Captain James A. Lovell Federal Health Care Center
Each intern’s graduate program is informed of the intern having been selected for training and a training needs assessment is solicited. Intern progress is communicated in the form of copies and/or summaries of rotation evaluations received by the intern for rotations completed to date, or on evaluation forms provided by the intern's graduate program. Additionally, informal communication is maintained by telephone or in writing, on an “as needed” basis. Interns' Academic Advisors or Clinical Training Directors are encouraged to site visit, evaluate and review our training program at least once during their interns’ tenure -- such visits maintain and enhance our contacts with our interns’ graduate programs. Unfortunately, we are unable to help defray expenses for such visits, due to budget constraints.
Training Schedule and Rotations
The Lovell FHCC Psychology Training Program achieves its training and educational goal and objectives by assigning interns to specific training "rotation" experiences. A rotation is defined in terms of duration, physical setting, patient population served, major intervention objective(s) and clinical assessment/treatment modalities used. The psychologist(s) in each rotation setting serve(s) as primary clinical supervisor(s) for all knowledge, skill and competency training areas pertinent to that rotation.
In addition to the major supervisor(s) in the rotation setting, interns may obtain additional consultative input from psychology staff in order to receive exposure in specific skill training areas.
The 52-week training year is divided into a 4-week orientation period followed by three 16-week clinical training rotation periods. A period of 16 consecutive weeks of full-time training is known as a “major” rotation. All interns are required to complete three major rotations, or two major rotations with the remaining 16-week period divided into two “minor” rotations. These rotations can either be completed as two consecutive 8 week training periods or completed concurrently (“split”) with other minor rotations on a “half-time” basis (i.e. 16 hours per week in each setting) for 16 weeks. Due to the nature of certain rotations, not all rotations can be offered as minors. Supervisors will notify trainees of the availability for minor rotations at the beginning of the training year. Additionally, since direct patient care should make up at least 50% of the trainees experience, the Administrative and Leadership rotation can only be offered as a minor.
Rotations allow interns total immersion experiences in treatment settings and ongoing clinical activities. This, in turn, facilitates the integration of the intern's professional psychology skill acquisition with a realistic understanding of the health care delivery system. It also provides opportunities for and socialization into a health service delivery environment in different settings and circumstances while interacting with members of different health care disciplines. Additionally, the rotation system allows for the development of in-depth supervisor-intern relationships and provides the intern with multiple professional role models, varied forms of clinical expertise and different patient populations. Finally, rotations provide interns with opportunities for socialization into the profession of psychology, through the process of "role transitioning," from the student role to that of the beginning professional.
Assessment of Training Needs and Rotation Assignment Policy
The assignment of interns to training rotations for the training year is based on the four factors listed below:
- The intern's stated training needs, professional goals and interests; prospective interns are asked to assess and document their prior clinical training and indicate areas of strength and weakness and career goals.
- The intern's training needs as perceived by his/her graduate advisor or program director; formal and informal inquiries are made from the intern’s academic representative(s) at the beginning of the training year to determine the intern's training needs.
- The intern's training needs, as perceived by the Director of Training and the Intern Rotation Assignment Subcommittee of the Psychology Internship Training Committee.
- Constraints and limitations imposed by staff, time, and resource availability.
Members of the Training Committee, including the Training Director and Assistant Training Director make-up the Intern Rotation Assignment Subcommittee and that committee meets with each intern at the end of the orientation period. The Rotation Assignment Subcommittee uses information received from the supervisors of the intern’s two to three 3 day mini-rotations, which are used to assess basic clinical skills, as well as the information from steps 1 through 4 above, to negotiate a rotation plan with the intern and recommend the rotation assignments for the training year. The rotation plans are then approved by the Rotation Assignment Subcommittee in collaboration with the Interns. Once each intern’s rotation plan and training goals and objectives are approved the Training Director makes copies of the plans and gives the interns a copy and places a copy in the intern’s file. The training plans are also shared with Supervisory Psychologists and the Training Committee. Finally, the Training Director drafts an Intern Rotation Assignment memorandum that is sent out to all interns and the entire psychology community at Captain James A. Lovell Federal Health Care Center informing every one of the Internship Rotations each intern will be completing during the training year.
