Policies and procedures for LGHP Neuropsychology Doctoral Psychology Internship

The Penn Medicine Lancaster General Hospital (LGH) doctoral internship model of supervision is consistent with an Integrated Developmental Model of Supervision (IDM) (Stoltenberg et al., 1998).

The IDM approach to supervision is deemed to be the better fit for our doctoral interns’ level of training and experience, and entry into a new environment, with new and unfamiliar processes, expectations and supervisors. Inherent in this change of environment will be a certain degree of uncertainty and anxiety about their own knowledge and skills, and that which is expected of them or their perception of what is expected. Consistent with IDM, they are likely to be high in motivation to make a positive first impression and enhance their skills, knowledge, self-confidence and autonomy. A major goal of the doctoral intern year is to not only further refine their knowledge base and skills, but to provide the intern with an increased sense of professional confidence and autonomy.

IDM focuses predominantly on novice provider and graduate students in training. Additionally, the experience level of doctoral interns may be quite variable, indicating the need for a flexible approach, the supervisor utilizing approaches that correspond to the level of the supervisee. Additionally, there is likely to arise throughout the internship year, unique and novel cases or responsibilities that require and more developmental approach to supervision. Zimmerman & Schunk (2003) referred to “scaffolding”, encouraging the supervisee to use prior knowledge and skills to produce new learning. As the supervisee approaches mastery at each stage, the supervisor gradually moves the scaffold to incorporate knowledge and skills from the next advanced stage. Throughout this process, not only is the supervisee exposed to new information and skills, but the interaction between supervisor and supervisee also fosters the development of advanced critical thinking skills (Smith, 2009).

This is accomplished by providing interns with the opportunity at the start of their internship year to observe advanced providers model their skills and knowledge in the provision of professional services to patients and clients, and in case conceptualization. At the start, emphasis is placed on faculty modeling skills, clinical practice, and theoretical understanding, ethics, and understanding the trainee’s role as a developing professional. The goal is to develop critical thinking, conceptualization, problem-solving, and other scientific skills that are particularly pertinent to clinical practice. As the intern develops the appropriate knowledge base and becomes more confident in their knowledge and skills, with concomitant decreased anxiety regarding supervisor evaluation and feedback, the more directive supervision and didactic training approach should give way to greater intern autonomy and confidence in case conceptualization and provision of services.

The Integrated Developmental Model of Supervision (Stoltenberg)

Based on two models of human development:

• Mechanistic approach – the acquisition of skills and knowledge over time
• Organismic approach – an interaction between the organism and the environment

The goal is to develop new and more complex ways of conceptualizing in addition to acquiring a broader array of skills and knowledge.

Eight domains of clinical activity

1. Intervention skills competence: the ability to implement therapeutic interventions with assuredness
2. Assessment techniques: the ability to utilize assessment protocols and devices with assuredness
3. Interpersonal assessment: the ability to theoretically conceptualize a client’s interpersonal dynamics
4. Client conceptualization: the ability to organize client data into a meaningful diagnostic understanding upon which to base clinical treatment
5. Individual differences: the ability to include the influences of diversity and difference into the understanding of an individual client
6. Theoretical orientation: the ability to utilize and integrate different clinical theories and approaches
7. Treatment plans and goals: the ability to contract for change with a client and to effectively intervene to achieve therapeutic progress
8. Professional ethics: the ability to coordinate professional and personal ethics with standards of practice

Three overriding structures of professional growth

1. Self-other awareness: thoughts and feeling about the self and about the client; self-preoccupation, awareness of the client’s world, enlightened self-awareness
2. Motivation: nature and stability of investment in training and practice over time; interest, investment, effort expended in training and practice
3. Autonomy: movement from dependence upon the supervisor’s authority to independent clinical functioning

Integrated developmental model of supervision (IDM)

Stoltenberg, C.D., McNeill, B. and Delworth, U. (1998) IDM Supervision: An Integrated Developmental Model of Supervising Counselors and Therapists. San Francisco: Jossey-Bass.

