alpert medical school of brown university

clinical psychology internshiptraining program

adult track

guidelines for long-term outpatient cases at the providence vamc

(Reviewed 5/3/2017)

As part of the year-long clinical internship, clinical psychology residents provide treatment for two long-term outpatient psychotherapy cases under the supervision of a licensed clinical psychologist who is also a member of the training faculty. Outpatients are seen at the Providence VA Medical Center through several services, including the Collaborative Addiction Treatment Services (CARS), Returning Veterans Program (RVP), Posttraumatic Stress Disorder Clinic (PTSD), and General Outpatient Psychiatry (CAPS). This is a unique opportunity to provide long-term therapy to men and women Veterans who present with a variety of clinical issues and diagnoses and who served in every branch of the U.S. Military (Army, Navy, Air Force, Marines, Coast Guard). Veterans enrolled at the PVAMC have served during every major conflict (World War II, Korea, Vietnam, Operation Desert Storm, Operation Iraqi Freedom/Enduring Freedom, etc.) as well as during peacetime.

The following guidelines have been established to ensure that residents successfully complete this component of their internship training, that they are in compliance with the rules and regulations of the VAMC, that the supervision experience is a rewarding one for residents and supervisors, and that we continue to provide the best possible clinical care to our military Veterans.

  1. Selection and Assignment of Long-term Cases
  2. Areas of experience and expertise. Residents will be asked to identify their areas of clinical expertise and interests regarding case assignment. Every effort will be made to attempt to match residents’ interests with available cases, and VA supervisors will be responsible for providing residents with appropriate treatment referrals.
  3. Familiarity with CBT and related treatment modalities. It is expected that residents will have a strong foundation of the principles and clinical applications of CBT and utilize empirically-supported treatments.
  4. Meet with Dr. Jennifer Lambert. Dr. Lambert will meet with the residents at the beginning of internship to provide an overview of the long-term outpatient experience at the VA. She will also meet with residents mid-year (January/February) to review progress, troubleshoot problems, and provide the Adult Track Faculty with an update on residents’ progress.
  1. Supervision
  2. Frequency and Duration. Residents are expected to meet with their supervisors regularly, that is, weekly, for clinical supervision. It is expected that 45-60 minutes will be devoted to supervision each week, which should provide ample time for reviewing both outpatient cases.
  3. Type (individual, phone). Supervision should be conducted in person; telephone supervision should be done only in situations in which the resident is not able to physically be present at the VA.
  4. Availability of Licensed Clinical Psychologist when seeing patients. VA regulations stipulate that a licensed clinical psychologist must be physically present on the grounds of the VA and available for consultation when a trainee is conducting assessment or treatment. If the resident’s supervisor is off grounds, it is the responsibility of the supervisor that s/he ensure clinical backup from another licensed clinical psychologist at the VA.
  5. Supervision Time. Supervision times and days will be arranged at the convenience of the VA supervisor and resident.
  1. Seeing Patients at the PVAMC
  2. Release Time. Residents will have 4 hours of dedicated release time per week throughout the year to see their patients at the VA (to include supervision time). The specific times must be agreed to in advance by the resident’ rotation supervisors and VA supervisor. The resident and VA supervisor should be in communication with and establish with the resident’s rotation supervisor at the beginning of the rotation what day and time the resident will be seeing his/her VA patients. Every effort should be made to accommodate schedules to allow for continued care of Veterans (not ending treatment because suitable times could not be found).
  3. Office space. Residents must see their patients at the ProvidenceVA and are not permitted to meet with their patients at any other location. The mental health reception staff can be of assistance in helping residents identify available offices to use to see patients; this may include use of conference rooms if individual offices are not available. Supervisors should also facilitate identification of office space for residents.
