Captain James A. Lovell Federal Health Care Center
Psychology Internship Training Model and Program Philosophy
On October 1, 2010, the North Chicago VA Medical Center and Naval Health Clinic Great Lakes were integrated into the Captain James A. Lovell FHCC.
THE FHCC’S MISSION: Readying Warriors and Caring for Heroes
The mission of the Lovell FHCC is to “provide comprehensive, compassionate, patient centered care to our Veterans and DoD beneficiaries while maintaining the highest level of operational readiness.” The vision of the Lovell FHCC is “creating the future of federal healthcare through excellence in world-class patient care, customer service, education and research.”
The legally mandated primary mission of the Veterans Health Administration system of health care facilities is the provision of comprehensive health care services to eligible Veteran beneficiaries. The Veterans Health Administration system of health care facilities is currently organized into 22 Veterans Integrated Service Networks (VISN’s). Each VISN consists of a geographic grouping of 6 to 12 VA Medical Centers. Each of the Medical Centers in a VISN has a specific mission complementing that of its network partners.
The Lovell FHCC is one of the 8 medical centers in VISN 12 (VA Great Lakes Health Care System), which includes, among others, the Hines and Jesse Brown VAMC's in Chicago, Illinois, and the Milwaukee, Madison and Tomah VAMC’s in Wisconsin. Within its broad legally mandated mission, the FHCC has the more narrowly defined mission of serving as the intermediate and long-term care facility for psychiatric and medical patients in VISN 12. As such, the FHCC operates a wide range of outpatient, residential, inpatient and community based programs serving veterans in a catchment area reaching into northern Indiana, southern Wisconsin and western Illinois.
The secondary mission of the Veterans Health Administration system of health care facilities is to provide training for future health care providers and administrators. The Lovell FHCC is a "Dean's Committee" teaching hospital. It therefore operates a variety of training programs, and maintains numerous teaching affiliations with institutions of higher learning, such as the Rosalind Franklin University of Medicine and Science, Northwestern, Loyola, and DePaul Universities, the University of Illinois, and various public and private four-year colleges. The teaching affiliations are evident in a number of clerkship, internship and residency programs in a broad variety of health care fields. In addition to psychology internships, there are ongoing training programs in nursing, social work, pharmacy, podiatry, psychiatry, medicine, dentistry, and many other health care disciplines. These affiliations offer opportunities for continued educational involvement and a rich source of multi- and interdisciplinary interactions.
The tertiary mission of the Veterans Health Administration system of health care facilities is to conduct basic and applied research on health related matters, especially as they pertain to veterans. Research activities at the FHCC cover a broad range of areas and include medical-physiological studies, as well as psychiatry and psychology research projects.
THE LOVELL FHCC STAFF
The FHCC's staff (approximately 1,040) consists of highly qualified support staff and clinical practitioners, the majority of whom have advanced credentials in their field of expertise, ranging from licensure and registration to specialty board certification.
The staff is organized in a manner somewhat analogous to that of “primary/managed care” oriented private sector health care delivery systems. Most professional service providers are therefore assigned to programs staffed by multidisciplinary primary care practice groups or “teams”. The programs, in turn, are part of “business units” in “product or care lines.”
At the FHCC there are three different kinds of programs to which professional provider groups are assigned: Primary Care programs, Specialty Care programs and Inpatient-Residential Care programs. Primary Care (PC) programs provide primary physical health care and primary mental health care, respectively in the “medical care/product line” and the “mental health care/product line”. Both are parts of the “patient care/product line.” Other multidisciplinary groups in this business unit, such as the PTSD-RRTP (Stress Disorder Treatment Unit), deliver "specialized" forms of care. The roles of the professional staff in these settings are analogous to those of providers in specialty group practices in the private sector.
