Training Experiences

Three primary training goals form a unifying basis for the program. Graduates will:

• Be prepared to enter into the professional practice of psychology.
• Be skilled in the interface among the science, theory, and practice of professional psychology.
• Be aware of and sensitive to individual differences and cultural diversity within areas of professional practice and scholarly inquiry.

Training Requirements

1. Complete two, 6-month major and minor rotations. This is the preferred schedule. No changes will be made unless approved by the Internship Training Committee. Interns are to receive two hours of individual supervision per week (one hour for each rotation). 
   
2. Complete 500 hours of direct client care mostly compromising of individual therapy, group therapy, and evaluations.
   
3. Complete and "pass" 7 psychological evaluation reports covering multiple testing domains (i.e., intellectual, personality, neuropsychological, malingering, etc.)
   
4. Present four case presentations throughout the training year, one per quarter. Two case presentations should pertain to an individual therapy case and two should pertain to a testing case.
   
5. Attend weekly, one-hour supervision with the Training Director at a time determined by the Training Director and intern.
   
6. Attend weekly, two-hour didactic seminars. Seminars occur every Friday from 1:00pm-3:00pm in the Administration Building Conference Room. Interns are to complete evaluations of the seminar (anonymously) and return to the Training Director at MS 400.
   
7. Attend weekly, one and one-half hour research meetings. Research meetings occur every Friday from 3:00pm-4:30pm in the Administration Building Conference Room.
   
8. Attend monthly, one and one-half hour meeting of the Cultural Competence Council. The Council meets every third Wednesday from 1:30pm-3:00pm in the Administration Building Conference Room.
   
9. Attend monthly one-hour Internship Training Committee (ITC) meetings. ITC meetings are held from 2:00pm-3:00pm the first Friday of every month in the Administration Building Conference Room.
   
10. Weekly group supervision with a professional, staff member not affiliated with the InternshipTraining Committee. Currently, this meeting is held every Wednesday from 10:30am-11:30am in the Guhleman Forensic Center with Anna Luebbert, MSW, LCSWS.
    
11. Complete monthly activity logs (excel spreadsheet) and email to the Training Director at the end of every month.
    
12. Complete evaluations of each supervisor at the end of each major and minor rotation and turn into the Training Director.
    
13. Interns must receive supervisory ratings of at least level 3 (Intermediate Competence) on all eight required competency domains by the end of the internship year in order to successfully complete the internship. The eight competency domains include:

1) assessment & diagnosis 

2) intervention

3) consultation

4) evaluation

5) supervision

6) scholarly inquiry

7) cultural & individual diversity

8) ethical, legal & professional conduct.

 Training Rotations

With these broad goals as a framework, the training director and other faculty assist interns to formulate individualized training plans and select from the range of training experiences listed below.Interns and faculty collaborate to decide such issues as the duration and percentage of time that will be spent in various training experiences. Our internship utilizes a flexible approach to training, allowing interns to craft a training plan that best fits their needs. Major and Minor rotations can be 4 or 6 months in length, and in some cases a rotation can be duplicated for more than one major rotation or minor rotation.

Forensic Evaluation (Dr. Kline , Dr. Kempker & Dr. Telander)
The Forensic Examination team at FSH is responsible for completing outpatient and inpatient court-ordered mental evaluations. During this rotation, the intern will be exposed to forensic evaluations of defendants in the State of Missouri. The evaluation process will focus on several legal questions commonly asked by the Court. These common questions include the issue of competency to stand trial, mental state at the time of the alleged criminal conduct (or criminal responsibility), risk assessment for sexual violence, and risk assessment for physical violence. Other questions sometimes posed by the Courts include issues pertaining to Battered Spouse Syndrome, Diminished Capacity, and issues pertaining to sentencing recommendations.

The intern will primarily shadow one of the three supervisors while they perform the court-ordered evaluations. As the rotation progresses, the intern will take on more responsibility for the interview and information gathering progress, culminating in the intern performing evaluations from beginning to end. The intern will be expected to assist with the interview process and perform independent, but supervised, interviews of defendants. Due to the legal issues involved, even when the intern does an evaluation in total, one of the three supervisors will be present for all forensic interviews with the defendant. Also, the Forensic Evaluation Team may co-sign and submit to the Court some of intern’s completed evaluations. Finally, interns will also have the opportunity to witness testimony of the Forensic Evaluation Team mostly regarding competency to stand trial, but also criminal responsibility and sexual violent predator statutes. Common counties for testimony include Jackson County (Kansas City or Independence, Missouri), St. Louis County, and St. Louis City.

