Student Medical & Counseling Clinic

Program Aims, Profession-wide Competencies, and Evaluation Elements

 

The APA Standards of Accreditation require that all accredited internships train in 9 broad profession-wide competencies.  These competencies are listed below along with the internship activities that address these competencies and the evaluation elements that are used to determine proficiency in these competency areas.  The aims of the program are the broad goals that our internship has for ourselves and our interns upon completion of our training program.  


Aim #1: 

To train psychologists with entry-level, culturally-competent clinical skills and practice. 

Profession-wide Competencies (listed in bold) addressed within this aim:

Assessment – To develop entry-level competency in the assessment and diagnosis of a wide variety of psychological difficulties through clinical interviewing and/or formal testing, with consideration for the influence of relevant diversity characteristics, and to communicate the findings in a professional and appropriate way to the intended audience(s). 

  Screenings:  Assessment, through clinical interview, as relevant, of suicidal/homicidal/NSSI concerns, drug/alcohol use, presenting concerns, symptom presentation, and diversity characteristics sufficient enough to:

(a) adequately address immediate risk issues;
(b) make appropriate service referrals;
(c) provide initial diagnostic impressions;
(d) describe initial brief conceptualization;
(e) the ability to write screening notes in a concise, professional manner while including essential information. 

  Testing (ADHD and Personality/Psychodiagnostic):  The ability to:

(a) provide appropriate informed consent for testing/socialize client to testing;
(b) conduct a thorough clinical interview, including individual/cultural variables;
(c) identify appropriate goals for testing;
(d) select a multi-modal assessment battery;
(e) administer, score, and interpret testing data, including providing a diagnosis when relevant, in the context of the client as a multicultural individual; and
(f) communicate the results in written and verbal formats with language and methods appropriate to a variety of audiences including client, referral source, and outside entities (e.g., Center for Disability Services). 

Intervention – To develop entry-level competency in a variety of intervention modalities (as listed below), via the ability to:

(a) establish and maintain effective relationships with service recipient(s);
(b) develop evidence-based intervention plans specific to service delivery goals;
(c) critically integrate – and modify as culturally relevant – evidence-based approaches and scientific literature into treatment planning, intervention, and outcome evaluation of interventions, while developing skills specific to each intervention modality; 
(d) work with a range of diverse individuals, including those whose world views, values, and beliefs significant differ from the intern’s own cultural or personal values, beliefs, or world views. 

  Crisis Intervention:  The ability to quickly establish an effective working relationship with client and any support/concerned individuals, using language and communication styles fitting to the individual and situation, to identify:

(a) the source of the crisis;
(b) magnitude of crisis, including any risk of harm concerns.

As well as to:

(a) provide focused intervention with respect to the current crisis in order to deescalate client and stabilize short-term functioning;
(b) develop appropriate safety and/or follow-up care plan/referrals that take into account the client’s cultural and contextual variables;
(c) appropriately determine when additional consultation/evaluation is needed and obtain such supports;
(d) communicate effectively and professionally, both verbally and in writing with supervisors, university officials, medical staff, outside referrals, and designated mental health professionals; and
(e) provide written documentation of crisis intervention and safety planning that is timely, professionally written, and can serve as a guide for other clinicians who might interact with client. 

  Individual Therapy:  The ability to:

(a) establish and maintain effective therapeutic relationship with individuals from a variety of individual and cultural backgrounds, using flexible verbal and non-verbal communication skills appropriate to the client and session content;
(b) develop a working case conceptualization and differential diagnosis, which guide, in consultation with the client, goal setting, treatment planning and intervention selection;
(c) intervene with clients in a manner consistent with their culture and worldview that is supported by research and/or theoretical literature, and integrates in some manner a focus on affect, cognition, behavior, and interpersonal process;
(d) appropriately address individual differences between client and therapist and integrate cultural concerns/environmental effects into therapy;
(e) periodically evaluate the progress of therapy and made adjustments to the treatment as necessary;
(f) use available outcome data to evaluate course of therapy, including, but not limited to CCAPS; and
(g) write case notes and termination summaries using appropriately professional language, balancing the need to document essential elements of session and also protects client confidentiality should records be required to be released to a third party.

  Group Therapy:  The ability to:

(a) integrate research and theoretical literature into design and facilitation of groups (structured and/or process);
(b) engage in administrative group management related to the formation and maintenance of group;
(c) successfully form effective working relationships with group members of diverse background and cultures;
(d) be aware of and facilitate group process for the benefit of group members, avoiding enacting individual therapy in a group setting;
(e) attend to stage of group formation and tailor interventions based on group development;
(f) demonstrate effective group facilitation, communication and interpersonal skills in the management of disruptive and or difficult group members;
(g) ability to teach and facilitate discussion in psycho-educational groups;
(h) ability to effectively enact process-based interventions in process groups;
(i) formation of effective working relationship with group co-leader; and 
(j) write group notes that are reflective of the overall group content and process as well as individual functioning in the group. 
 