In keeping with a primary care oriented approach to health service delivery, the medical and mental health primary and specialty care programs each are responsible for their own cohort of patients, whom they follow across the full treatment continuum, from preventative to aftercare services. The FHCC primary and specialty care programs thus function in a manner similar to that of group practices in the private sector. Their task is to maintain their patients’ health in the most clinically effective and most cost-effective manner, in the least restrictive treatment environment. This entails providing as much care as possible on an outpatient basis, admitting patients to inpatient care or residential care only when absolutely necessary and keeping admissions and lengths of stay to a minimum while maintaining quality.
The remaining clinical staff at the FHCC function in a variety of other professional, paraprofessional or technical service provider support roles, in various inpatient or residential (i.e. "facility based") programs and settings. Examples include the Addiction Treatment Program and the Homeless Veterans Domiciliary. These residential care settings therefore also employ most of the nursing, technician, and administrative support and plant maintenance staff, with roles similar to those of salaried professional and technical employees of private sector hospitals, clinics and similar facilities.
Additionally, many FHCC staff members serve in a variety of non-clinical program leadership, management or consultative roles, as well as in support roles in various business units in the administrative product line, akin to roles in private sector health care administration.
THE LOVELL FHCC PSYCHOLOGY INTERNSHIP PROGRAM
The Department of Veterans Affairs (DVA), formerly known as the Veterans Administration (VA), is commonly acknowledged as the birthplace of professional psychology in the US. It is also regarded as one of the prime movers behind the process of APA accreditation for professional psychology graduate education and training programs. The VA initiated and funded the first publicly supported professional psychology internships in the US immediately after W.W.II. While accepting interns only from APA accredited doctoral programs, the first VA internships did not submit themselves for APA accreditation until the middle 1970's.
The psychology internship program at the FHCC has been in existence since its inception in the 1950’s as a VA internship at the North Chicago facility, and has been continuously accredited by the APA’s Committee on Accreditation since 1979. Its latest APA Accreditation review occurred in 2013. Its next accreditation review and site visit will occur in 2020. The psychology internship’s training mission is clearly consistent with the VA’s secondary (i.e., training) mission.
Psychology Interns at Captain James A. Lovell FHCC
Our well-qualified psychology interns are recruited from APA Accredited doctoral programs in Clinical and Counseling Psychology from all over the US. Our efforts at recruiting for interns from broadly diverse backgrounds have been rewarded with intern classes that clearly reflect those efforts. Over the years our program’s training model has evolved in response to program evaluation outcome data, from a “scientist-practitioner” oriented model into a “practitioner-scholar” model. The Practitioner-Scholar Model is consistent with the mission of the VHA which includes; patient care, education, training, and research. Our intern classes are therefore typically composed of roughly equal proportions of traditional (Ph.D.) program students and professional school (Psy.D.) students, balanced along gender, cultural background and other diversity dimensions. Consistent with our training model’s expected outcomes, the overwhelming majority of our interns become employed as licensed professional psychology practitioners in a variety of health service settings.
Role of the Intern
Interns at FHCC pursue the internship’s training objectives while assuming the role of beginning professional psychologists within their clinical training assignments. Such a role requires full awareness of, and adherence to principles of professional ethics and conduct as well as a genuine commitment to the welfare of the patients under their care.
In addition to pursuing the commonly assumed objectives of professional skills training, interns become socialized into their profession through contacts with psychology staff and fellow interns. An open-minded, non-judgmental but thoughtful attitude, active listening skills and the ability to exercise critical thinking, combined with a well-developed sense of humor, are necessary assets in this professional socialization process. Tolerance for ambiguity, variability and change are other desirable assets for the intern role. Interns who are unable to develop those attitudes will find themselves sorely tried by the often frustrating and sometimes amusing random vagaries of a large and complex health care operation.
