Psychology Fellowship Training

Postdoctoral Fellowship 2010-2011

The Rocky Mountain Blood and Marrow Transplant Program, a collaboration between Presbyterian/St. Luke's Medical Center and Rocky Mountain Cancer Centers, offers a one-year clinical psychology postdoctoral fellowship specializing in adult oncology and bone marrow transplant. For the 2010-2011 training year, there will be at least one, and possibly two fellowship positions.

Overview

The Rocky Mountain Blood and Marrow Transplant Program (RMBMTP) (www.rockymountainbmt.com) is a large regional transplant center for Colorado and surrounding states. Transplanting over 200 patients per year, the program performs allogeneic and autologous transplants for adult patients. Stem cell transplantation is utilized as treatment for hematological diseases and myeloproliferative disorders such as leukemias, lymphomas, multiple myeloma, amyloidosis, aplastic anemia, and myelodysplastic syndrome.

The transplant program is housed in two facilities: Presbyterian/St. Luke's Medical Center (PSLMC; www.pslmc.com ) and Rocky Mountain Cancer Centers (RMCC; www.rockymountaincancercenters.com ). PSLMC is a large medical center, licensed for 680 beds, serving Denver and the Rocky Mountain and Great Plains regions. There are two inpatient units at PSLMC dedicated to stem cell transplantation. A third inpatient unit, adult oncology, provides care for transplant patients as well. Across the street from PSLMC is RMCC, a free-standing outpatient cancer treatment center. As Colorado's largest and most comprehensive provider of cancer care, Rocky Mountain Cancer Centers provides advanced care for all types of cancers and hematological diseases, including bone marrow transplantation. Fellowship training occurs at both the inpatient and outpatient settings.

Utilizing a multidisciplinary team approach, RMBMTP provides comprehensive care to transplant patients and their family members. Psychology is integral to the multidisciplinary team, providing support to transplant patients and caregivers throughout the transplant process. In addition to the psychologists and the postdoctoral fellows, the team includes six transplant physicians, nurse practitioners, nurses, social workers, and nutritionists. At PSLMC there are also chaplains, physical and occupational therapists, pharmacists and a healing arts program.

Training Program

The training program for the postdoctoral fellowship follows a developmental model. Fellows are assumed to have a strong basis of competency in assessment, diagnosis and intervention. In addition, many fellows come in with a strong background in health or medical psychology. Thus, the early weeks of the fellowship are spent orienting fellows to the specialty area of stem transplant as well as familiarizing them with the multidisciplinary team and daily procedures. As the fellows develop confidence in the setting, they take on more responsibility and independence. The transplant program is busy, with a brisk pace, which provides opportunities for fellows to master how to work efficiently within a medical setting as well as how to prioritize their time with the demands of their clinical responsibilities. Because of the busy service, we have found that some experience in a health care setting prior to the fellowship is helpful.

Fellows carry a clinical case load that is comprised of individual transplant patients and caregivers (usually family members) of the transplant patients. Work is done within a systems model, incorporating those people who are involved in the patients' care into the supportive work with the patient. The multidisciplinary team is seen as part of the patients' care system, affecting the patients' adjustment to illness, coping and providing support. Fellows meet patients and caregivers prior to transplant for a psychosocial intake, and then follow those patients through the transplant process and during the post-transplant recovery. Patients are seen in both inpatient and outpatient settings which provides for continuity of care and allows the fellows to be involved throughout the transplant process. Treatment planning and case discussion occurs during three weekly multidisciplinary meetings.

Fellows spend approximately 25-30 hours per week in direct and indirect patient care. Direct clinical services include conducting patient intakes and providing individual, family or group interventions. Indirect patient care includes providing consultation to staff regarding patient behaviors and treatment planning, and active involvement in weekly multidisciplinary meetings. The rest of the fellows' time during the week is spent in supervision, didactics, administrative activities, or other training activities.

Colorado has a large Latino population and a large ‘Spanish-speaking only' population. There are opportunities for bilingual Spanish-speaking postdoctoral fellows to work with Latino patients and their families in the transplant program. Supervision for these clients is provided by a bilingual psychologist on staff at the RMBMTP.