Rotation Training Contracts
Each intern must negotiate a training contract with the supervisor(s) of the assigned rotation(s) during the first week of each rotation. The Director of Training and the parties then review the training contract and formalize it. The training contract “operationalizes” the training experience the intern is to receive. It briefly defines the methods of evaluation and performance feedback to be used to assess and communicate the intern's progress, performance and competence. Training contracts may also be used to address potential problems in meeting training objectives, as well as in remedial interventions for problems and/or performance deficits, if any.
Training Requirements and Constraints
- All interns are required to participate in administrative and training experiences during the first weeks. During this period, they have an opportunity to meet and talk with all Psychology staff, visit all rotation settings, receive safety and other mandatory employee training and become familiar with the FHCC, its layout, and resources.
- During the first month of training, all interns are required to do “mini-orientations” in two particular rotation areas to which they are assigned by the training director. These two weeklong orientations serve to familiarize interns with the patient population of the FHCC and allow the interns to be evaluated for basic clinical skills and training needs. During this period interns must review their training needs, start to formulate a proposed rotation plan to fulfill those training needs and make inquiries as to the availability and willingness of the training supervisors with whom they propose to take those training rotations. This includes meeting with the training supervisors ahead of time to ensure the rotation is able to meet the trainee’s needs and goals. Final assignment to those rotations is contingent on the concurrence of the Intern Rotation Assignment Subcommittee and the approval of the Director of Training.
- All interns are required to participate in two “major” rotations. The remaining training time will consist of either one other major and or two “minor” rotations. Rotations are assigned to assure broad and general training. Rotation schedules must reflect training exposure to different patient populations and do not allow interns to “specialize”. This means that interns are limited to one major rotation per “special” patient population (e.g. Substance Abuse, PTSD). We also require interns to select training plans which are varied in terms of age-ranges, settings (outpatient, inpatient, residential), and specialties (health, addictions, trauma). Additionally, we view this year as the last year to fill in knowledge/training gaps. We will, therefore, require justification as to how each rotation addresses identified areas of growth from the interns’ self-assessments. All rotation training plans are subject to approval from and modification by the Rotation Selection Committee to ensure the interns’ training year is reflective of our principles and values.
- As rotations are tailored to individual interns’ needs there is no “standard” rotation schedule or sequence. Schedules therefore vary for each intern. Each rotation will include individualized assessment/testing and intervention training. All rotations and their patients are unique: learning within each is graduated and cumulative.
- All interns will be assigned “long term” individual psychotherapy responsibilities for at least three to five patients during the training year.
- All interns will be assigned a practicum extern to supervise for the year. Interns will serve as the evaluative supervisor for the extern’s psycho-diagnostic assessments. The interns are expected to shadow at least two of the extern’s diagnostic interviews, proof-read all psycho-diagnostic assessments, approving them for final input in the patients charts, and ensuring all necessary intake paperwork is completed in a timely manner. They will also be responsible for completing the extern’s assessment competency evaluations throughout the year. The intern will additionally serve as a peer/mentor supervisor for the extern’s clinical cases. This will consist of meeting with the extern at least every other week to consult and support the extern in his/her/their clinical work. Lastly, the interns will co-lead the extern group supervision weekly. This may include developing didactic materials and leading case presentations.
- All interns will also be required to complete Specialty Medical Exams (SME) throughout the year. The Special Medical Examinations (SME) Clinic offers interns experience in conducting Veteran and Active Duty disability examinations to enhance and refine their diagnostic interviewing and assessment skills. In particular, interns will be provided opportunities to conduct diagnostic clinical interviews, review claims folders, military treatment and personnel records, conduct chart reviews and write final reports as part of the examination process. The SME Clinic offers the opportunity for trainees to further develop their understanding of the role of diversity and context in shaping assessment and the veteran/service members experiences and interactions with others. Interns will be given time to complete online Compensation and Pension Examination Program (CPEP) certification courses before conducting examinations, as well as developing competency with specialty software (CAPRI) and certifications for these exams. It is expected that the intern will develop enhanced assessment abilities and proficiency with the DSM-5, formulate opinions about the etiology of veteran/service members’ current mental disorders, gain competency in determining levels of functional impairment related specifically to claimed mental health conditions, and synthesize various sources of information into an integrated report. Readings and related certification training are also used to reach learning objectives. A minimum of one hour of supervision per exam will be completed surrounding case conceptualization and written assessment. Supervision will be provided by experts in assessment and disability/forensic examinations.