To develop into professionals, interns must be willing to assume the responsibility of being teachers as well as learners in their interactions with staff, other interns and clients. After all, the title “doctor” simply means “teacher”, and to be able to teach well one must always be willing to learn. Interns must therefore actively seek and accept supervision and request performance feedback whenever they feel the need to so do. They provide their supervisors with thoughtful feedback on their supervision, to become used to one day having their supervisors as peers and in anticipation of the occasion that they will have their own supervisees. Interns are expected to respond to and follow up on supervisory input and feedback in a mindful and mature manner. As participant-observers, interns also learn experientially about the supervision process.
While interns are treated as beginning professionals and must comport themselves accordingly, their tasks are primarily learning oriented; to the extent that they deliver services, such service delivery is considered entirely incidental to the learning process and unrelated to revenue generation. Interns are never expected to assume duties, responsibilities or workloads normally assigned to the professional psychology staff, nor is intern service delivery meant in any way to substitute for staff effort. Interns are expected to work no more than 40 hours per work week with 50-60% of time in provision of clinical services, 10% in supervision, 10% in training, and 20-30% in administrative tasks.
As junior colleagues, interns participate in Psychology’s clinical, administrative, in-service training and staff meetings, take responsibility for certain clinical and training documentation activities and perform at least three service level presentations (e.g. case presentations, seminars, colloquia) during their tenure as an intern at FHCC. Interns serve on a variety of Psychology’s professional committees as full voting members (e.g. Psychology Training Committee-Intern Selection Subcommittee, Intern Rotation Assignment Subcommittee).
At the end of the training year, the psychology intern can obtain their doctoral degree pending completion of their school’s academic requirements, be eligible to sit for the psychology licensing exam, and be ready for a post-doctoral fellowship or entry level employment as an unlicensed/licensed psychologist.
The Psychology Staff of the Lovell FHCC
The Psychology staff is comprised of 43 full-time licensed doctoral psychologists, 4 postdoctoral fellows, 7 Psychology Interns and 1 program assistant. Psychologists operate in a variety of multidisciplinary and interdisciplinary treatment settings as licensed independent service providers with clinical practice privileges. The Executive Psychologist functions as the administrator of the Psychology Professional Community and as the Senior Psychology Consultant to FHCC management.
The broad range of expertise, training backgrounds and experience represented in the Psychology Service staff is reflected in the diversity of their professional duty assignments throughout the FHCC. Staff Psychologists at the Captain James A. Lovell FHCC offer a complete range of psychodiagnostic and behavioral assessment, psychological evaluation and intervention services, as well as consultative and administrative services.
Psychologists provide these services across the entire continuum of patient care (from preventative to aftercare services), and serve as Primary Care Mental Health care providers, as well as in several “specialized” outpatient service delivery settings and inpatient or residential care programs. Psychologists' primary care mental health care activities therefore range from mental health intake, admission and crisis intervention tasks to treatment duties, consultative and administrative tasks in acute and long-term care inpatient mental health and medical programs, and follow-up outpatient therapy in aftercare, such as community based treatment.
Psychologists are also involved in specialized provider activities, such as those of the Primary Care Mental Health Integration team, and with inpatient and residential facility based programs, such as the Post-Traumatic Stress Disorder Residential Rehabilitation Treatment, the Acute and Long-term Substance Abuse Programs and the Homeless Veteran Domiciliary Program. In all of the aforementioned efforts, psychologists participate as both independent service providers and consultants, or as program administrators.
Psychology also operates one “unidisciplinary” program. The Neuropsychology Department administers a broad array of neuro-cognitive, ability, personality, vocational interest and achievement assessment instruments to patients from all over the FHCC on a consultation/referral basis and is staffed by two rehabilitation psychologists and one neuropsychologist.
Role of the Staff
The Director of Training serves as the interns' overall supervisor, advisor and advocate throughout the training year. The Director of Training maintains an open-door policy, and meets regularly with all interns, both in regularly scheduled meetings and informally on an as-needed basis. The Training Committee will also provide guidance to the interns throughout the year.
The professional psychology staff members are expected to provide the intern with viable role models in the areas of:
- Responsible and competent professional practice within the scope of their clinical privileges.
