Doctorate of Psychology in Clinical Psychology (PsyD) Clinical Training Manual

Revised June 2023

CLINICAL TRAINING MANUAL

Clinical Training Model - Evaluation of Progress - Clinical Practicum Sites

CLINICAL TRAINING MODEL

The competencies that students need to develop to become professional psychologists are multiple and complex. These competencies are only developed through practical experiences in supervised contexts. Therefore, the clinical practice component of the Clinical Psychology program of Ponce Health Sciences University (PHSU) pays special attention to the processes through which students develop the competencies of the profession. Specifically, our model stipulates that graduates will be proficient in building relationships, especially with those suffering from psychological distress. They will be able to utilize their relationship skills to perform evaluations of patients’ circumstances and of their psychological functioning. Our students will develop competencies in the administration and interpretation of psychological tests. Likewise, students will acquire intervention competencies in a range of approaches and modalities, which are a significant component of the clinical skills available to professional Clinical Psychologists.

To achieve the goal of providing its students the clinical skills of the profession, the Clinical Psychology Doctoral Program at PHSU offers its students the following experiential components:

1. Practicum seminars emphasizing clinical skills.

2. Clinical practice in designated practicum sites.

The practicum component of the program is structured in a sequential manner in order to foster the progressive acquisition of clinical skills. The sequence is as follows:

During the first semester of the first-year students register in PSY 5810, through which they develop basic interviewing and clinical skills.

For the second semester of their first-year students register in PSY 5820 and complete a minimum of 50 hours of clinical instruction. This experience includes the opportunity to practice clinical skills within the safe environment afforded by the Standardized Patient Program.

During summer after first year, students take PSY 6870. This seminar serves as a bridge between the two introductory clinical practice seminars offered during the first year and the sequence of model-specific therapy courses of the second-year curricula. This introductory seminar focuses on how to begin a psychotherapeutic process. Students will learn how to begin the psychotherapeutic journey with patients, what they need to do along the way, and how to assist patients in their self-exploration and growth-enhancing healing process.

During the two semesters of the second year, students complete 400 hours of clinical practice in a designated clinical site and 100 hours of academic instruction while registered in the PSY 6830 & PSY 6850 clinical practicum and seminars. The clinical experiences in practicum sites allow student to gain further exposure to clinical work and to spend more time in the acquisition and refinement of clinical skills. PSY 6850 focuses on the development of conceptualization and basic intervention planning skills. Students have the opportunity to practice case conceptualization and treatment planning skills in their practicum sites. These skills are taught within the context of managed care and of the recent emphasis on integrative health care delivery systems. The instructional component of PSY 6830 focuses on the discussion and application of interventions, especially of psychotherapeutic techniques. At their practicum sites, students perform intake assessments, mental status examinations, case conceptualizations, treatment plans, and provide individual or group psychotherapy. During the second semester, they may also conduct cognitive assessments. All students are supervised by an on-site licensed clinical psychologist.

During the first semester of the third year, students again have the opportunity to practice their clinical skills, in a different setting. At this level of the training sequence, students register in the PSY 7860 seminar, which is designed to assist students in learning to integrate acquired knowledge with diagnostic and general clinical skills. At this stage of the program, every student has approved the cognitive and personality evaluation courses. It is expected that the student will utilize these skills throughout the third year to gain a better understanding of the cases seen at their practicum site. The didactic component of the practicum seminar also focuses on exposing students to empirically validated procedures. While at their practicum sites, students continue to meet weekly with their supervisors to discuss their clinical experiences and to continue with the development of advanced skills in the integration of clinical data and in implementing intervention strategies and techniques. Additionally, during this third year, and before submitting the APPIC application for pre doctoral internship, students must meet the policy of Psychological Testing (Appendix E).

During the second semester of the third year, students will be exposed to a more advanced level of clinical integration. The General Clinical Practice: Integration II (PSY 7870) seminar explores the different types of interventions supported by empirical evidence as presented in the textbook “Clinical Handbook of Psychological Disorders: A Step by Step Treatment Manual” by Barlow, (2008 & 2014) and “A Guide to Treatments That Work” by Nathan and Gorman, (2015)”.