- All interns will be required to complete 3 integrated assessments. The definition of an integrated psychological testing report is a report that includes a review of history, results of an interview and at least two psychological tests from one or more of the following categories: personality measures, intellectual tests, cognitive tests, and neuropsychological tests. The intern can select a testing case from one of their long-term psychotherapy patients, rotation patients, or can ask for cases from the Neuropsychology Testing Department. The intern will be assigned an assessment supervisor at the beginning of the year and the intern will meet with the assessment supervisor on an as-needed basis to complete the testing requirement. The assessment supervisor will have input on the interns’ Training Director evaluation completed at the mid-way and end-of-the year points. They will need to get a score of 4 or above on all assessment competencies to complete this requirement.
- All interns are required to complete a diversity project. The Intern Diversity Project offers interns simulated learning opportunities to recognize diversity processes in their daily lives, increase introspection and inspire taking an active role in challenging personal and institutional bias and privilege. Through the use of a multiphasic developmental model, trainees will investigate and apply interventions that address gaps in clinical care and assessment pertaining to diversity and mental health. Interns will apply framework for effectively working with diverse populations not previously encountered over the course of their careers. During this project, interns are encouraged to participate in the following activities;
- Discussion Groups: monthly, one hour, intensive small group experiences aimed at personal growth through expanding awareness, exploration of intrapsychic as well as interpersonal issues in relation to various aspects of diversity. Readings will include a sampling of theory, research and media regarding how culture shapes psychological experience and behavior are used to reach learning objectives. Groups are facilitated by a Clinical Psychologist and are NOT framed or facilitated as group therapy. Please note, this is an optional opportunity. If you choose to participate, we ask you attend the group for the remainder of the year and complete a one page, double spaced reflection statement on a diversity topic of choice for every two Encounter Groups that are missed. Process groups are evaluated on participation only and not on the content discussed in the group. If you opt to not participate in the process group, we ask you complete a ten page, double spaced reflection paper on a diversity topic of your choosing in its’ place.
- Rotation Diversity Integration: The Intern will work collaboratively with each of their rotation supervisors to identify, develop and implement a clinical or programmatic diversity initiative. Initiatives are expected to provide the opportunity for greater learning in the areas of self-reflection, scholarly awareness, integrative clinical application and effectiveness in addressing diverse populations. The opportunity for shared learning will be facilitated through a brief presentation (5-7 minutes) to their intern cohort, training leadership and respective supervisors at the end of each rotation during a Friday group supervision. Seminar feedback forms will be completed for the presentations. Additionally, rotation supervisors will evaluate Intern performance on the initiative as part of the Intern Evaluation Rotation Form: III. Individual Differences and Cultural Diversity.
It is expected that the intern will build cultural competence and cultural humility, appraisal of personal areas of growth in approaching diversity issues and skills with creating systemic change in various clinical rotations. Intervention and response regarding Psychology Intern performance will be addressed in accordance with the Lovell FHCC Training contract. Overall evaluation of the Intern Diversity Project will be included as part of the APA training guidelines for Cultural Competence. Facilitators of the Intern Diversity Project will provide additional feedback to the Intern Training Director and Assistant Training Director. Participation and rotation evaluations will be considered in the Intern Final Evaluation Form completed by the Training Director or Assistant Training Director at the end of the year. Facilitators: Kelly Hoffmann, Psy.D., ABPP, Jeffery Vergo, Psy.D., and Suchi Daga, Ph.D.
Didactics, Other Training Events and Learning Activities
The Psychology training calendar offers a series of short (1-4 session) bi-weekly Clinical-Professional Issues Seminars on a broad variety of topics in professional psychology, presented by psychology staff members, as well as occasional seminars or workshops presented by outside consultants when funding permits. Additionally, the training calendar provides for a bi-weekly clinical Case Conference Seminar in individual therapy and assessment, at which interns present cases with group/peer supervision. Intern attendance at psychology training calendar events is mandatory.
Didactic and other non-rotation based learning activities are typically conducted on Friday mornings (0900 to 1200 hours) -- Interns are requested to plan their leave and other absences accordingly. The hours required for these activities are subsumed under the interns' current rotations for time accounting (i.e. rotation duration) purposes. Research activities, holidays, annual leave, authorized absences and sick leave are similarly subsumed under the interns' current rotations for time accounting purposes. Interns are requested to distribute their absences throughout their training year so as to optimize their rotation exposure.