- Caring and respectful treatment of patients, colleagues, interns, other supervisees and staff.
- Adherence to psychology’s ethical principles and standards of professional conduct.
- Participation in professional self-regulatory and self-review activities, as exemplified in the Psychology Peer Consultation Program.
- Commitment to continued professional self-development through participation in training and continuing education activities.
- Promotion of professional autonomy as exemplified in membership in and/or active involvement with local, state and/or national professional organizations and activities.
Clinical training rotation supervisors must limit their supervision to one full-time psychology intern or two half-time interns per rotation. They also must be able to commit to all the required supervisory responsibilities and be readily available for the intern. All licensed doctoral psychology staff members are eligible to serve as training supervisors. Clinical training supervisors may decline the privilege of training supervision; additionally, intern supervision is a privilege that may be denied to individual staff members.Additionally, staff members who function as training supervisors are expected to:
- Be appropriately licensed psychologists, capable of independently supervising interns with minimal consultative guidance from the Director of Training and/or Assistant Director of Training.
- Assist the Director of Training and Assistant Director of Training with program coordination activities by serving on the Training Committee, as assigned by rotation.
- Assess the interns’ level of competence in relation to the program’s Training Goal and Objectives, at the start of training rotations.
- Provide interns with activity schedules and caseloads that are appropriate to their level of competence, optimize their learning and facilitate the achievement of Training Objectives
- Discuss, at the beginning of each training rotation, activity schedule and caseload, expectations for intern performance, methods of performance evaluation and feedback.
- Discuss, negotiate and complete with interns a training contract specifying the training and supervision to be provided, in terms of goals, content, method, and duration, and provide the properly completed, signed and dated training contract to the Director of Training.
- Provide the intern with regularly scheduled, direct (face-to-face) individual supervision for a minimum of two hours a week (more may be negotiated/required, depending on intern needs). Additional informal or unscheduled supervision and such samples of references to the professional literature and other background readings as are pertinent to the training rotation may also be provided.
- Provide interns with timely, regularly scheduled formal feedback, as well as unscheduled informal performance feedback. Feedback should inform interns of their level of performance in relation to agreed-upon expectations and training objectives, and of problems in performance (if any), as well as methods of correcting those problems (if remediable).
- Provide the Director of Training with regular informal updates on their supervisees' progress, performance, and problems (if any) and their remediation.
- Exchange and review with supervisees, at the end of each rotation, properly completed signed evaluations to be forwarded to, reviewed and signed by the Director of Training for 1) transmittal to the intern's graduate program and 2) filing for future reference.
Training Model and Program Philosophy
- NO part-time internship positions are offered.
- The internship is a yearlong full-time training program. It starts Monday, August 15th, 2022 and concludes on Friday, August 11th, 2023. This means that interns may not end their training before the end of the 52nd week.
- The program does not allow “accelerated early completion” of the training year.
- Interns are required to be present on the last day of the 52nd week to “process out”.
- The internship’s duration of 2080 hours fulfills APA accreditation standards as well as the eligibility requirements of all states for professional psychology registration, certification, or licensure.
- Completion of the program requires both full-time attendance and satisfactory performance evaluations on all training assignments.
Number of Intern Positions
- The current number of psychology internship positions at the FHCC is seven, one of who will be in the neuropsychology track.
- The number of internship positions can vary from year to year, depending on annual congressional budget allocations -- Budget allocations are announced in late January of the year in which a new training cycle starts.
- VA Psychology interns are paid as full-time temporary (“term”) employees appointed for one year. Our program does NOT accept unfunded interns.
- The “Per annum” intern salary of $29,164 which includes locality differential, is payable in 26 bi-weekly checks subject to Federal, State, Social Security and FICA withholding.
- Funding is allocated out of VA Central Office. Base VA psychology intern compensation levels are uniform throughout the VA system, and tend to be above the national median.
- Hourly pay for interns is prorated on the basis of a 2080-hour work year.