  Outreach:  The ability to:

(a) understand group presenting to, including important demographic and cultural variables;
(b) clarify purpose and goal(s) of presentation and clearly articulate these in the presentation and on outreach feedback form;
(c) effectively research information related to topic and to cultural diversity concerns, incorporating relevant research, scholarly, and multicultural literature either directly into the presentation and/or to inform the planning and structure of the presentation;
(d) use oral and non-verbal communication skills that are both professional and appropriate to audience;
(e) produce professional written material to accompany presentation (e.g., powerpoint, handouts, etc.);
(f) effectively build rapport with audience in order to facilitate participation and interaction; and
(g) solicit feedback from audience members regarding effectiveness of presentation via Outreach Evaluation Form.

Note:  Basic tabling or public relations outreach events, while important to the overall clinic and other competencies, are not experiences considered as part of the “Intervention” competency area. 

Supervision – The ability to apply knowledge of supervision models and practices by actively participating in peer supervision via group supervision, assessment group supervision, group therapy consultation, (and, when available, supervision of supervision) and, through supervising a junior trainee, when available. 

In the context of peer supervision, the ability, based on informal case/assessment/group therapy/supervision presentations and group video review, to:

(a) ask exploratory questions of peers to deepen case conceptualization and encourage consideration of the impact of individual cultural variables on treatment;
(b) provide constructive feedback regarding assessment/intervention/supervision skills, course of treatment/assessment/supervision, provider variables, and other relevant concerns;
(c) offer information from the scientific and scholarly literature relevant to clinical work being discussed;
(d) use effective interpersonal and communication skills to address differences of opinions or practice with peers in a constructive manner; and
(e) articulate rationale for feedback given to peers. 

In the context of supervising a junior trainee, the ability to:

(a) use effective communication and interpersonal skills to form an effective supervisory relationship with supervisee;
(b) attend to and actively discuss individual and cultural differences in supervisory relationship, in client-therapist relationship, and with respect to supervisee’s adjustment to the agency;
(c) use a model of supervision (primarily the Integrated Developmental Model) to guide supervisory practices and approaches, while integrating other research and scholarly literature and individual difference considerations;
(d) provide constructive formative and evaluative feedback to supervisee using concrete examples and with specific direction for improvement;
(e) receive constructive feedback from supervisee and modify, as needed, supervisory approach to meet the individual needs of supervisee;
(f) use effective interpersonal and communication skills to constructively address differences between self and supervisee, including differences of approach, opinion, and cultural background;
(g) be knowledgeable regarding supervisee’s caseload in general and particularly any high risk concerns;
(h) review case notes and session tapes in a timely and regular fashion and provide feedback to supervisee regarding these;
(i) document supervision in an effective, timely, and appropriately professional manner using agency system;
(j) serve as a role model and mentor to supervisee within the agency as a whole; and
(k) if not supervising a junior trainee directly, to serve as a peer supervisor in supervision of supervision meetings as outlined under the peer supervision section above. 
 
Consultation and Interprofessional/Interdisciplinary Skills – The ability to intentionally collaborate with individuals or groups to address a problem, seek or share knowledge, or promote effectiveness in professional activities.  Within the internship activities, this is demonstrated by the ability to:

(a) use effective interpersonal and communication skills when working with SMaCC medical staff regarding client/patient referrals in both written and verbal formats;
(b) actively participate in multi-disciplinary team meetings by presenting cases and providing feedback/contributing to discussions, including raising issues related to individual/cultural differences as relevant;
(c) actively participate in counseling case conferences by providing feedback to colleagues or the team as a whole on both clinical concerns as well as programmatic issues;
(d) collaborate with university case managers and other university staff/faculty on common clients and high risk students while maintaining appropriate confidentiality boundaries; and
(e) work collaboratively with other SMaCC or university staff on outreach programs or other joint projects. 

Aim #2: 

To train entry-level psychologists who exhibit the self-awareness, attitudes, cultural competence, communication/interpersonal skills, and scientific knowledge for effective and ethical professional practice.

Profession-wide Competencies (listed in bold) addressed within this aim:

Research – The substantially independent ability to critically evaluate and use existing knowledge to solve problems and to disseminate research or other scholarly knowledge to others.  This competency is demonstrated by the ability to:

(a) actively participate in seminars via the critical discussion of readings, including the ability to critique methods, conclusions, and cultural diversity implications;
(b) intentionally integrate scientific, scholarly, and multicultural literature into formal case presentation delivered to counseling clinic staff, interns, and other trainees;
(c) research and design an effective and relevant presentation on a topic of intern’s choosing related to health service psychology, and successfully deliver the presentation to clinic's multi-disciplinary staff;
(d) active integration of research, scholarly, and cultural diversity literature into outreach presentations; and 
(e) successful completion of two formal case presentations.

Ethical and Legal Standards – The ability to respond ethically and with respect to legal constraints regarding practice to increasingly complex situations and with progressively greater degrees of independence over the course of training.  At the profession-wide and institutional level, demonstrated working knowledge of:

(a) the current version of APA Ethical Principles of Psychologists and Code of Conduct;
(b) relevant state and federal laws governing the practice of psychology and confidentiality in an educational environment;
(c) relevant professional standards and guidelines; and
(d) the ability to recognize ethical dilemmas as they arise and apply ethical decision-making processes to resolve the dilemmas. 

