Prevention & RecoveryCenter

Practicum Information

Memorial Hermann Prevention and Recovery Center is an Alcohol and Drug Treatment facility licensed by the Texas Department of State Health Services. Our services include inpatient detoxification, residential, and outpatient treatment for patients with cocaine dependence, alcohol dependence, cannabis dependence, opioid dependence, and benzodiazepine dependence. We also treat psychiatric co-morbidities and medical complications related to addiction.

Patients include adolescent and adult men and women with primary substance use disorders. Depending on the patient population, at least half of the patients have co-occurring psychiatric disorders. The most common psychiatric diagnoses include mood disorders and anxiety disorders. Treatment approaches include individual and group therapy, CD-education, 12-step meetings, psychopharmacology, recreation activities, and family programs.

This program is registered with the Texas Department of Health and Human Services as a Clinical Training Institute (CTI) to facilitate practicum and internship for chemical dependency counseling. The clinical supervisors also have board certification as approved supervisor for the Texas state boards of Marriage & Family Therapy, Professional Counseling and Social Work.

Practicum is a three to nine month clinical rotation in chemical dependency counseling that a student completes as part of their course of study related to human services, counseling, marriage and family therapy or social work. All direct clinical mental health services at the PaRC are conducted by licensed mental health practitioners. The practicum student at the PaRC will have the opportunity to observe the clinical practice of chemical dependency counseling and engage in other training experiences but they will not have the opportunity to conduct formal assessment or to independently conduct clinical counseling services.

Practicum Requirements

1. The practicum student (“student”) is 18 years of age or older.

2. The student is enrolled in clinicalexperience course as part of an associates, bachelors or masters degree program with an accredited college that has a formal affiliation agreement with MHPaRC.

3. The student has completed an occupational health screening through the university they are attending and have been certified eligible to provide patient care.

4. The student signs and adheres to the DSHS LCDC Code of Ethics Agreement

5. The student agrees to comply with Memorial Hermann Prevention and Recovery Center’s Behavioral Expectations

6. The intern is able to work a minimum of 3 daytime shifts at the 3033 Gessner – Houston, Texas 77080 location from 8:00am-4:30pm Monday – Friday.

Application Requirements

The practicum student will submit an application portfolio that includes the following items;

1. Practicum student vaccination attestation and consent to background check (see attached).

2. Practicum application (see attached).

3. Cover letter describing the clinical experience needs of the student and an explanation of what sets them apart as an exceptional applicant.

4. Transcripts (official or unofficial) of educational history.

5. Resume

6. List of 3 references with contact information.

Please scan and Email a .pdf file of your complete application portfolio to: Vaughn Bryant

Incomplete applications will not be evaluated.
MHPaRC PRACTICUM APPLICANT INFORMATION SHEET

Thank you for your interest in Memorial Hermann Prevention and RecoveryCenter (PaRC) as a mental health / addiction recovery counseling practicum placement. You can learn more about the PaRC @ .

Please complete this form and submit the requested accompanying documents. Your application will be reviewed and you will be contacted.

Personal Data Today's Date:

Name: Date of Birth:

Address: City/Zip:

Phone #: Home: Work: Cell:

Email:

Texas Drivers License#Social Security #

Current work status:  Unemployed  Self Employed  Employed Part Time  Employed Full Time

Practicum

University / Training Institute:

Professor:Email:Phone:

Practicum requirements: Specify total number of hours as well as specific requirements for client contact types (individual, group, mft,…).

Supervision requirements:

Educational History

Name of SchoolDiploma / Degree CompletedMajor / FocusDate (from – to)

Please submit copies of all transcripts and diplomas of all educational history.

Behavioral Health Related Experience

Place of EmploymentPosition Dates (from – to)

Include volunteer and practicum experiences as well as paid employment experiences.

Unique Skills, Certifications or Intern License (LCDC Intern, LPC Intern, LMFT Associate)

References

NameProfessional RelationshipContact Information: Phone / Email

Please list three references who know you professionally. References can include a supervisor, academic advisor, or professor. Also ask one reference to write a letter of recommendation and mail, fax or email to: Vaughn Bryant / MHPaRC / 3043 Gessner / Houston, Texas77080 ● ●

PRACTICUM STUDENT vaccination attestation and consent to background check /

The Memorial Hermann Prevention and Recovery Center (PaRC) requires that all students or interns applying for enrollment in practical experience at PaRC meet certain regulatory compliance conditions related to health and immunizations required of all healthcare providers in the state of Texas.

IMMUNIZATIONS

Circleone
Hepatitis B: Have you had one series of Hep B and a positive Hep B serum antibody ortwo series of Hepatitis B vaccine (6 total vaccines)? / Yes No
MMR (Measles, Mumps and Rubella): Have you had two MM vaccinations and one rubella vaccination orhad a positive titer for each? / Yes No
Varicella: Have you had two doses of Varicella vaccinations or one dose of Zoster vaccine orhad a positive serum antibody Varicella titer? / Yes No
Tdap/td (Tetanus, Diphtheria, Pertussis): Have you had at least one vaccination that included Pertussis andthat vaccine was in the past 10 years? / Yes No
Influenza: Have you had a seasonal flu immunization for the current influenza season (October-March)? / Yes No
Are you at risk for another vaccine preventable disease not listed above? / Yes No
Are you aware if you have had a non-response to a vaccine or if you have no immunity to any disease listed?
Please provide details for no immunity: / Yes No

In order to comply with Texas state law each health care professional must provide Memorial Hermann any one or combination of four proof or exception options:

(a) Immunization records

(b) titers indicating immunity

(c) request an exception (religious, medical or reason of conscience) to the vaccine preventable disease policy (please review policy for requirements if you select this option)

(d) if you answered “yes” to questions 1-5 no further action may be necessary.

I do hereby consent to a review of my criminal background through review of public records related to my driver’s license number.

I do hereby attest that the information above is true, accurate and complete to the best of my knowledge and I understand that any falsification, omission or concealment of any material fact may subject me to disciplinary action up to and including termination of practicum, or suspension of privileges.

Print Name:TXDL#DOB:

Student Signature: Date & Time:

If you would like to explain your response to experiences on your criminal background, please attach a statement to this document explaining your responses.