- Pay may not exceed 40 hours per week. Interns receive pay for the actual number of hours per week that they are in training, up to 40 hours. Hours in excess of 40 per week are unpaid.
- There is no extra or differential hourly pay for overtime or weekends. Unused annual and sick leave at the end of the training year is forfeited.
- Interns do receive regular pay for each of the 11 annual Federal Holidays.
- Interns must spend at least 5/6ths of their required training time on the FHCC’s premises. This allows for up to 320 hours (equivalent to 8 full-time workweeks) of training outside of the FHCC for training with populations not available at the FHCC. To this purpose interns may, with the approval of the training committee, complete a minor rotation at the Evanston Vet Center.
- The intern’s primary responsibility is training. No contingent relationship exists between an intern’s productivity, work output or level of service delivery and the compensation paid. As temporary full-time (“term”) employees their fringe benefits are limited.
- In addition to 11 paid Federal Holidays per year, the VA provides 4 hours of annual leave (AL) and 4 hours of sick leave (SL) per pay-period (i.e. every two weeks). Unplanned federal holidays may also occur such as Christmas Eve and National Days’ of Mourning.
- Health insurance and life insurance benefits are available.
- The FHCC will provide only emergency care for injuries incurred while on the premises during formal training duty hours. Trainees are eligible for COVID-19 care on-site if they become sick while working on-campus. They may also be eligible for on-site COVID-19 testing under certain circumstances.
- Malpractice liability coverage is provided for interns, trainees and staff through the Federal Tort Claims Act of 1956, which provides liability coverage only during duty hours while on the FHCC premises or at the Evanston Vet Center and only within the scope of assigned duties.
Principles and Values
- Preparation for professional practice requires practical experience:
- Albert Einstein is reputed to have said: “Only experience provides knowledge, all else just provides information.” Therefore our internship is about “learning by doing”; it focuses on practical, hands-on, experiential learning, rather than on theoretical/didactic/academic learning.
- Practice and theory inform one another:
- Our internship respects the interdependence of theory and practice. It strives therefore to integrate practical-experiential learning with the interns' prior academic-didactic preparation in the theoretical-scientific foundations of the field of psychology and encourages life-long learning and continued scholarship.
- Preparation for entry level professional practice should be “broad and general”:
- Advanced, in-depth, focused specialty practice training must be built on a solid foundation of broad and general learning. For instance, we believe that to become a skilled professional neuropsychology practitioner one must first be a competent “general” psychology practitioner. Specialty training should be obtained at the post-doctoral level. We discourage narrowly focused technique-oriented training in the belief that it may lead interns to rely excessively on rote technical skills that can impair their abilities to adapt to the continual changes in health care and disadvantage them in the job market.
- Individualized, graduated and sequentially organized learning results in the best practice skills and knowledge:
- Beginning interns vary considerably in their prior practicum and coursework experiences and their didactic and theoretical backgrounds. Our internship therefore strives to build on the intern’s existing abilities and previous learning. We make a sincere effort to provide our interns with tailored, individualized, cumulative sequences of training experiences, which promotes gradual increases in responsibility and autonomy and gives them confidence in their competence.
- Learning occurs best in an atmosphere of mutual respect, courtesy and dedication to improving psychological service delivery:
- Our program therefore stresses information exchange and reciprocal learning rather than a traditional didactic approach. We treat interns as colleagues and professionals to socialize them into their roles as professionals, and require them to demonstrate a sincere interest in the welfare of their patients.
- Practice competence is based on knowledge about, and skills in dealing with, individual differences:
- We believe that the true meaning of the concept of diversity is exemplified in each person being a unique individual. No program of studies can ever hope to provide comprehensive and exhaustive knowledge about every possible origin, cause of, and influence on individual differences. Our program therefore endeavors to teach interns an attitude of openness to and respect for individual differences, combined with a realistic awareness of their knowledge and skill limitations in this area, while stressing the need to continually expand their knowledge of, and competency in dealing with the many determinants of individual differences.