Interns are also occasionally required to attend a variety of mandatory non-psychological “Employee Education” training events sponsored by the FHCC or VA Headquarters. Examples of such events are Suicide Prevention Training, Diversity Training, Safety Training, Sexual Harassment Prevention Training, Computer Security Training, Customer Service Training, etc. Additionally, computer-based Employee Education modules may have to be completed as required by the FHCC (For Example: Telehealth, Comp & Pen Evaluations, Suicide Prevention Initiatives, scheduling training, etc.). The training program makes every effort to restrict or eliminate the amount of non-psychological trainings the interns are required to participate in, especially if they don’t service their training as psychologists. However, at times, these trainings are required by the facility in order to provide certain services such as C&P exams or tele-mental sessions, which would ultimately advance the intern’s learning. The time these events require is also subsumed under the interns' current rotation.
Training Sponsored by Other Disciplines or Outside the FHCC
The FHCC's many professional services each have their own training calendars, providing opportunities to attend numerous educational events throughout the year. Interns are encouraged to attend such extra-service events when appropriate to their training assignments. Interns are also encouraged to attend professionally relevant training events conducted and sponsored by psychology organizations outside of the FHCC (i.e., workshops, conventions) during weekends or approved research time. While interns may not receive pay for attending such events, they may receive credit towards the number of certified internship hours required for licensure.
A word of caution is in order, however. Due to the multitude of training events sponsored by other disciplines and professions at the FHCC throughout the training year, attending even a small portion of them could easily result in spending 40 hours per week at seminars, workshops, presentations, etc. Interns are reminded that the primary purpose of their internship is “hands-on” practical and experiential training, and that this should be reflected in their spending the bulk of their time and effort on their assigned training rotations, engaged in supervised service delivery activities. Attendance at training events that are not on the Psychology or FHCC mandatory training calendars should therefore always be cleared with the rotation supervisor, entered as official leave or authorized absence requests and approved by the Director of Training.
Interns and trainees at Captain James A. Lovell FHCC are encouraged to pursue opportunities for continued professional growth through scholarly activities such as research involvement, within the limited amount of time allotted for such activities. The resources available at the FHCC and affiliated institutions offer some opportunities for research in both basic and applied areas. The patient population served by the FHCC represents a subject pool that is sufficiently varied and large to accommodate a wide range of research interests. Psychology staff and faculty at affiliated institutions are often themselves actively involved in research and welcome the involvement of interested interns. The majority of psychology staff members hold adjunct or clinical appointments at one or more institutes of higher learning and several staff members contribute to the field through professional publications, presentations, workshops, symposia and seminars. Additionally, occasional opportunities arise for involvement in program evaluation projects as part of the Psychology’s and the FHCC’s ongoing quality management activities.
Interns may receive assistance with their scholarly efforts in the form of consultation from staff, computer access, library literature searches, IRB, etc. Most past interns who have taken advantage of the allotted research time and available resources have done so through completing their doctoral dissertation or doctoral comprehensive research projects.
To facilitate interns’ completion of degree requirements, interns may use up to 5 workdays (i.e., 40 hours) of research time for approved doctoral dissertation projects. For interns who have already completed their dissertation, up to 5 working days or 40 hours are allowed for the conduct or completion of VA-approved research projects.
Research time is allotted with the understanding that the intern will spend at least the equivalent number of hours pursuing the research during off-duty time, off the FHCC’s premises. "Research" is defined as the actual conduct of studies (i.e., running subjects, analyzing data, writing results) and assumes the presence of an approved proposal/prospectus. Preliminary literature searches, proposal writing, or "thinking about a project" do not constitute creditable research activities.
Interns receive a total of four hours of supervision per week in accordance with APA requirements.