Goals and Objectives

Goals

The primary goals of the Rocky Mountain Blood and Marrow Transplant Program Postdoctoral Fellowship are to:

1. develop the advanced clinical skills necessary to work competently and independently with diverse cancer populations,
2. understand the professional, ethical and legal issues that arise in a medical setting and how to address these issues,
3. train fellows in administrative activities and provision of supervision, and
4. prepare fellows to obtain a position in a medical or healthcare-related setting.
5. A variety of clinical, administrative and didactic experiences are provided in our state-of-the-art transplant program to meet these goals. In addition to supervised clinical training experiences with transplant patients and their caregivers, fellows will collaborate in multidisciplinary forums, educate patients and staff on psychosocial oncology issues, obtain experience in administrative activities, and enhance supervision skills through provision of supervision to interns or practicum students.

Objectives

By the completion of the fellowship year, postdoctoral fellows are expected to demonstrate competency in the following areas:

• Expertise in assessing psychosocial issues, coping style, and caregiver support of patients faced with a blood or marrow stem cell transplant (BMT).
• Refined presentation skills addressing the psychosocial risk for BMT candidates to a multidisciplinary team.
• Competence in development of multidisciplinary treatment plans for BMT patients considering psychiatric diagnosis, stage of disease, type of transplant, psychosocial background, personal attributes and resources, immediate and extended social supports, and community resources.
• Effective communication, consultation, coordination and collaboration with the medical team.
• An advanced level of understanding of the complex interplay between medical and psychiatric disorders.
• Development of differential diagnostic skills, considering biopsychosocial factors, in identifying the etiology of psychiatric symptoms.
• Advance understanding and consideration of ethical and legal issues in a medical setting.
• Effective intervention in staff-patient interactions that create obstacles to effective medical treatment.
• Supervision of psychosocial assessment and therapy by interns or practicum students.
• Sophistication in personal and professional understanding of issues of diversity in the context of clinical practice and professional development.

Fellowship Activities

The postdoctoral fellows engage in a number of clinical, didactic, teaching, supervisory and administrative activities through their fellowship year to meet the expected clinical competencies.

Patient Evaluation:
Fellows conduct initial psychosocial evaluations with transplant candidates and their caregivers using a semi-structured interview format. On average, fellows will conduct 2-4 intakes per week. Coping strategies and resources, psychiatric history and current symptoms, substance abuse history, and availability of a responsible caregiver for transplant are assessed to determine patients' psychosocial eligibility and safety risk for transplant. If psychosocial issues or concerns are identified, the fellow addresses them with the team in a weekly multidisciplinary meeting where patient eligibility is discussed. Information acquired from the psychosocial evaluation is also important for developing a preliminary treatment plan for support of the patient and their family members through the transplant process.

Psychotherapy:
Short-term supportive psychotherapy is provided to patients and their family members throughout the transplant process. Long-term psychotherapy is sometimes indicated when patients experience difficulty coping with their illness, transitioning back to life or work following transplant, or dealing with changes in their life or relationships due to illness and transplant. Fellows often carry a case load of 2-3 long-term psychotherapy patients per week.

Professional Development:
Understanding one's healthcare beliefs and values is deemed by our team to be important when working with patients from diverse backgrounds and cultures, and those facing a life-threatening illness. Thus, a significant effort is made through seminars, readings and supervision to explore personal beliefs and values, and how these might impact care. In addition, oncology work, by its nature, involves facing existential issues, including death and dying. It is important that fellows feel a level of comfort with this work, and comfort exploring their own thoughts and feelings regarding death and dying. The fellow is not expected to be an expert in this area, but rather have an openness to exploring these issues with patients when they come up, and exploring their own feelings regarding these issues.

Group Therapy:
Fellows will have an opportunity to co-facilitate, as well as develop and facilitate groups during their fellowship year. During part of their fellowship year, fellows will co-facilitate a weekly caregiver support group with one of the staff psychologists. They will also have the opportunity to co-facilitate other groups with a staff psychologist or staff social worker. In addition, fellows are expected to plan, develop and facilitate at least two short-term groups on topics of interest (stress management, bereavement, coping skills, survivorship issues, etc.) during their fellowship year. Didactic training in group psychotherapy, as well as supervision and consultation on group work, is provided.