- The internship focuses on experiential training in preparation for entry-level professional practice, i.e. on appropriately supervised “hands-on learning by doing”.
- Experiential training is augmented by other learning experiences, e.g. didactic seminars and lectures, for 3-4 hours each week.
- Time and opportunities to carry out independent research are limited. Interns are allowed to dedicate up to 40 hours (5 workdays) of their training year to the completion of their doctoral research projects, or up to 40 hours towards participation in FHCC approved studies or projects, if they have already completed their doctoral research.
Our Training AIM: To prepare competent entry-level professional psychologists.
Our training aim is informed by and based on the above-listed values and principles. We prepare interns primarily through “learning-by-doing”. Interns receive an organized individualized sequence of closely supervised professional service delivery experiences. These “hands-on” experiences are graduated in complexity, build on abilities and previous learning, and are augmented by other forms of learning. Such learning activities are aimed at expanding interns' theoretical understanding and knowledge and integrating it with his/her professional practice skills and competencies.
The program encourages scholarly interest and provides some time and support for scholarly activities. Its primary focus, however, is on broad and general supervised experiential training in preparation for psychology practice.
By nature of its setting and the VA’s primary and secondary missions (service delivery and training), the program's primary training strengths are in preparing interns for institutional practice in complex comprehensive public health service environments, with ethnically diverse adult patients who suffer from a wide range of physical and mental health problems. Interns may also have opportunities to work with active duty personnel presenting with physical and mental health problems.
The training aim above defines the “long-term expected outcome” of our training program. With an additional year of “on-the-job” supervision and training (assuming completion of doctoral academic requirements), the intern is expected to sit for and pass the professional psychology licensure, certification or registration examination, and enter the practice of psychology as a beginning professional.
The degree to which our training aim is attained is reflected in the number and percentage of interns from our program who have obtained licenses and are employed to practice professional psychology, and serves as our ultimate outcome evaluation index.
Upon completion of the program interns are expected to have demonstrated an intermediate to advanced degree of understanding and knowledge of, or skill and competency in techniques or methods of:
- Integration of Science and Practice
- Ethical and Legal Standards
- Individual Differences and Cultural Diversity
- Professional Values and Attitudes
- Communication and Interpersonal Skills
- Consultation and Interprofessional/interdisciplinary skills
- Patient Centered Practices
These Competencies collectively define the above-described Training Aim. The degree to which these Aims are attained defines the program’s and intern’s expected intermediate and short-term “competency outcomes.”
They are measured and documented in the evaluations each intern receives at the end of each training rotation. The minimum level of achievement required to demonstrate competency is obtaining a score of 4 or higher on all competencies by the end of the rotation. The evaluations form part of the program’s outcome evaluation efforts.
To achieve the training aims we strive to provide interns with opportunities to:
- Transition, in a gradual, realistic and systematic manner, from the student role to that of the beginning professional, by performing of professional duties under professional supervision;
- Expand theoretical knowledge of psychological and non-medical empirical views of human behavior and integrate it with the professional practice of psychology through supervision, didactics and discussions;
- Expand skill and competency in a variety of psychological assessment and intervention strategies, through work with a variety of patients in different settings;
- Learn ways of acquiring knowledge about individual differences and the impact of biological, cultural and other influences on human diversity though didactic seminars and working with patients and other healthcare workers from a variety of backgrounds;
- Become self-aware as a psychologist in different professional roles through exposure to different psychology role models;
- Develop tolerance for the ambiguity, variability and constant change of health care service delivery processes in a complex health care environment;
- Develop increased appreciation of the influence of his/her own personality characteristics, values, beliefs, attitudes and opinions on others, and gain a realistic awareness of the limitations of her/his professional practice competency;
- Gain confidence in his/her competence as a beginning independent practitioner, combined with confidence in her/his ability to learn what still needs to be learned.