  4. Telephone messages/access. Residents are expected to provide their patients with up-to-date business phone numbers so that patients can contact residents directly. Residents are also expected to receive and respond directly to phone messages from their patients. Residents have voicemail boxes assigned to them at ButlerHospital. They will also be given VM at the VA. The outgoing message on the voicemail must include required VA wording (whether it is VA or Butler, if the latter is given to VA patients). Residents should check their voicemail at least daily and should also inform their VA patients of emergency services at the VA and how to access them if patients cannot immediately get in touch with the resident. Residents are expected to work closely with their VA supervisors to ensure that continuity of VA patient care is always maintained, regardless of what rotation or hospital the resident is assigned to.
  5. Medical Chart Notes. After each patient contact (telephone contact, therapy), residents must enter a note into the patient’s electronic medical record (CPRS). Access to the electronic medical chart will be arranged by Janice Marra, secretary to the Chief of Staff of MHBSS. Residents will have a clinic in CPRS that they will use for entering their notes. Supervisors will provide guidance and supervision to residents as to the content and structure of these notes. Residents must enter treatment notes within 24 hours of clinical contact with a patient. Supervisors must co-sign these notes.
  6. Scheduling appointments. All clinic appointments must be scheduled at times when a licensed clinical psychologist is physically present at the PVAMC. This is a VA-wide requirement that must be followed. Normal business hours are Monday-Friday 8:00 a.m-4:30 p.m.; this may vary depending on supervisors’ schedules. There are some clinical psychologists who are on the grounds after 4:30 p.m. It is the responsibility of the residentand the VA supervisor to ensure that if they see patients after 4:30 p.m., that a clinical psychologist be physically present on the grounds of the VA as clinical backup. An appointment slip must be filled out and submitted to the reception staff in order for clinic appointments to be entered into CPRS.
  7. Activity Log. Residents will keep a weekly log of their clinical and supervision hours for review byDr. Lambert as needed. This log should include all time spent at the VA, including telephone calls made, no shows, etc.
  8. Number of Cases per Year. Residents are expected to carry two cases per year at the PVAMC. If patients drop out of treatment 2 or more months prior to the end of the internship year (i.e., prior to April 30), residents will be expected to pick up a replacement case for the remainder of the internship year. For residents doing intensive exposure therapy, preferably only one of the two long-term cases is intensive exposure therapy.
  9. Terminating/transferring patients. Residents will either terminate treatment or transfer their patients to another clinical provider at the end of the internship year, on June 30. This requires that residents (1) work with their supervisors to determine whether termination or transfer is clinically appropriate; (2); inform their patients well in advance of the end date of internship and of treatment; (3) in the case of transfers, inform their patient of the transfer and in all possible cases have the new clinical provider meet with the resident and patient to review treatment goals and schedule a future appointment.
  1. Continuing to see patients after completion of internship
  2. Residents who are interested in continuing to see their long-term cases at the PVAMC after completion of internship may do so provided that they receive an extension of WOC (work without compensation) status. Requests for WOC must be made at least 3 weeks in advance of the end of the internship year on June 30 and can be forwarded to Ms. Marra and Dr. Lambert.
  3. Continuity of supervision must be arranged in advance. Residents must request continued supervision from their supervisors, and continued supervision would be contingent on the supervisor’s availability and schedule. If the supervisor is not available after the completion of the internship year, residents must arrange continued supervision from a licensed clinical psychologist on staff at the VA.
  1. Contact information
  2. Jennifer F. Lambert, Ph.D.—any problems or questions, 273-7100 x2010
  3. Tracy O-Leary-Tevyaw, Ph.D., Chief of Psychology 273-7100 x3400
  4. Supervisors:

Nancy Brand, Ph.D., 273-7100, x3618

Amy Cameron, 273-7100, x6162

Samantha Collum, 273-7100, x6327

Caren Francione, Ph.D., 273-7100, x2145

Heather Frank, 273-7100, x2367

Jennifer Lambert, Ph.D. 273-7100, x2010

Jane Metrik, 273-7100, x3400

Karen Oliver, Ph.D., 273-7100, x3694

Janell Schartel, Ph.D., 273-7100, x3400

  1. Emergencies—VA Police 273-7100 x4999