Multidisciplinary Meetings:
There are 3 multidisciplinary team meetings per week. Transplant candidate eligibility (medical and psychosocial) is discussed in the weekly Pipeline meeting. There is a weekly inpatient and a weekly outpatient multidisciplinary meeting to discuss treatment planning for current patients. The fellow and other members of the psychosocial team play an active role in these meetings, educating the staff on patients' psychosocial issues and needs for support, or advocating for patients. Fellows also have the opportunity to facilitate one of these meetings.

Consultation with the Team:
A large part of the fellows' work focuses on assisting the staff with patient-staff relationships and communication, especially when patients present with challenges such as Axis I or Axis II disorders. Medical staff rely on the psychology team for guidance in working with difficult patients. Consultation to the team is provided in a number of ways. Medical rounds are conducted daily on the inpatient units. The fellow and psychology staff regularly participate in these rounds with the medical staff to observe patient-staff interactions, provide education to the team on psychological issues, and provide input for treatment planning. Family conferences initiated by the psychosocial staff are often utilized to enhance communication between the medical team and the patient and their family members, to reduce patient and family anxiety, and to set treatment goals. Finally, individual consultation with staff is frequently conducted on an informal basis to provide education and support.

Training and Education:
Fellows have many opportunities to present educational programs to patients, staff and members of the community. The RMBMTP requires BMT patients and caregivers to attend a class prior to transplant, which is taught bimonthly by various members of the BMT team, and fellows are assigned to teach part of the class on stress management. RMCC offers a number of educational programs for oncology patients. Fellows are asked to develop and present a didactic presentation for one or more of these programs. In addition, fellows are expected to present to the transplant staff on a topic of interest either at the monthly Journal Club, or through a scheduled staff in-service. Finally, RMCC has a close relationship with the Leukemia and Lymphoma Society, which regularly presents educational lectures to the community. Fellows may have the opportunity to present on the psychosocial aspects of cancer at one of these lectures.

Supervision:
Weekly supervision is provided by each of the two staff psychologists for a total of 2 hours of scheduled individual face-to-face supervision per week. In addition, individual or group supervision is provided for group work. To enhance the supervision process, the fellow is expected to audiotape or videotape some of their clinical work. There are often opportunities for the postdoctoral fellow to provide supervision to an intern or practicum student, in which case the fellow would receive additional hours of "supervision of supervision."

Didactics:
The fellow attends a weekly 1 ½ hour psychosocial oncology seminar series at Rocky Mountain Cancer Centers. Some of the topics include healthcare disparities, ethics, the use of genograms in understanding healthcare beliefs, cultural competencies, spirituality and cancer, adherence, case presentations, and review of relevant literature. In addition, there is a bi-monthly 1 ½ hour professional development postdoctoral seminar series with the fellows from the University of Colorado at Denver that focuses on topics such as preparing for the EPPP, learning the health and mental health systems, preparing a resume, marketing yourself, interviewing for jobs, and other topics of relevance for launching your career. RMCC also hosts a monthly Psychosocial Oncology Rounds that fellows attend. Throughout the year, there are also full-day training opportunities that arise for topics of interest.

Theoretical Approach:

The variety of issues that arise in a medical setting working with patients facing a life-threatening illness demands an integrated therapeutic approach. The theoretical orientations of the supervising psychologists range from psychodynamic, short-term psychodynamic and existential, to behavioral and cognitive-behavioral. Supportive, crisis-oriented approaches are often utilized to address emotional distress experienced by patients during aggressive medical treatment. Cognitive-behavioral techniques, existential theory and systems theory are helpful in providing effective coping strategies, addressing patients' existential distress and understanding the interactions between patients and the medical team. Diversity in the broad sense is embodied in the work, assessing patients' healthcare beliefs and understanding their perspective from their own diverse backgrounds. There is a focus throughout the training on what healthcare beliefs we bring to our work and how that may influence our perceptions and clinical work with patients and family members.

