Practicum Policies

Practicum Student & Therapist’s Policies

Student therapists provide services under the supervision of qualified clinical faculty to fulfill these supervisory and teaching functions.   

CLIENT CASELOAD & HOURS OF CLINIC-RELATED RESPONSIBILITIES

Student therapists are expected to carry an active caseload of three to five active individual psychotherapy clients and one ongoing psychological assessment. A therapist may have more clients on their caseload, but this is the minimum number of clients that are seen on a weekly basis. At times, it may be necessary for a therapist to be assigned more therapy or assessment cases to help maintain an active caseload and keep their number of clinic-related hours at an expected level. New clients will be assigned to therapists as former clients are terminated or discontinue therapy and as psychological assessments are completed. Groups and families in the caseload will mean a reduction in the number of individual clients. Although the practice manager and supervisors will be keeping track of therapist’s caseloads, the therapist should immediately inform the practice manager, or supervisor when an opening in their caseload occurs.

It is estimated that student therapists will need to allow 15-20 hours per week for clinic-related matters including therapy, assessment, meetings with your supervisor and supervision team, and paperwork. 

CLIENTS

Appropriate Clients: Clients seen by student therapists may include children, adolescents, adults, individuals, couples, and families. Most non-emergency psychological conditions are treated at The Shea Center for Mental Wellness.

Inappropriate Clients: Callers or walk-ins that are immediately suicidal appear to represent danger to themselves or others, those who are currently under the influence of a substance, and those who demonstrate acute psychotic symptoms should not be seen and need to be rescheduled or referred to other agencies. The Shea Center for Mental Wellness is neither equipped nor insured for handling crisis situations on a routine basis. If clients or walk-ins arrive at the office in an agitated state or in an immediate crisis, contact any available supervisory staff or call 911 for immediate assistance.  These individuals may be referred to a local hospital emergency room.

Client-Therapist Suitability: Under circumstances where the intake therapist is not the most appropriate therapist, but the client is still suitable for The Shea Center, clients should be informed that they will be contacted within one week to schedule with their new therapist. Clients should also be informed that even though the therapist is conducting the initial session, they may not be the client’s therapist. These assignments are made based on client needs and supervisory expertise to make sure that the client receives the best possible services. In such instances when the intake therapist will not continue as the primary therapist, the intake therapist should notify the office manager so that a client can be referred to a new therapist and needed information and materials can be assigned to the new therapist. If a client is not appropriate for services at The Shea Center, or does not wish to continue treatment, it is still important to complete all paperwork and documentation (e.g. intake report).

When the Student Therapist Must Miss an Appointment: It should be rare that a student therapist must cancel an appointment. This is permitted only in the case of illness or extreme family emergency. When this happens, the student therapist is responsible for contacting their clients well in advance to provide adequate notice. The therapist should also notify their supervisor and the practice manager if an absence must occur. If the call to cancel the appointment must be made outside of the office, then *67 (+the number being dialed) can be dialed to block personal phone numbers from being displayed on caller ID. You are responsible for any fees charged to you that are associated with this feature.

The office manager will assist with cancellations if student is unable.

THERAPY PHASE

The following section provides both procedural and therapeutic information. Whereas adherence to procedural issues assures continuity of cases across supervisors and therapists, the therapeutic information below is intended only as a guideline. All therapists are encouraged to plan and discuss therapy with their supervisors. If at any time during the therapy phase, a client presents with a high risk of suicide or harm to others, then additional treatment is needed. Please consult with the supervisor for next steps.

Following the initial intake session, between one to three further sessions are typically spent assessing the problem and selecting the most appropriate treatment method. As a rule, however, assessment is an ongoing activity throughout therapy. During these initial assessment sessions, continue the investigation started during the intake session by finding out more detailed information about the nature of the problem. Use information from self-report measures completed by the client, family members, and other associated individuals (e.g., teachers, physicians) as beginning points in a line of questioning. Clarify confusing information from the intake and self-report measures. Attempt to gather information about the presenting problem from a variety of sources using a variety of methods (self-report versus direct observation) to check the validity of the information. Discuss intake and assessment information in supervision and case consultation.

Psychotherapy Notes (individual & group): During treatment, therapists should write a psychotherapy note for each session beginning with the session after the initial intake meeting. Your supervisor will instruct you on the form that the psychotherapy note should take. Typically, psychotherapy notes should include (a) the date of contact, (b) the nature and length of the service provided (e.g., 50-minute individual therapy), (c) who attended, (d) client status or behavioral observations, (e) progress toward the treatment goals, (f) any relevant new information, (g) interventions (h) homework assignments and completion, (i) and the date and time of the next scheduled session. Psychotherapy notes of any contact with the client, whether the contact is in person, by telephone, or is simply documentation of a missed or cancelled appointment must be typewritten and shared via HER (SimplePractice) to supervisor within 48 hours after each client session or contact. Psychotherapy notes will be signed by both the therapist and supervisor.