New Outlook Program (Dr. Robbins, Dr. Stinson)
The New Outlook Program was developed to treat people with severe mood and behavioral dysregulation. Many of the people that we treat have intellectual and developmental disabilities. The primary reasons for placement in our program include severe aggression, sex offending behavior, and/or self-harm behaviors. The treatment modalities in this program include Dialectical Behavior Therapy (DBT) and Positive Behavior Support. Interns on this rotation will receive training and supervision in providing DBT in an inpatient forensic setting. Interns will provide individual DBT therapy, group DBT skills, participate in DBT consultation team, and provide coaching. Additional experiences can include case management, multidisciplinary treatment team, program development, functional behavioral assessment, and writing behavioral support plans. All interns choosing a rotation in the New Outlook Program will be required to read Cognitive-Behavioral Treatment of Borderline Personality Disorder (Linehan, 1993) and Skills Training Manual for Treating Borderline Personality Disorder (Linehan, 1993). This program rotation will primarily occur in the intermediate security unit with some consultation in the maximum security unit.

Dr. Robbins and Dr. Stinson have presented several papers describing clinical and demographic characteristics of clients with intellectual and developmental disabilities and co-occurring mental illness and sexual behavior problems at national conferences, including the American Psychological Association (2008) and the National Association for the Dually Diagnosed (2007). Additional research has focused on the development of a program for intellectually/developmentally disabled clients in a forensic setting and the use of functional behavior assessment in describing sexual behavior. Interested interns would have the opportunity to collaborate in such research.

Program Evaluation (Dr. Beck)
The Program Evaluation and Research Service at FSH is charged with assisting the executive leadership team at FSH with assessing the cost and effectiveness of facility treatment and rehabilitation programs, as well as evaluating and developing new treatment/rehabilitation technologies and related techniques. Ongoing specific projects include review and analysis of data related to observational assessments of psychosocial rehabilitation programs, research involving clients with sexual behavior problems (including functional behavior assessment studies, characteristics of sex offenders with intellectual and developmental disabilities, and empirical validation of a new manualized approach to sex offender treatment) and utilization of multivariate predictive models to identify patients with a high risk of intramural aggressive behavior. Co-authorship of resulting manuscripts and conference presentations is available for interested interns.

In this rotation, interns will gain supervised experience in the selection, use, and development of appropriate program evaluation measures, and in appropriate data collection and analysis techniques. They will assist treatment staff in developing goals, monitoring progress, and interpreting and using data as part of program-based and unit-wide program evaluation projects. They will prepare reports of their findings to the executive management team. Much of this work requires collection of clinical data using psychological assessment techniques and tools (e.g., BPRS, PANSS, MMPI, Wechsler scales, MSI II) as well as more recently developed observational assessments (e.g., TSBC, SRIC).

Psychiatric Rehabilitation (Dr. Bucklew & Dr. Coleman)
The Psychiatric Rehabilitation Program (PRP) is a comprehensive psychosocial rehabilitation program based on the Boston Model developed by William Anthony, et al. Originally developed as an outpatient treatment model, Fulton State Hospital (FSH) has modified and implemented it for an inpatient treatment setting. The PRP at FSH uses client-centered methods of interaction to move clients through the rehabilitation phases of Engagement, Readiness, and Choosing and Achieving. This is an evidence-based approach that has been found successful in a variety of settings for individuals with moderate to severe persisting mental illnesses that reconstitute relatively quickly with medication. More specifically, clients participate in a five level program in order to achieve the goal of transferring to a less restrictive setting or to the community.To achieve the fifth level of the program, clients complete a relapse prevention plan that reflects an understanding of their mental illness and substance abuse (if applicable) and how it has contributed to their hospitalization. Each client’s plan must identify what they will do, now and in the future, to continue on the path of recovery and reduce the risk of relapse and repetition of dangerous behaviors.

At FSH, the PRP approach is implemented across three distinct, geographically separated security levels:  maximum, intermediate, and minimum. At this time, interested interns are able to choose rotations in either maximum with Dr. Bucklew or in minimum security with Dr. Coleman. In maximum security, or Biggs Forensic Center, PRP is offered on three adult male wards. Clients are often admitted with primary psychotic disorders such as Schizophrenia or Schizoaffective disorder or a mood disorder, which is usually some form of bipolar disorder. Clients may also have dual diagnoses including substance abuse and/or personality disorders. The maximum security PRP consists of three hospital wards with a maximum capacity of 51 clients whose ages vary from late teens to late 60's in a decreasing order of frequency as follows: 20-30 and 30-40 are about equal, then 30-40, 50-60, and 60-70. The client population is male. Educational and vocational training and experience vary widely.