Fellow Evaluation

Evaluation of the postdoctoral fellow occurs every four months (three written evaluations) during the fellowship year using a competencies-based evaluation form, which is made available to the fellow at the start of the fellowship year. Competencies are assessed in general clinical areas as well as healthcare-specific areas. Both supervisors provide separate evaluations. Because supervision is seen as a collaborative process, fellows are provided a supervisor evaluation form to provide feedback to their supervisors if they feel comfortable doing so. Formal due process procedures in the event of a grievance are provided to fellows at the start of their fellowship year. However, open communication regarding problems is encouraged to allow issues to be addressed in an informal way with the hopes of resolving conflict or disagreements.

Licensure

Fellows will accrue a total of 2080 hours of training during their fellowship year minus vacation time. The 12 month fellowship training program meets the requirements for licensure in the state of Colorado.

Training Staff

Teri Simoneau, Ph.D. received her Ph.D. in Clinical Psychology from the University of Colorado at Boulder in 1995. She completed her internship at the VA Palo Alto Health Care System with an emphasis in Behavioral Medicine. She then completed a postdoctoral fellowship at the University of Colorado Health Sciences Center with their Bone Marrow Transplant Program. Following her fellowship, she remained as faculty at the Health Sciences Center, continuing her work with the Bone Marrow Transplant Program. In 1998, she came to the Rocky Mountain Blood and Marrow Transplant Program to develop psychosocial services within the transplant program and started a postdoctoral training program in 2004. Her clinical and research interests include quality of life issues for oncology patients, coping with illness as a couple or family, and caregiver coping and support.

Athena Y. Baca-Chieza, Psy.D. received her Psy.D. in Clinical Psychology from the Chicago School of Professional Psychology in 2006. She completed a health psychology internship at Brooke Army Medical Center in San Antonio, Texas, with an emphasis in oncology and women's health issues. She then completed a postdoctoral fellowship at the Rocky Mountain Blood and Marrow Transplant Program in conjunction with the University of Colorado Health Sciences Center. Following her fellowship, she remained a full-time staff member of the Rocky Mountain Blood and Marrow Transplant Program as an employee of Presbyterian/St. Luke's Medical Center. Her clinical interests include working with underserved, indigent, and Latino populations, coping with chronic and terminal illness as a patient and family, and providing education and support to oncology nurses/staff. Dr. Baca-Chieza is fluently bi-lingual in Spanish and is a founding member of the COLORES de Cancer initiative (Colorado Latino Outreach and Resource, Education, & Support).

Benefits and Salary

Benefits include three weeks of vacation plus six major holidays; partially paid health insurance; dental insurance; optical benefits; malpractice insurance; and free parking. If desired, fellows have the opportunity to work a 4-day (10 hour/day) work week. Financial support up to $1200 is provided to attend a conference. In the past, fellows have attended the American Psychosocial Oncology conference with the RMCC psychosocial team. Salary: $34,000. The fellowship starts September 1, 2010.

Facilities and Support

Fellows' offices are at Rocky Mountain Cancer Centers. However, training occurs at both the inpatient (PSLMC) and outpatient (RMCC) facilities, and both psychologists are involved in the training at both sites. Support includes computer, phone, and pager. In addition, dictation services are available for the psychosocial intakes conducted by fellows. The fellow is not responsible for any on-call hours outside of their regular work hours. Sometimes fellows will run a group in the early evening or occasionally on a weekend and flex-time is offered on these occasions.

Applicant Requirements

Applicants must have completed all professional doctoral degree requirements from an APA/CPA-accredited doctoral program by the start of the fellowship. The predoctoral internship must be APA/CPA accredited or meet APPIC standards. If accepted for the fellowship, fellows must go through a background check and pass a drug screen.

Application

To apply, send your vitae, a letter of interest, and have 3 supervisors/mentors send letters of recommendation to: Teri Simoneau, Ph.D., BMT Program Psychologist, Rocky Mountain Blood and Marrow Transplant Program, 1800 Williams St., Denver, CO 80218 or email application to: teri.simoneau@usoncology.com. Applications are due January 15th, 2010. Our program follows the Uniform Notification Date (UND) procedures, so offers for the fellowship will be made on February 25th, 2010 in accordance with the outlined procedures.

If you have questions about the fellowship, please contact Dr. Simoneau by phone (303/285-5082) or email teri.simoneau@usoncology.com.