Treatment Plan: Treatment plans help guide the therapy process and increase the probability that the therapist and client will both "go in the same direction" as the issues that brought the client to treatment are addressed. The plans form a contract for the work that the client and therapist will do together. These plans can often be empowering for many clients. A treatment plan can be developed with or without the client but should ultimately be reviewed and agreed upon by the client. Supervisors will direct you in what should be included in the treatment plan and how to format the plan. These areas may include things such as (a) Identifying Problem, (b) Long Term and Short Term Goals, (c) Interventions, (d) Frequency, (e) Treatment Modality, (f) Outcomes, (g) Completion Date for Goal(s), and (h) Who is Responsible for Treatment Services. Treatment plans must be completed with signatures from the client, therapist, and supervisor, no later than the third session after intake. Treatment plans can be updated when needed but should be reviewed by the therapist and supervisor no less than once every six months. 

RECORDING SESSIONS 

The Shea Center for Mental Wellness maintains and owns records of all counseling clients. These include intake reports and therapy session progress notes. You are required to write a brief note for each counseling session. Notes should be completed the day of the session. Your notes will be reviewed by your supervisor who will indicate in the record their acceptance of the note. Counseling notes and records should not ever be taken out of The Shea Center for Mental Wellness.

It is a requirement of all student therapists that they make video recordings of their counseling sessions. The client is informed at intake that they are being assigned to a student therapist who is required to record each session. Written consent to record sessions must be secured from each of your clients. Forms for this consent are part of the on-line forms that are signed by the client before they come to their first session. If a client refuses to be recorded, the case will be transferred to a Shea Center staff member who is not required to record. The offices assigned to student therapists have a digital recording system. You will need to learn how to use it properly. All recordings are kept on a secure server and can be accessed by yourself and your supervisor for training purposes.

 REPORTING CHILD ABUSE

Therapists are required by law to make a report to the Department of Health and Human Resources Child Protective Services (CPS) when they have a reasonable suspicion (proof is not needed) that a minor is being physically or sexually abused or neglected. Should therapists suspect such situation they must contact their primary supervisor. In the event that the primary supervisor is not available the therapist can contact the Clinic Director or any available clinical faculty. This contact with CPS should be made immediately and not more than 48 hours after suspecting this abuse. If the child is in imminent danger the therapist should contact the police and any law-enforcement agency having jurisdiction to investigate the complaint. The supervisory staff will assist the therapist in reporting the suspicion. 

DANGER TO SELF OR OTHERS

When therapists believe that a client is likely to harm their self or another person, that is when suicidal, homicidal, or violent actions appear likely, students must seek immediate consultation with their supervisors or another clinical faculty member. You should note that therapists are required by law to report about or warn any identified individual whom they believe to be in danger as a result of a client’s threat or expected future action. Clients who are believed likely to harm themselves or others may require intervention of law enforcement personnel or civil commitment. 

DISCHARGE PHASE

The successful termination of the psychotherapy relationship is each psychotherapist's goal. The ending phase includes a review and reinforcement of individual change which has occurred in the therapy; the therapist guides the departing client to a resolution of the relationships with the therapist; and the individual is helped to face future life demands with the tools provided in the therapy. The ending process of therapy may also arouse a reappearance of presenting symptoms and/or previous conflicts that have been dealt with in treatment. Additionally, the ending may trigger unresolved conflicts related to previous losses and separation. 

Discharge Paperwork: If a client terminates services after the intake, then both an Intake Assessment & Discharge Report should be completed. The final formal discharge report should be written and signed by the therapist and supervisor. Your supervisor will guide you in what to include in a Discharge Report as well as the preferred format. Some things that are typically included in this type of document are (a) Presenting Problem, (b) Number of Session Attended, (c) Manner of Termination (e.g., mutually agreed upon, no showed last appointment and did not return contact after two attempts were made, etc.), (d) Treatment Progress and/or Amount of Progress Made, and (e) Recommendations and Referrals for Future Services. Discharge reports should be completed within two weeks of the last appointment. Discharge reports will be signed by both the therapist and supervisor.

Transfers: Transfers are completed when a client is not terminating treatment services, but their case is being transferred to another therapist working in The Shea Center.  Although transfers can happen at other times, transfers typically occur when a student therapist is completing their practicum work. It is recommended that upon transfer, the present therapist bring in and introduce the new therapist no later than the last session with the present therapist. Being transferred is often a stressful and uncomfortable experience for the client. By introducing the client to the new therapist there is a continuity of treatment which often aids in the client continuing treatment.

Transfer Summary: A transfer summary is written by the outgoing therapist in place of a discharge summary if the client is continuing services.  Your supervisor will guide you in the format and what to include in the transfer summary.  Typically, these are similar to discharge reports and include things such as (a) Presenting Problem, (b) Reason for Transfer, (c) Treatment Progress and/or Amount of Progress Made, and (d) Recommendations and Referrals for Future Services. Transfer summaries should be completed within two weeks of the last appointment. Transfer summaries will be signed by both the therapist and supervisor.