The program offers a sequence of elective practicums. These practicums provide students with additional opportunities to develop their clinical skills and to explore additional areas of interest. Also, these practicums allow students additional exposure in specialized areas of the profession. The sequence of elective practicum begins during the summer following the second year. The General Clinical Practicum (PSY 7810) and the Advanced Clinical Practicum I (PSY 8810) are available for students during the summers of second and third year respectively. The Advanced Clinical Practicum II (PSY 8820) and the Advanced Clinical Practicum III (PSY 8830) are available to students that want to expand their clinical experiences during their fourth year. The Advanced Clinical Practicum IV (PSY 8840) and the Advanced Clinical Practicum V (PSY 8850) are available to students who want to expand their clinical experiences during their fifth year. These practicums allow students to gain additional exposure to specialized areas or to further strengthen general clinical skills in a setting different from the one selected for the previous semester (Appendix F).

Students will complete a minimum of 1,100 hours of practice before entering the doctoral internship. For each practicum experience, students should complete 100 face to face contact hours for a minimum of 400 face to face hours for all practicum experiences. These face to face hours includes clinical intake, crisis interventions, psychotherapy (individual, group, couples and family), shadowing and testing. The shadowing hours will amount to .5 of the total reported (e.g., of 20 shadowing hours reported, 10 will account as face to face). Record keeping, case management, training, administrative services, staff meetings and supervision hours will be recorded as supplemental hours. If the student cannot complete the 100 face to face contact hours per semester, the Coordinator of Clinical Practice (CCP) and the student will sign an agreement stating the amount of hours owed for the semester and the specific plan to complete them. The plan may include a summer rotation or a practicum placement during the fourth year. The agreement is to be reviewed every semester.

EVALUATION OF PROGRESS

Student Evaluations

• Students receive two performance evaluations from their site supervisor during each semester. The first evaluation is conducted at mid-semester (beginning of October/March) and the second at the end (December/May). The evaluation form is included in Appendix B.

Evaluation of Students Professional Competencies

• The supervisor should also complete and submit the Evaluation of Students Professional Competencies Form (Appendix C) for each supervisee at least once during the semester. Any concerns in this area will receive immediate attention by the CCP and the program administration.

Site and Supervisor Evaluation

• The student will evaluate the practicum site and the clinical supervision received at the end of the practicum experience. The evaluation form to be used is found in Appendix D.
• Students enrolled in clinical practice are responsible for obtaining and submitting the evaluations and other requirements of the practicum to the CCP in a timely manner. No grades will be posted in a student’s transcript until all evaluation forms are turned in.

Grading of Clinical Practice Seminars

• The practicum hours are credited by the office of the CCP, based upon the practicum log in Time2Track. The student’s clinical supervisor signs this log, and the student must submit it to Time2Track system each month. By the end of the semester, the CCP informs the professor of the practicum seminar about the student’s performance in their practicum site and the number of hours completed. If the student’s performance is evaluated as satisfactory by the practicum supervisor and the number of hours logged for the semester is acceptable, the CCP will certify the student’s approval of the practice and of the seminar by using the designation “Pass” (P) or “Not Pass” (NP). A satisfactory evaluation is at least 3 in each section. The description of the score is as follows: 1= Very Poor: Performance well below expectations; 2= Below Average Performance: Below expectations for a trainee at this level; 3=Adequate performance: Comparable to others at this level of training, trainees’ demonstration of skills is solid/adequate; 4=Above Average performance: Above expectations for trainee at this level; 5=Outstanding performance: Exceeding expectations for a trainee at this level and Not Applicable (N): This specific item was not observed in this practicum site.

Remediation of clinical skills deficiencies

• A grade of No Pass will require a remediation of clinical skills. Deficits detected through clinical practicum are required when ratings on the Student/Trainee Evaluation Form, and Evaluation of Students Professional Competencies indicate unsatisfactory performance (Total score less than 3 in each section). This procedure is also activated when unsatisfactory performance is detected through any other written evaluation method in use at any practicum site, in addition to the Student/Trainee Evaluation Form. Based on the information collected, a remedial plan is developed by the CCP in consultation with the student’s practicum supervisor and academic advisor. The student receives a letter from the CCP stating the steps to follow to benefit from the plan, the expected amount of time required to complete, and the possible consequences of non-compliance, including a referral to the Students Promotions Committee for consideration of other actions that may include dismissal from the program.

