Clinical Competency Examination Guidelines, Summaries of Clinical Psychology

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Revised 4/26/

GUIDELINES

Nova Southeastern University

Center for Psychological Studies

Clinical Competency Examination

All doctoral candidates are required to sit for and pass a clinical competency examination. The examination evaluates the student's ethical knowledge, understanding of, and skills in psychodiagnostics and intervention. It is a prerequisite to internship eligibility. In the event of failure, the examination may be retaken up to three times. A fourth failure results in automatic dismissal from the doctoral program.

General Description

The Clinical Competency Examination (CCE) is designed to assure that students have achieved the level of clinical knowledge, clinical skills, and ethical knowledge expected of a student ready to begin internship. The CCE requires the student to prepare a written and an oral case presentation through which he/she demonstrates satisfactory skills in assessing a case, developing an appropriate conceptualization and formulating a treatment plan based on it, conducting pertinent interventions, and evaluating the progress and outcome of the intervention(s) chosen.

All students in the School of Psychology are required to demonstrate mastery of specified clinical skills, identified above, through the CCE as a component of establishing internship eligibility. It is the student's responsibility to identify a case for the CCE.

Eligibility

The CCE evaluation criteria are designed to assess clinical competence at a level appropriate to students who have completed required course work and practica, and are presenting as ready for internship. To be eligible to sit for the CCE, students must have successfully completed the assessment and therapy course sequences, six (6) credits of intervention electives, and four (4) 4- month semesters of Clinical Practicum and Intensive Supervision. This training sequence is delineated in the CPS Handbook. At the discretion of the Director of Clinical Training, the eligibility requirement of six credits of intervention electives may be waived for students in the Clinical Neuropsychology and Forensic concentrations. Students in these concentrations may therefore petition the Director of Clinical Training for waiver of this requirement. In addition, the student must be in good standing (i.e., not on academic or other probation, leave of absence, etc.). In exceptional circumstances, however, students who have completed all course requirements excluding Dissertation may request permission to sit for the CCE while on a leave of absence.

Practicum & Supervision

_______ Psy 1703 Pre-Practicum _______ Psy 2701 Practicum I _______ Psy 2703 Supervision I _______ Psy 2702 Practicum II _______ Psy 2704 Supervision II _______ Psy 270A Summer Clinical Practicum _______ Psy 270B Summer Clinical Supervision _______ Psy 3701 Practicum III _______ Psy 3703 Supervision III _______ Psy 3702 Practicum IV _______ Psy 3704 Supervision IV _______ Psy 370A Summer Clinical Practicum _______ Psy 370B Summer Clinical Supervision

PH.D.

CCE ELIGIBILITY CHECKLIST

(ENTRY YEAR 2006 or later)

________Psy 1401 History and Systems _______ Psy 1403 Adult Psychopathology _______ Psy 1405 Developmental: Child & Adolescent _______ Psy 1407 Developmental: Adult & Older Adult _______ Psy 1408 Child & Adolescent Psychopathogy _______ Psy 1409 Professional Issues & Ethics _______ Psy 1501 Assessment: Intelligence Testing _______ Psy 1502 Assessment: Interviewing _______ Psy 1605 Diversity in Assessment and Intervention _______ Psy 1610 Adult Intervention I _______ Psy 2507 Objective Personality Assessment _______ Psy 2509 Behavioral Assessment _______ Psy 2511 Projective Personality Assessment _______ Psy 2603 Systems/Family Therapy I _______ Psy 2604 Child and Adolescent Intervention _______ Psy 2606 Case Conceptualization

6 CREDITS - Intervention Electives* (list each course) SEE NOTES BELOW

_______ Psy 46__ Intervention Elective__________________________ _______ Psy 46__ Intervention Elective__________________________

*** After 4 semesters of completed practicum, one intervention must be completed and you must be enrolled in the second one during the semester you sit for the CCE. If you have completed 6 semesters of practicum, you must have completed both intervention electives prior to sitting for the CCE.**

***** Waived for Forensic and Neuropsychology Students for CCE only. But, must be completed for internship eligibility.

Practicum & Supervision

________Psy 1703 Pre-Practicum _______ Psy 2701 Practicum I _______ Psy 2703 Supervision I _______ Psy 2702 Practicum II _______ Psy 2704 Supervision II _______ Psy 270A Summer Clinical Practicum _______ Psy 270B Summer Clinical Supervision _______ Psy 3701 Practicum III _______ Psy 3703 Supervision III _______ Psy 3702 Practicum IV _______ Psy 3704 Supervision IV ________Psy 370A Summer Clinical Practicum ________Psy 370B Summer Clinical Practicum

PH.D.