CONFIDENTIALITY & SECURITY OF CLIENT FILES

Discussion of Clients: Clients are to be discussed only with supervisors and The Shea Center personnel. No discussion of clients with people outside of The Shea Center may take place without the written consent of the client. This includes even any acknowledgment that the client is our client, or that we have ever heard of them. Any discussion of a client with any Shea Center personnel should occur in the form of supervision meetings. A couple exceptions to this rule can occur.  Discussion can happen if all people present are associated with The Shea Center or your institutions program (if applicable) and the discussion is occurring as part of a meeting or in a classroom situation.  For this to occur, there must be an educational benefit to the discussion, the discussion is intended to benefit the client, and is limited to Shea Center personnel with a need to know about the client or with insight to offer.  Consent to discuss a client is also not required, when another provider (psychologist/case manager, etc.) is rendering professional services as part of a team or interacting with other appropriate professionals concerning the welfare of the client (provided that all persons receiving the information abide by the rules of confidentiality and have written consent of the client).

JUDICIAL & ADMINISTRATIVE PROCEEDINGS

If a client is involved in a court proceeding a request could be made for information. The therapist should contact their supervisor and the supervisory staff will assist the therapist if court-related requests are made.   

SUBPOENAS

You may, on occasion, receive a subpoena for clinic-related material about a client. If you receive a subpoena do not send the records. Contact your supervisor to discuss this further.  The reason you must not send records simply on receiving a subpoena is because your client has the legal right to be informed by you that you have received the subpoena, and the client further has the right to go to court and attempt to quash that subpoena by a judge’s order.

Thus, if you receive a subpoena for client records you may only send those records to the requesting party after you have first informed your supervisor and the client of the subpoena and either received written permission from the client to proceed with sending the requested materials (and, of course, with that written permission from the client no subpoena would have been necessary in the first place), or after the client has failed to seek and win an order to quash the subpoena. 

LIABILITY INSURANCE

Students and their supervisors are covered by Hartford Underwriter’s Insurance Company for general liability insurance. It is recommended that student therapists obtain additional malpractice coverage. Many insurance companies have reduced rates for students.

CLINIC EMERGENCIES

Clinical emergencies in a variety of forms may arise. In such situations therapists must contact their primary supervisor. If that person is not available, the therapist should try to contact another Clinical faculty member. If no supervisory staff is reached at this point, then the therapist should contact the Clinic Director.

Immediate threat or danger: In the unusual event of immediate threat or danger to the therapists or to others, first responders should be contacted first. If a client leaves the Clinic and immediate danger or threat is suspected, then the therapist should note what the client is wearing, the direction the client is going, and have client contact information available so that this information can be given to the police or other authorities.

Although it is extremely unlikely that therapists will ever be unable to contact a supervisory staff member by telephone, the hospitals and Shea Center personnel listed previously may be contacted for guidance in handling emergency and/or crisis situations.

If a therapist is concerned that an emergency call from a client might occur in the future, possibly at a time that the Clinic is closed, the therapist must discuss this with the client and the therapist’s immediate supervisor. Therapists must never provide to clients their home (or work), cell, or other telephone numbers or addresses under any circumstances.

AGE OF CONSENT TO TREATMENT  

In the State of Kentucky a person must be 18 years of age in order to seek treatment at The Shea Center for Mental Wellness. Younger persons must have permission from a parent or guardian.

The only exception is for emergency situations, for which there is no lower age limit. However, it is rare that an emergency situation would extend beyond an initial ninety minute visit with an underage client. 

SEXUAL HARASSMENT POLICY

It is the policy of The Shea Center for Mental Wellness to maintain a work and educational environment free from all forms of sexual harassment of any employee, applicant for employment, or student. Sexual harassment in any manner or form is expressly prohibited. It is the responsibility of The Shea Center to provide educational opportunities to create this free environment and to take immediate and appropriate corrective action when sexual harassment is reported or becomes known. Supervisors at every level are of primary importance in the implementation and enforcement of this rule. Any complaint regarding discrimination or sexual harassment should be made to your immediate supervisor, or the office manager. All allegations will be investigated. A complete copy of the Sexual Harassment Policy can be obtained from the office manager.

All Shea Center employees MUST COMPLETE the Sexual Harassment Training WITHIN ONE MONTH of starting their work in the Clinic. This training can be completed by going to: 

__________________ A score of 80% or greater must be obtained on the post-exam at the end of the training. Employees can re-enter the training program and go through the training again if they score below 80% on the exam. At the completion of the training and exam, the employee should print a copy of their completion certificate, sign it, and give this to the practice manager. If the employee has already taken the training, then a copy of the completion certificate needs to be given to the practice manager.

VIOLATIONS & ADHERENCE OF CLINIC POLICIES

Some violations of The Shea Center policies might be quite minor while others, including ethical violations, can be quite serious. Such violations may result in removal from the Clinical practicum.