Overriding Structures	Specific Domains
Self and other Awareness	Intervention skills
	Assessment Techniques
	Interpersonal Assessment
Motivation	Client conceptualization Individual Differences
	Theoretical Orientation
Autonomy Treatment plans and goals
	Professional Ethics

Level 1

Motivation	High Motivation High levels of anxiety Skill acquisition focus
Autonomy	Dependent upon supervisor Needs structure from supervisor Positive feedback Minimum direct confrontation
Awareness	Self-awareness is limited Self-focus is high Evaluation apprehension Unaware of strengths/weaknesses
Overall:	Focuses on basic skills Motivated by anxiety and enthusiasm Emulates a role model Categorical thinking Learns “right way”, cookbook answers Is highly dependent with self-focus Has difficulty conceptualizing Lacks self-awareness Does not know what he or she does not know Overuses a model, tunnel vision Has difficulty confronting and self-disclosing Limited number of intervention strategies and plans Lacks integrated ethics

Transition to Level 1

Motivation: May decrease for new approaches/techniques
Autonomy: May desire more than is warranted
Awareness Begin to move towards client – away from self

Level 2

Motivation	Fluctuating, sometimes highly confident Increased complexity shakes confidence Confusion, despair, vacillation
Autonomy	Dependency – autonomy conflict Can be quite assertive, pursue own agenda Functions more independently May only want requested, specific input Other times dependent or evasive
Awareness	Focuses more on client Empathy more possible Understanding client worldview more possible May become enmeshed, lose effectiveness May become confused, lose effectiveness Appropriate balance is an issue

Transition to Level 3

Motivation: Increased desire to personalize orientation
Autonomy: More conditionally autonomous Better understands limitations
Awareness: Focus begins to include self-reactions to client

Level 3

Motivation	Stable motivation Doubts remain, but not disabling Total professional identity is the focus
Autonomy	Firm belief in own autonomy Knows when to seek consultation Retains responsibility
Awareness	Focuses on client, process, and self Uses therapeutic self in sessions

Transition to Level 3 Integrated

Motivation: Strives for stable motivation across domains
Autonomy: Moves conceptually and behaviorally across domains Professional identity solid across relevant domains
Awareness: Personalized understanding across relevant domains Monitors impact of personal on professional life

Level 1 Supervisor Methods and Strategies

General considerations	Provide structure and keep anxiety manageable
Client assignment	Mild presenting problems or maintenance cases
Interventions	Facilitative (supporting, encouraging) Prescriptive (suggest approaches) Conceptual (some, and theory) Catalytic (late level 1)
Mechanisms	Observation (video or live) Skills training Role-playing Interpret dynamics (limited, client or trainee) Readings Group Supervision Appropriate balance of ambiguity/conflict Address strengths, then weaknesses Closely monitor clients

Level 2 Supervisor Methods and Strategies

General considerations	Less structure provided, more autonomy encouraged particularly during periods of regression or stress
Client assignment	More difficult clients with more severe personality problems (e.g., personality disorders)
Interventions	Facilitative Prescriptive (only occasionally) Confrontation (now able to handle it) Conceptual (more alternative views) Catalytic (process comments, highlight counter transference, deal with affective reactions to client/supervisor
Mechanisms	Observation (video or live) Role playing (though less important now) Interpret dynamics and parallel process Group Supervision Broader clientele

General considerations	More structure provided by supervisee, more focus on personal and professional integration and career decisions
Interventions	Facilitative Confrontation Conceptual; from personal orientation Catalytic: in response to blocks or stagnation
Mechanisms	Peer supervision Group Supervision Strive for integration

The Penn Medicine Lancaster General Hospital (LGH) doctoral internship is organized around a Practitioner-Scholar model: “Within the practitioner-scholar model of training…scientific training is integrated into the practice training component. Scientific activities are in the service of practice” (Stoltenberg et al., 2000). Embedded in the practitioner-scholar model is the belief that professional identity is not a static phenomenon that ends once a terminal degree or appropriate licensure or certification is achieved but instead consists of life-long learning that evolves as the field does. We recognize that science and practice are interlocking skills that form the foundation of psychological knowledge and its application (Belar & Perry, 1992). In contrast to pure practitioner or scientist-practitioner programs, the Penn Medicine LGH program is committed to training local clinical scientists who are "practitioner-scholars." As an institution, Penn Medicine LGH is committed to training professionals who are prepared to develop as leaders in their professional contexts. Consequently, our program is designed to produce students who are well equipped to emerge as leaders in behavioral medicine, mental health and neuropsychology. This is accomplished through a carefully planned sequence of Didactics and adjunctive training experiences. All of these program components are designed to cultivate a life-long commitment to ongoing learning and professional scholarship, which is particularly relevant to practice and professional service.