In minimum security, or Hearnes Psychiatric Center, the PRP consists of one ward serving male and female clients. Clients assigned to the PRP are typically diagnosed with a psychosis spectrum disorder, major depressive disorder, or bipolar disorder of a moderate to severe nature which may be persistent (but reconstitutes relatively quickly with medication). In the HPC PRP, persons diagnosed with antisocial personality disorder may also be considered for acceptance. Clients may also have had repeated hospitalizations with failed community placements or they may be newly diagnosed with mental disorders. They may have moderate to severe deficits in the areas of social skills, higher order self-care skills, and/or instrumental role performance. The many PRP clients are deemed likely to return to a relatively independent setting once achieving discharge to the community, and may not exhibit high rates of bizarre, unusual, and/or aggressive behaviors relative to clients assigned to other programs. In HPC, opportunities to work with geriatric consumers are also available.

In this rotation, interns will serve as a member of a multidisciplinary treatment team providing services to adult clients residing on the Psychiatric Rehabilitation Program. The treatment team consists of a Psychiatrist, Program Coordinator, Treatment Team Leader, Social Worker, Psychologist, Registered Nurse, Special Education Teacher, Recreation Therapist, Music Therapist, and Forensic Rehabilitation Specialists. Also, interns will gain supervised experience with a range of clinical interventions, including psychological assessment, individual and group psychotherapy, social skills training, cognitive rehabilitation, and case management. Other members of the treatment team work alongside the intern to enhance the learning experience. The rotation is available in maximum (Biggs Forensic Center) and minimum security (Hearnes Psychiatric Center) settings. The composition of the treatment team may vary slightly between units.

Psychological Services Clinic (Dr. Trull, Dr. Skinner & Dr. Bell)
The Psychological Services Clinic (PSC) is an outpatient clinic that operates under the auspices of the Department of Psychological Sciences at the University of Missouri-Columbia. It is staffed by doctoral student clinicians and Ph.D. level psychologists affiliated with the Department’s clinical training program, as well as psychiatry residents and psychology interns from the University and other area training programs. The PSC’s primary mission is to provide high quality training to doctoral students, interns, and residents, emphasizing a clinical science approach to clinical service delivery, and to provide affordable, empirically supported assessment and treatment to the community.

Clinicians in training gain supervised experience in individual, couple, and family therapy with a wide variety of presenting concerns, as well as in various specialty groups (e.g., dialectical behavior therapy). Interns in this rotation will participate in the PSC’s Dialectical Behavior Therapy program, which provides empirically-supported intensive outpatient services to adults with Borderline Personality Disorder and related issues (impulsivity, emotional dysregulation, etc.). Interns will have the opportunity to co-lead groups, provide individual therapy, and participate in ongoing consultation and training with the DBT treatment team. As interests and caseloads permit, interns may also carry cases outside of the DBT program. This internship rotation is available as a year-long rotation, with the intern spending 8 to 12 hours per week during their internship year at the PSC. Four to seven of these hours will be spent providing individual and group therapy. The remaining time will be devoted to supervision, DBT consultation team meetings, and other administrative tasks.

Sex Offender Treatment (Dr. Stinson)
The Sex Offender Treatment program provides group and individual treatment to clients who have a documented history of illegal or inappropriate sexual behaviors in community and residential settings. Many of these clients have corresponding diagnoses of paraphilias and involvement with the criminal justice system, as well as co-occurring intellectual and developmental disabilities, substance abuse, personality disorders, and a range of other Axis I psychopathology. This rotation is available across a variety of treatment programs and security levels. Assessment opportunities involving sexual history evaluations, standardized assessment of sexual interests (e.g., MSI-II), functional behavior analysis, and risk assessment for potential Sexually Violent Predators are also available.

Interns assigned to this rotation will be involved in co-facilitating sex offender treatment groups using a new manualized treatment approach. These groups follow a model emphasizing the development of adaptive and appropriate regulatory strategies, focusing on such areas as client motivation, self-regulatory deficits which may have contributed to a variety of problematic behaviors, skill replacement, and self-monitoring. Interns would receive training in manualized treatment, engage in related clinical activities such as providing input to assigned treatment teams and examining records for pertinent clinical information, and have the opportunity to participate in empirical validation of treatment efforts and assessment techniques used at the facility.

Dr. Stinson is currently supervising several research projects related to characteristics of intellectually/developmentally disabled sex offenders, regulatory strategies in a sex offender population, the use of new assessment tools to describe sexual behavior, and a new treatment manual for those with sex offending behavior. Results from these studies have been recently presented at conferences for the American Psychological Association(2008) and the National Association of State Mental Health Program Directors (2007). Interested interns would have the opportunity to collaborate in such research.

Social Learning (Dr. Coleman, Dr. Martin & Dr. Zolnikov)
The Social Learning Program (SLP) is an empirically-supported comprehensive psychosocial rehabilitation program designed to treat those individuals with the most severe and persistent mental disorders. The majority of clients in the SLP have primary diagnoses in the schizophrenia spectrum. Most are in their mid-30s or older, have never been married, and have limited educational backgrounds. SLP rotations are available on all-male and co-ed wards in the hospital’s maximum security setting, on all-male and co-ed wards in the intermediate security setting, and on a co-ed ward in the minimum security unit.

