Mitrushina, Boone, Razani, & D Elia 14. Forensic Neuropsychology, Fundamentals and Practice (1999), Sweet 15. Forensic Neuropsychology: a Scientific Approach (2005), Larrabee 16. The American Psychiatric Publishing Textbook of Traumatic Brain Injury, 2 nd edition, Silver et al. 14

15 17. Dementia: A Clinical Approach, 3 rd edition, Mendez & Cummings 18. Neuropathology: A Reference Text of CNS Pathology, Ellison et al. (2003 edition) 19. A Textbook of Neuropathology, 3 rd edition, Davis & Robertson 20. Adams and Victor s Principles of Neurology, 8 th edition. Ropper and Brown 21. Neuropsychological Assessment of Neuropsychiatric Disorders, 2nd ed (Sep 96) Grant and Adams 22. Detection of Malingering During Head Injury Litigation (Critical Issues in Neuropsychology) (1998) Reynolds 23. Aphasia (I 996) Benson and Ardila 24. Clinical Neurology for Psychiatrists, 6 th edition (2006) Kaufman 25. Injured Brains of Medical Minds (1997) Kapur Finally, graduate students may be assigned reading of selected journal articles. 15

16 APPENDIX 6: Evaluation Intern/Practicum Student Competency Evaluation Internship/Advanced Practicum in Clinical Neuropsychology Meier Clinics Wheaton, Illinois Neuropsychology Specialty Track Student s Name Supervisor: Date: Quarter (1,2,3,4): Self evaluation Supervisor evaluation Satisfactory rating indicates that student is currently making appropriate, expected progress toward competency. Please provide comments on any item rated 1, 2, or 5. A rating of 1 or fail on any item will require a remediation. Ratings of 2 or Needs Improvement may result in a remediation plan, depending on the judgment of the supervisor. (DK = Don t Know, NA = Not Applicable) A. Objective 1 Advanced Practice Skills and Knowledge Ethical Behavior: Behavior is consistently ethical and reflects a mature understanding of ethical principles. 16

17 Ethical/Legal Knowledge: Aware of ethical and legal issues and can articulate ethical dilemmas. Cultural Competency: Demonstrates sensitivity to issues of diversity and takes into account cultural issues in the delivery of services. 17

18 Professional Responsibility: Maintains schedule as agreed; follows Meier Clinics procedures; relates well with staff, support staff, fellow students, and other professionals; maintains professional behavior with others; handles clinic details. Written Material: Maintains records as required by site, in a timely manner. Please note what records are required; e.g., progress notes, assessment reports, case and termination summaries. Professional Writing: Well organized, clearly written, with meaningful content, and appropriate to referral question/presenting problem. 18

19 Professional Consultation: Communicates information effectively with other professionals in a concise and understandable manner. _ B. Objective 2 Specialty Competencies: Neuropsychology Knowledge: Demonstrates acquisition of the knowledge required for advanced training in Clinical Neuropsychology to include (a) general neuropsychological principles, (b) developmental principles, (c) clinical syndromes, (d) treatment and rehabilitation, (e) neuroanatomy/neurophysiology, (f) neuropathology, (g) clinical neurology/neuroimaging, (h) and military application of neuropsychology. 19

20 Testing and Measurement: Demonstrates a high level of expertise in broad state-of-art Clinical Neuropsychological assessment techniques and be familiar with psychometric properties of each of the tests and assessment techniques. Evaluations: Demonstrates a high level of professional expertise in the conduct of Clinical Neuropsychological evaluations, in differential diagnosis, clinical interviewing and in case formulation based on contemporary clinical practice. Teaching and Consultation: Develop professional consultation skills and the ability to provide lectures and information on neuropsychological issues. 20

21 Supervision: Obtained skills in supervision of junior trainees and provides input in the development of training curriculum for those trainees. C. Objective 3 - Research & Scholarly Inquiry Research: Developing the capabilities need to initiate and carry out scholarly inquiry and independent programmatic research. 21

22 D. Objective 4 Knowledge of Evidenced Based Practice Fund of Knowledge: Demonstrates an appropriate use of current literature and an advanced knowledge of the scientific basis for clinical psychological assessment and intervention. E. Objective 5 Professional Development Supervision and Teaching: Developing teaching or supervisory skills when experience is available. 22

23 Professional Development: Takes advantage of opportunities for additional training events/conferences outside of required fellowship activities. Professional Activities: Participates in professional or community activities to facilitate advancement of professional identity (teaching assistant for College of DuPage class in Assessment of PTSD, TBI & Co- Morbid Disorders; community volunteer activities). Additional Comments: 23

24 Signatures: Intern/Advanced Practicum Student Date Supervisor Date Director of Training Date 24