At Penn Medicine LGH, the training faculty expects interns to learn to practice psychology in a manner that is informed by psychological theory and research. This is true in areas of individual diversity, treatment of underserved populations, multiple contexts dictated by community needs, and multicultural issues to provide non-discriminatory service (Rodolfa et al., 2005) and an understanding of social and political influences resulting from psychologist’s practice. Emphasis is also placed on faculty modeling skills, clinical practice, and theoretical understanding, ethics, and understanding the trainee’s role as a developing professional. The goal is to develop critical thinking, conceptualization, problem-solving, and other scientific skills that are particularly pertinent to clinical practice. As a part of practitioner-scholar training, interns are taught to develop reflective skills and to view their practice as an opportunity to apply and test scientific knowledge. Although research is not required as part of the internship, we encourage interns to learn about evidence-based practice and to become familiar with interventions that have been supported by research. Although the internship program provides practitioner-scholar training, we recognize that many of our interns come from scientist-practitioner graduate programs and we believe that the Penn Medicine LGH internship complements and is consistent with a long-term goal of scientist-practitioner training.

Specifically with regard to training, Penn Medicine LGH provides doctoral psychology interns as well as other trainees in psychology with professional literature and resources which are integrated into both supervision and seminars which parallel the trainees’ clinical activities. Encouraging critical evaluation of the research and theoretical literature in this way supports trainees’ growing ability to use the scientific method in clinical thinking, including developing awareness of bias, hypothesis testing, and evaluation. Furthermore, doctoral psychology interns are given professional development time to make progress on their own research, whether that is working toward dissertation completion or other research projects.

Violation of any of the hospital’s rules and regulations or violations of accepted professional standards as noted elsewhere in this manual may result in disciplinary action, which may include the termination of the individual from the internship program.

Corrective action

1. Initiation of an Investigation
   • Whenever a member of the Neuropsychology Department, medical staff, or student becomes aware of activities or conduct of any intern which may be considered unprofessional, disruptive, fail to meet the acceptable standard of psychological care, or fail to maintain the standard of conduct required of interns, he/she shall bring the problem to the attention of the Managing Provider within five (5) days, or as soon thereafter as feasible.
   • The Managing Provider will notify the Training Director and may consult with other members of the staff, including the involved intern’s supervisor, other interns and/or Penn Medicine Lancaster General Health (LGH) employees, administrators, medical staff, as may be necessary to investigate the matter fully.
   • The Managing Provider shall notify the involved intern within five (5) business days of the initiation of an investigation of the intern’s conduct.
2. Disciplinary Action
   • Suspension or Termination
     • In some circumstances, the conduct of an intern may be considered sufficiently serious to warrant suspension or dismissal from the Internship Program. The following are examples of such conduct:
       • any action which materially jeopardizes the welfare of patients;
       • the use or possession of alcoholic beverages, or the use or possession of illicit controlled substances while on duty or on Hospital property;
       • illegal, immoral, dishonest, or unprofessional behavior;
       • failure to report to work as assigned, without notification of the proper individuals;
       • breach of the intern’s contract with Penn Medicine LGH;
       • any conduct not in accordance with the Compliance Program - Addendum C -Principles of Responsible Conduct described in Penn Medicine LG Health & Hospital Administrative/Operational Policies Compliance Program (see appendix A). **
   • If the Managing Provider determines that the conduct of the intern is sufficiently serious to warrant a suspension or dismissal from the Internship Program, the Managing Provider shall proceed as follows:
     • The Managing Provider shall convene a meeting of the Administrative Committee which consists of the Managing Provider and the Director of Training in addition to a representative from Penn Medicine LGH Administration to discuss the matter, conduct any investigation the Administrative Committee deems appropriate and prepare written findings and recommendations. This meeting shall be held within two (2) business day of the Managing Provider being notified of the intern’s conduct.
     • The findings and recommendations of the Administrative Committee shall be given to the involved intern within two (2) business days of the Committee’s meeting.
     • In the event that the Administrative Committee recommends that the involved intern be suspended or terminated from the Internship Program, the intern may seek review of the decision as permitted in Section III, below.
   • Other disciplinary Action
     • If the conduct of the intern is of a less serious nature than that described in Section II-A above, the Training Director shall review the matter with the Managing Provider and the intern’s primary supervisor as soon as practicable after being informed of the intern’s conduct. The Director of Training will then meet with the involved intern and his/her supervisor to discuss the matter. A plan of action will be developed to remedy the situation. Such an action plan may include, but is not limited to:
       • informal counseling of the intern by staff member;
       • requiring the intern to receive psychological counseling;
       • a written reprimand; or
       • placing the intern on probation.
     • If the intern does not agree with the action of the Director of Training, the intern may seek appeal as outlined in Section III, below.
3. Intern Appeal Procedure
   • General Information
     • The appeal process is established to afford the intern with a procedure to resolve conflicts, disputes, or other disagreements which may result in disciplinary action as described in Section II, A and B or affect an intern’s professional progress. This process is available to all interns being subjected to any disciplinary action including any action taken pursuant to Section II, above.
     • The intern may appeal the decision of the Administrative Committee to the Penn Medicine LGH Senior Vice President of Human Resources who is designated by the Penn Medicine LGH President/CEO as the final arbiter in the appeals process. The decision of the Senior Vice President will be FINAL AND BINDING upon the parties.