Formal "one-to-one" supervision is set at an absolute minimum of two scheduled hours per week: one hour with the rotation supervisor and one hour with either the Training Director or Assistant Training Director. Interns negotiate with their rotation supervisors the amount, type, level and additional duration of individual supervision and feedback needed. Interns often negotiate and receive more individual supervision (ranging from 4 to 6 hrs/wk.) earlier in the year and reduce supervisory hours later in the year. Supervision will also typically be more intensive at the beginning of each rotation and at the beginning of the training year, and will become less intensive as the intern displays increasing levels of knowledge, skill and competence. Towards the end of the training year the intern is expected to function with considerable independence, using his/her supervisor mostly as a consultative resource, rather than in a traditional supervisory mode.
Additionally, extensive amounts of informal and unscheduled supervision are provided by supervisors, through staff meetings, team meetings, and rounds and in the form of group supervision during a bi-weekly three-hour, yearlong group supervised case conference seminar. Supervisors are expected to provide, and interns are encouraged to solicit, ongoing verbal performance feedback throughout the rotation. Similarly, interns are encouraged to seek supervision and consultation when they feel the need, in addition to the formally scheduled supervision periods. Unscheduled supervision must total one hour, if there are not two hours of scheduled rotation supervision.
Interns will participate in a mandatory group supervision for one hour each week that is led by the Training Director and Assistant Training Director.
In certain rotations, interns have opportunities to teach in the form of staff in-service training events or patient education classes. The interns will also be required to supervise at least one psychology extern over the course of the year. Additional supervisory experiences may present themselves, depending on the interns’ chosen rotations.
Requirements for Completion
The Training Year
The training year is defined as 52 weeks, from August 15th, 2022 to August 11th, 2023. Federal holidays (11 workdays), absences due to annual leave (13 workdays), sick leave (13 workdays) and research days (5 workdays) are included in those 52 weeks. For time accounting purposes, leave and other absences are assumed to be idiosyncratically distributed throughout the training rotations and are included in/counted as part of the duration of the rotation in which they occur. Interns should use planned absences judiciously and are not allowed to curtail their training year by ‘saving’ leave days in order to finish the internship in less than the 52-week time span allotted. Leaves should be planned to minimize absences during mandatory training experiences. There is no reimbursement for Annual or Sick Leave not used by the year’s end. A “Certificate of Internship” is issued upon successful completion of the program. "Graduation” occurs in late August, and must be attended by all interns.
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.
It is expected that, upon completion of the program, all interns will demonstrate competence in the following general areas. 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. This category may include, but is not necessarily limited to, the following skills:
- Integration of science and practice
- Ethical and legal standards
- Individual differences and cultural diversity
- Professional values and attitudes
- Communitcation and interpersonal skills
- Consultation and interprofessional/interdiscplinary skills
- Patient centered practices.
Evaluation of Training Outcomes, Processes and Resources
At the end of each rotation, the intern receives an evaluation in combined checklist/narrative form from his/her supervisor, addressing the intern’s performance in relation to the program’s training objectives. The rotation evaluations serve both as a method of intern performance feedback and as a measure and documentation of training outcomes, i.e., the degree to which training objectives have been met. These evaluations of interns’ clinical rotation performance (i.e., demonstrated knowledge and skill) rate the intern in terms of competence and professional attributes. The rotation evaluations are a component of the program’s “outcome evaluation” efforts. Evaluations are forwarded by the interns to their academic program to provide it with feedback on the interns’ progress, and filed with the intern’s records for future reference.
The intern similarly completes an evaluation of the supervision received at the end of each rotation. Supervisor and intern are expected to exchange their evaluations of one another, to discuss and sign them and to forward them to the Director of Training for review and concurrence. Evaluations of supervisors are part of the program’s efforts at “resource evaluation” as well as “process evaluation.”
At their option, interns are allowed to utilize group supervision for support, socialization, program evaluation and feedback purposes. Additionally, interns have the option to conduct a year-end retreat, during which they are expected to assess and evaluate their internship training experience and feedback about their impressions of the program.
A global assessment of the internship program, in combined structured and narrative form, is solicited from the interns at the year's end, as another part of the program's systematic efforts at self-evaluation. The year-end evaluation contains both “process evaluation” and “resource evaluation” components. Information gleaned from the various evaluations is reviewed, analyzed and utilized to make adjustments in the training program.
IMPORTANT NOTE: Continual changes in public and private sector health service delivery systems also affect the Veterans Health Administration and the FHCC. Interns are reminded that there may be changes in the administrative and organizational structure of this training site that are beyond the control of the Internship Training Program and may affect its training resources, processes and program structure.