Procedure to follow when students present health problems during clinical practices

• The whole health of each student is vital to obtaining an adequate supervised practicum experience. We strive to ensure the well-being of students, supervisees, and the people who receive our services. For such purposes, we adopt the following procedures when health problems arise during practicum experiences:

• When the student, administrator of the site, or supervisor identifies that any practicum student is experiencing a health problem of a physical or emotional nature, they must ensure that such student receives the necessary medical/psychological care and keep the recommended rest. If the condition requires more than two weeks of rest, it is recommended that the student applies for a Leave of Absence (LOA). To be able to return to their site, the physician or psychologist who provides the health services must certify that the student is ready to retake their practicum responsibilities. The academic advisor must be aware of and collaborate in the necessary coordination to support the student in the required process. The supervisor and the student (to the extent possible) will be responsible for ensuring the transfer of patients as necessary.

• The Practicum Coordinator must be notified of each case and will meet with the parties to clarify any doubts. She/he will inform the program director and recommend a referral to the counseling department as deems necessary. The director should use the Student Assessment Committee (SAC) referral form for such a purpose.

• Students have the responsibility to notify the supervisor of any physical or emotional health issues limiting their practicum experience. Practicum students must also abide by supervisors’ recommendations at the site or in the academic program about remaining or not in the practicum site during the corresponding semester. As far as possible, the student must collaborate to transfer the cases they are assisting. Under no circumstances will the safety or the best well-being of patients be put at risk.

• If a practicum student refuses to follow this policy and procedure or the recommendations offered, it will be treated as a professional behavior fault. The program director or the SBBS dean could refer the student to the professional conduct committee (PCC) for evaluation and recommendations. Based on the advice of the PCC, the dean will decide the action to be taken, which may include a referral to the Promotions Committee with a recommendation of dismissal from the academic program.

Steps to follow in case of ethical breaches or perception of discrimination in the practice center:

1. Familiarize yourself with the policies, regulations, or protocols of the practice center. This is to understand the steps to follow. If they don’t exist, you can proceed to step two.
2. If the situation is related to the practicum site itself (and does not involve supervision), notify the person responsible for your supervision verbally and in writing. If a satisfactory solution is not reached, you can proceed to step three.
3. If the situation involves supervision, notify it in writing by sending an email to request a meeting with the coordination of clinical practices, your academic counselor, and at least one representative from the faculty’s diversity committee.

CLINICAL PRACTICUM SITES 

Clinical Psychology Practicum Sites - Puerto Rico  - Clinical Psychology Practicum Sites - St. Louis, MO  

Affiliation

• Each practicum site has an affiliation contract with PHSU. The CCP is responsible for coordinating contracts, handling issues related to students’ malpractice insurance, assigning students to their practicum sites, and securing all pertinent documentation related to students’ practice. Any situation related to students in practicum or to their practicum sites will be reported to and handled by the CCP.

Criteria for certification of practicum sites

• To assure the availability of adequate training sites, PHSU has engaged in multilateral affiliations and agreements with local and national agencies and organizations. The primary focus of these organizations is the delivery of health, mental health, and psycho-educational services to their constituents. These organizations provide the resources needed by our students to develop their clinical and intervention skills and to forge their identity as professional psychologists. To achieve this goal, practicum sites must satisfy the basic requirements set forth by our program. These requirements are:

  • The site must be engaged in the delivery of health-related, educational or social/community services to individuals, couples or families.

  • Licensed health professionals must conduct administration and staff supervision.

  • The training site must abide by the appropriate standards of safety that protect students, employees and the persons served from potentially dangerous or risky situations.

  • An individual within the organization is designated to supervise and facilitate the student’s training program. This person should be a licensed psychologist with a doctoral degree.

  • There might be instances in which the requirement of a psychologist with a doctoral degree may be waived, given the characteristics or experiences obtained in the practicum site. In case that a licensed psychologist with doctoral degree is not available on site, two requirements must be met:

    •  A licensed health or mental health professional will provide all the guidance and support required for the assignment of cases and will guarantee that students have all the resources needed to benefit from the practicum experience.

    • The student will be supervised on a weekly basis by an assigned field licensed supervisor. An organization may request that a particular student is assigned to the site, based upon mutual interests. However, no student will accept or ask to rotate through a practicum site without the consent of the CCP.

In order to provide diverse experiences, students are usually not allowed to remain in the same practicum site for more than one semester. Nonetheless, under special circumstances, this requirement may be waived. The training experience begins and ends according to the calendar of each training site. Those training calendars do not necessarily correspond to the academic calendar. Students cannot practice in any site without previous authorization from the CCP and/or the Program Director. This policy includes summer research experiences in or outside the Program. Students are not allowed to continue providing clinical services to the center’s clients after completing their rotation every semester.