In the event there is a grievance against any party associated with the internship (e.g., staff member, supervisor), the intern is encouraged to resolve the issue informally with the party involved. If the intern is unable to satisfactorily resolve the issue or believes he/she needs the assistance of a third party, the intern should proceed through as many of the following steps as may be necessary in order to resolve the problem.

1. Discuss the issue with the Director of Training or the Managing Provider of Neuropsychology. At this initial exploratory stage, the student may speak confidentially to either of these members of the Clinical Training Committee to help clarify the problem. In some cases, this contact may be sufficient to resolve the complaint.
2. If necessary, the Director of Training or the Managing Provider of Neuropsychology may, with the permission of the intern, perform an informal investigation that might include interviewing the parties involved or any party who has evidence concerning the validity of the complaint.
3. If this informal investigation fails to lead to the resolution of the grievance, the Director of Training or the Managing Provider of Neuropsychology will assist the student in formulating a plan of action. This plan of action may take the form of utilizing the formal grievance procedure as outlined below.
4. If the above procedures are used and are unsuccessful in resolving the complaint, then a formal meeting of the Grievance Panel will review the complaint. Such a review is formal and requires a written complaint on the part of the student. The Grievance Panel is composed of the Managing Provider of Neuropsychology, the Director of Training, the Senior Vice President of Clinical Services at Penn Medicine LGH, and the intern’s supervisor. If the supervisor is already on the Panel, a member will be chosen from the hospital staff. The Grievance Panel will meet within five (5) working days of the complaint and will render a decision about the complaint that will be communicated in writing to all parties involved.
5. If the student would like to appeal the decision of the Grievance Panel the student may make a final appeal to the Human Resources Senior Vice President who is the FINAL ARBITER. Within five (5) working days after receiving the written appeal by the student, the Senior Vice President shall respond in writing to the complainant. The Human Resources Senior Vice President is designated by the Lancaster General President/Chief Executive Officer as the final arbiter in the complaint system. All decisions are considered FINAL AND BINDING upon the parties.

Policy statement

There shall be a procedure for evaluation and process improvement of the internship program incorporating feedback from exiting interns and staff.

Purpose

The purpose of this policy is to outline the process for program evaluation and improvement to optimize the potential growth and development of the internship program.

Procedures

Staff Meetings

1. Discussion of issues pertaining to the functioning of the internship program, intern performance shall be on the agenda of each departmental staff meeting.
   Pertinent issues to be addressed may include program expectations of interns and supervisors, requests or requirements of interns, and any modifications of the program that might be indicated and beneficial.
2. Issues pertaining to individual intern performance of an evaluative nature shall be discussed amongst supervisors privately prior to the dissemination of this information to the intern.
3. A written record of the nature of these discussions shall be kept by the Director of Training.

Intern/Supervisor Meetings

1. Interns are encouraged to address any individual concerns they may have re: shortcomings of the program or recommendations for improvement with their supervisor or other faculty member if the concerns are of a nature that the intern would be reluctant to discuss openly during staff meetings.