Within the context of the internship, these skills include the ability to:

(a) actively provide informed consent to clients across all modalities of treatment and intervention, including screenings, crisis intervention, testing, individual therapy, group therapy, and consultations/advocacy work;
(b) navigate confidentiality issues when providing consultation to concerned others;
(c) balance safety concerns and confidentiality concerns when student or university safety is a pressing concern;
(d) actively consider, consult regarding, and navigate potential or actual dual relationships or boundary crossings that result from living and practicing in a rural community and/or from individual and cultural diversity factors; and
(e) identify ethical and legal concerns with respect to clinic policies, procedures, and daily operations and instigate and/or contribute to conversations and problem-solving regarding such concerns.  

Professional Values, Attitudes, and Behaviors – The ability to understand oneself as a developing professional psychologist and incorporate values and attitudes consistent with a competently functioning psychologist.  At the profession-wide and institutional level, demonstrated behaviors consistent with:

(a) consistency of self-report and observable behavior across time;
(b) willingness to uphold ethical standards even in difficult situations;
(c) presenting oneself in a professional manner via dress, oral and written communication, and non-verbal behaviors appropriate to the setting and professional duties executing;
(d) development of professional identity as an early career psychologist-to-be through objective assessment of and ability to embrace one’s strengths and weakness;
(e) taking responsibility for one’s actions, decisions, and commitments;
(f) self-directed research and learning engagement consistent with the attitude of a lifelong learner (i.e., willingness to go beyond learning assigned as part of the internship);
(g) concern for the welfare of others including clients, colleagues, and university as a whole via ability to consider impact on others and wider ramifications of decisions made individually or as part of the agency;
(h) the use of self-reflection in regards to personal and professional identities and functioning inside and outside of supervision;
(i) an appreciation for the impact of human diversity on one’s professional practices;
(j) awareness of and behavior consistent with the appreciation of and respect for cultural diversity across a wide variety of domains and identities;
(k) awareness of oneself as a multicultural being, with continued self-reflection inside and outside supervision regarding how cultural identities affect worldview, bias, assumptions, values, and professional identity and functioning;
(l) the use and balance self-care, stress-management, and developmentally appropriate risk-taking in order to increase personal and professional integration, effectiveness and well-being;
(m) the ability to communicate in an appropriately assertive manner while being attentive to relationships and the needs of others;
(n) seeking of and openness to feedback and supervision across all competency areas;
(o) ability to integrate supervisory feedback into future functioning;
(p) ability to provide constructive and timely feedback to supervisor(s) regarding supervisory relationship and its effectiveness;
(q)  functioning at a developmentally appropriate level of independence; and
(r) the ability to effectively communicate with peers, supervisors, medical staff, front office staff, and other university officials in order to communicate needs, address needs of others, and work through differences or conflict with respect to opinions, ethics, individual and cultural differences, and needs of self or clients.

Individual and Cultural Difference and Communication and Interpersonal Competencies
As noted above, the profession-wide competencies for Individual and Cultural Differences and Communication and Interpersonal Skills are integrated throughout other competency areas.  Evaluation items for each of these competencies are designated with “ICD” for Individual and Cultural Differences and “C/I” for Communication and Interpersonal Skills.  See Appendix B for the Comprehensive Intern Evaluation.  These evaluation items reflect the expectations of the profession-wide competencies as outlined below. 

The Implementing Regulations for these profession-wide competencies emphasize the following knowledge, skills, and abilities:

Individual and Cultural Differences – “…[T]rainees must demonstrate knowledge, awareness, sensitivity, and skills when working with diverse individuals and communities who embody a variety of cultural and personal background and characteristics. The Commission on Accreditation defines cultural and individual differences and diversity as including, but not limited to, age, disability, ethnicity, gender, gender identity, language, national origin, race, religion, culture, sexual orientation, and socioeconomic status…. Trainees at all levels are expected to demonstrate:
(a) an understanding of how their own personal/cultural history, attitudes, and biases may affect how they understand and interact with people different from themselves;
(b) knowledge of the current theoretical and empirical knowledge base as it relates to addressing diversity in all professional activities including research, training, supervision/consultation, and service; and
(c) the ability to integrate awareness and knowledge of individual and cultural differences in the conduct of professional roles (e.g., research, services, and other professional activities).

This includes the ability apply a framework for working effectively with areas of individual and cultural diversity not previously encountered over the course of their careers. Also included is the ability to work effectively with individuals whose group membership, demographic characteristics, or worldviews create conflict with their own.” (Commission on Accreditation, Implementing Regulation C-8.I.III, 2016)

Communication and Interpersonal Skills – “Interns are expected to:
(a) develop and maintain effective relationships with a wide range of individuals, including colleagues, communities, organizations, supervisors, supervisees, and those receiving professional services;
(b) produce and comprehend oral, nonverbal, and written communications that are informative and well-integrated; demonstrate a thorough grasp of professional language and concepts; and
(c) demonstrate effective interpersonal skills and the ability to manage difficult communication well.”  (Commission on Accreditation, Implementing Regulation C-8.I.V, 2016)