Primary Responsibilities of Practicum Supervisors

• Provide guidance and advice to students throughout their training and serve as professional mentors.
• Enable students to become thoroughly familiar with the policies and procedures of the practicum site.
• Develop graded, sequential experiences for students that will prepare them to assume entry- level responsibilities within the field of Professional Clinical Psychology.  
• Complete, with the student, the “Students Practicum Contract” (Appendix A) and provide the expected amount of weekly individual supervision of at least 1 hour.
• Screen and assign to students’ cases of adequate levels of complexity.
• Review the cases assigned to students on a regular basis.
• Verify that the student completes all forms and required paperwork. 
• Address in supervision sessions the scientific basis of clinical psychological practice, professional ethics, and topics related to managed care and its effects on healthcare systems.  
• Provide guidance and encouragement for students to progressively acquire independence in their clinical functioning.
• Keep the student, as well as the CCP, informed as to the student’s progress through both, formal evaluation forms and through informal verbal feedback. 

GUIDELINES FOR CLINICAL PRACTICE ETHICAL STANDARDS

Students will abide by the ethical standards of the American Psychological Association with regards to professional behavior and to delivery of clinical services. Students will follow all rules and regulations of Ponce Health Sciences University and will conduct themselves according to applicable legal standards. Any concern about the student’s professional behavior in the clinical setting will be addressed according to PHSU policies and due process. The safety of clients and issues related to dual relationships are considered to be among the most important aspects of ethical behavior to be observed by all students. It is the responsibility of the students to evaluate for the presence of dangerousness to self or others in the clients served. Likewise, situations of child or elderly abuse need to be reported according to the applicable law. Issues of domestic violence and of abuse to women and children in any form will be handled with utmost care.

DRESS CODE

The way in which a student dresses to attend their clinical sites has particular significance at different levels. Adequate clothing transmits a sense of professionalism and respect for patients and for the professional staff of the training site. Attire should be consonant with the setting of practice, with the weather and the time of the day. Shorts, running shoes, blue jeans, women pants that are skin-tight, or clothes that excessively expose portions of the body (except arms and legs from the knee down) are not acceptable clothes to be wear on a Practicum site. However, sites that serve children predominantly usually tolerate (and at times require) less formal attire and running shoes. Male students are encouraged to use long or short leaves shirts with tie.

DOCUMENTATION OF CLINICAL ACTIVITIES

The student will document each intervention performed with a patient, with his/her collaterals or with any other person involved in the case. The SOAP model is recommended to orient progress notes. The DAP model is likewise acceptable. However, the student will utilize whichever system is utilized or required by their Practicum site. When the Practicum site does not promote a particular system, the student is expected to utilize SOAP (preferably) or DAP. The student needs to remember that failure to document sessions or crucial information about patients being served constitutes a serious infraction of the ethics of clinical practice.

SUPERVISION

Each student will have at least one hour of individual supervision each week. The student may cancel a supervision appointment but only when the circumstances that prompted such cancellation justifies such action. Any supervisor may require objective proof of such justification. All supervisory session will be documented and countersigned by the supervisor. Students must receive at least one direct/in vivo supervision per semester.

DOCUMENTATION OF TIME IN CLINICAL TRAINING

Students will enter their clinical practice hours through their Time to Track accounts. This service is included in all students’ fees and except for extraordinary circumstances, no paper logs are accepted. Students receive a thorough orientation to the use of this system prior to beginning their first practicum. The CCP and the Assistant Dean for Clinical Training serve as system administrators for students’ accounts and provide guidance and assistance in the use of the system.

EVALUATION FORMS

Besides the monthly log, students in practice have the responsibility of obtaining and submitting on time to the office of the CCP, all the required evaluations in original.

• Teaching-Learning Contract: at the beginning of every year (Appendix A)
• Site and Supervision Evaluation by Student: end of semester (Appendix D)

All practicum students will be evaluated by their supervisors as described above. The CCP will make a request for evaluation to students’ supervisors via the Time2Track system. The CCP will receive the completed evaluations, already reviewed and discussed with the student, via Time2Track. Additionally, the following documents are submitted via the Time2Track system

• Student Evaluation by Supervisor: mid semester and end of semester (Appendix B)
• Evaluation of Students Professional Competencies by Supervisor: one of each semester (Appendix C)