End of Year Evaluations

1. The Intern Evaluation of Internship Site form shall be completed at the end of the year just prior to the awarding of the certificate of completion. Completion of these evaluations shall be the responsibility of the Training Director.
2. Upon completion of the Intern Evaluation forms, the Director of Training shall meet with all supervising staff and a written action plan shall be developed for any areas that do not meet expected standards.
3. The Director of Training shall be responsible for maintaining a written record of ratings, perceived strengths, weaknesses and modifications of the program in response to the intern evaluations.

Other relevant institutional policies which the program is required to comply (specify)

CATEGORY A: Due to the determined seriousness of the behaviors listed below, an employee may be subject to immediate and summary release.

A(1) Theft, stealing, hiding or concealing LG employee, patient or guest’s property or the unauthorized taking or use of that property.

A(2) Misrepresentation or unauthorized use of time record, willful disregard of payroll policy or falsifying time or payroll records. Falsification of any records, reports, resumes, applications, or other LG documents.

A(3) Possession of firearms or other dangerous devices on Lancaster General property, or the conviction of any criminal laws, codes, or ordinances related to the employee’s job functions.

A(4) Imbibing and possession of alcoholic beverages or the use of illicit controlled substances while on duty or on LG property other than an approved LG function. Conviction that involves the off duty sale, solicitation, possession, or purchase of illegal substances. Failure to submit to required drug testing.

A(5) Unauthorized, prohibited, or undue access to and disclosure of any confidential or proprietary information regarding patients or employees. Unauthorized disclosure of any information, records or data that LG considers confidential or proprietary. Unauthorized access to PHI of any “A” patient.

A(6) Gambling or conducting gambling operations on LG premises.

A(7) Sabotaging, deliberately damaging, defacing, destroying, vandalizing or misusing Lancaster General property or the property of visitors, patients, or employees.

A(8) Abuse of, intimidation of, or disrespect to patients, visitors, or employees, either physically or psychologically. Acts involving assaults, fights, or disorderly conduct. Any action that jeopardizes the welfare of the customer.

A(9) Insubordination with disregard for an appropriate confirmed managerial or supervisory directive.

A(10) Three (3) consecutive work day absences with failure to directly or personally notify or contact the employer or failure to report to work within three (3) days of a leave of absence or a layoff/recall. Failure to report to work within the designated period as outlined in the Military Leave of Absence Policy.

A(11) Conduct that is immoral, indecent, or unethical including but not limited to lying or other deceitful behavior.

A(12) Making false, malicious or vicious statements, vilifying, slandering or defaming any employee, physician, patient, visitor or guest, of the LG.

A(13) Soliciting or receiving monetary tips or other gratuities from patients, or sale of services or items to patients.

A(14) Harassment, including sexual harassment.

A(15) Any dereliction of responsibilities which directly threatens the health and safety of any patient, employee or visitor, including but not limited to, smoking inside an LG owned or leased building or job abandonment.

As part of your employment with Penn Medicine Lancaster General Hospital, you will accumulate Paid Time Off. Paid Time Off is accumulated at a rate of 0.093/hr for a total of 192 hours per year. Your Paid Time Bank is to be used for any time off including personal time and sick time.

Penn Medicine Lancaster General Health designates select holidays as paid holidays that do not require Paid Time Bank hours. The following are the designated holidays in a typical year (subject to change from year to year) and the department will be closed accordingly: • Labor Day • Thanksgiving • Christmas • New Year’s Day • Martin Luther King Jr. Day • Memorial Day • Juneteenth • Independence Day

As part of your internship, you are also entitled to 10 days for education leave, dissertation work or research activities.

Requests for time off for any of the above reasons must be forwarded to and approved by Kimberly Manos, Corie Hynicker, and/or Dr. Main. The process for requesting time off is as follows:

• Open Outlook and Click on “Calendar”
• Look across the top and click “Actions” and click “New Meeting Request”
• Complete Information: Example below
• Date and Time: Click on drop box to see calendar
• Select start and stop date and start and stop time if partial day only
• If all day, click “ALL DAY EVENT”
• Write any specific notation at the bottom
• Click send and it will be sent to approver-approval will be confirmed in your via email