The SLP is modeled after the evidence-based approach developed by Dr. Gordon Paul. Dr. Paul’s longitudinal, empirical investigation supported the effectiveness of the social learning approach over that of traditional hospital treatment and milieu therapy in decreasing maladaptive behaviors, increasing adaptive skills, and facilitating release into the community and independent functioning for a severely disabled psychiatric population (Paul & Lentz, 1977). Direct observational data collection regarding client behavior/functioning (Time-Sample Behavioral Checklist; Paul, 1987) and staff-client interactions (Staff-Resident Interaction Chronograph; Paul, 1988) is ongoing at Fulton State Hospital and is used to support individual treatment planning and monitoring, program evaluation, and quality improvement.

Interns on the SLP rotation serve as a member of a multidisciplinary treatment team. They receive supervised experience with psychological assessment and a range of clinical interventions, including individual and group psychotherapy, social skills training, cognitive rehabilitation, and case management. They also receive training and experience in using observational assessment data to assist the treatment team with evidence-based clinical decisions and evaluation of client progress and outcomes. Other members of the treatment team work alongside the intern to enhance the learning experience.

Didactic Training & Research Seminars

The internship provides a full calendar of didactic experiences that occur two hours each week. Presentations are offered by members of the Internship Training Committee as well as special guests from the Department of Mental Health and the community. Seminar topics include advanced issues in assessment, treatment, cultural competence, diversity, and ethics as well as professional issues. Seminars are specifically designed to complement the experiential training that occurs on various rotations. Particular emphasis is placed on empirically supported approaches to psychological practice. Also integrated into the seminar calendar are four presentations offered by interns. These presentations occur quarterly and focus on interns' individual therapy clients and completed psychological evaluations.

Throughout the year, interns will also participate in the weekly, one and one half hours Research Seminar. This meeting focuses on research and program evaluation projects conducted by the clinical research team which also includes various hospital faculty members, research assistants, undergraduate psychology practicum students, and affiliated persons and agencies. Interns will be expected to participate in ongoing research either by collaborating in existing projects or by generating their own projects. Although we strongly advise interns to have at least a proposed dissertation project prior to the internship year, this seminar can be useful in providing assistance with the dissertation project.

2008 - 2009 Seminar Calendar

Additional Opportunities

Other didactic or workshop experiences are available to interns throughout the years, including invited speakers presenting to FSH professional staff and Grand Rounds at the University of Missouri.

Cultural Competence Council

Fulton State Hospital’s workforce is comprised of a diverse population not dominated by one gender, race, or even culture. Our hospital and its leadership embrace this diversity and strive to create a safe workplace environment attractive to staff of all backgrounds. The leadership wants everyone to work together in a climate of respect and appreciation for the uniqueness that every individual brings. This includes employees, visitors, and especially the individuals we serve.

Interns are strongly encouraged to participate in FSH’s Cultural Competence Council. The Council meets once per month and is involved in a variety of activities and projects throughout the campus. The Council is charged with implementing this philosophy and supporting the belief that all people must be valued because of their humanity, unique abilities, perspectives, and skills. The mission statement of the Cultural Competency Council reads as follows:

This council is to make available continuous education for staff and patients related to Cultural, Ethnic and Spiritual needs, relevant to the facility’s Mission, Vision and Values statement.

For the purposes of the Cultural Competence Council, culture is defined as “The sum total of ways of living built up by a group of humans and transmitted from one generation to the next, which includes shared patterns of behavior that are based on shared knowledge and meaning communicated through language, beliefs, and values. It also includes socially transmitted behavior patterns, arts, beliefs, institutions, and all other products of human work and thought characteristic of a community or population.” Diversity is defined as “The differences that make each of us unique” (from a Winning Balance). Finally, Ethnic is defined as “Pertaining to a religious, racial, national or cultural group.”

The responsibilities of the Cultural Competency Council include:

• Offer continuous educational programs for all staff in order to provide optimum care to our clients and sensitivity to their unique needs.
• Offer continuous educational programs for all clients in order to be sensitive to individual and cultural needs.
• Provide oversight, assessment, and evaluation of continuum of care related to cultural, ethnic and spiritual assessments to provide clients with the right to be treated according to their unique needs.
• Provide oversight, assessment, and evaluation of employee working conditions to ensure an environment that promotes and respects human diversity.
• Be available to the Administrator to explore alleged discrimination when first reported.
• Sponsor cultural celebrations.
• Promote community involvement with Cultural Competence Council.
• Evaluate annual patient and staff satisfaction surveys related to cultural issues.
• Review data collected on cultural issues and make recommendations to improve the facility’s Affirmative Action Plan.
• Identify, understand and interpret Joint Commission requirements for facility.