CCE ELIGIBILITY CHECKLIST

(ENTRY YEAR 2005 or Earlier )

_______ Psy 1403 Adult Psychopathology _______ Psy 1405 Developmental: Child & Adolescent _______ Psy 1408 Child & Adolescent Psychopathogy _______ Psy 1409 Professional Issues & Ethics _______ Psy 1411 Conceptual Foundations _______ Psy 1501 Assessment: Intelligence Testing _______ Psy 1502 Assessment: Interviewing _______ Psy 1605 Diversity in Assessment and Interviewing _______ Psy 1610 Adult Intervention I ( OR 2603 AND 2604 ) _______ Psy 2507 Objective Personality Assessment _______ Psy 2509 Behavioral Assessment _______ Psy 2511 Projective Personality Assessment _______ Psy 2603 Systems/Family Therapy I _______ Psy 2604 Child and Adolescent Intervention _______ Psy 2606 Case Conceptualization

6 CREDITS - Intervention Electives* (list each course) SEE NOTES BELOW

_______ Psy 46__ Intervention Elective__________________________ _______ Psy 46__ Intervention Elective__________________________

*** After 4 semesters of completed practicum, one intervention must be completed and you must be enrolled in the second one during the semester you sit for the CCE. If you have completed 6 semesters of practicum, you must have completed both intervention electives prior to sitting for the CCE.**

***** Waived for Forensic and Neuropsychology Students for CCE only. But, must be completed for internship eligibility.

Semester/Year Practicum & Supervision

________Psy 1703 Pre-Practicum _______ Psy 2701 Practicum I _______ Psy 2703 Supervision I _______ Psy 2702 Practicum II _______ Psy 2704 Supervision II _______ Psy 270A Summer Clinical Practicum _______ Psy 270B Summer Clinical Supervision _______ Psy 3701 Practicum III _______ Psy 3703 Supervision III _______ Psy 3702 Practicum IV ______ Psy 3704 Supervision IV ______ Psy 370A Summer Clinical Practicum _______ Psy 370B Summer Clinical Supervision

In addition, students have found it helpful to prepare themselves further by (1) attending the CCEs of classmates in order to familiarize themselves with the process and (2) reviewing the sample written CCE documents available in the Clinical Training Office and in the Library Research and Information Technology Center. All CCE candidates are encouraged to take advantage of these opportunities.

Timing

For 2011-2012 applicants (planning to complete an internship during 2012-2013), the LAST DAY to SIT for the CCE can be no later than 10 ( TEN ) working days prior to the LAST day of the FALL 2011 semester. The examination must be conducted while school is in session, not during intersessions or breaks. Examinations may be scheduled in the summer session if the committee members are available ( generally 12 month faculty ) and agree to the arrangement. It is each candidate’s responsibility to adhere to the deadlines noted herein.

Procedure

A checklist of procedures for the student and each committee member is presented. Accompanying this checklist is a detailed explanation of these procedures.

Procedure Checklist for Students

1. ____ Review CCE Guidelines
2. ____ Obtain, complete, and submit CCE committee request form
3. ____ Prepare written case material (3 copies). Select sample audiotaped or videotaped session to accompany written material (one copy for each committee member).
4. ____ Arrange oral exam date with assigned Committee.
5. ____ Contact the Clinical Training Office to arrange for room reservation space and public posting at least four (4) weeks in advance of the examination date. At the same time, present the client's CONSENT TO TAPE form to one of the Assistants in the Clinical Training Office.
6. ____ Three (3) weeks before the CCE provide the examination committee members with copies of the written and taped materials. Provide the Clinical Training Office with a copy of the written materials only.
7. ____ Arrange for audiotaping of oral exam. Allow for up to 2 hours of tape space. (1½ to 2 hours is typical)
8. ____ Obtain a sign-off form from the Clinical Training Office to present to the CCE Committee at the time of the oral examination.

a. Indicates the treatment modality of the case intended for presentation.

b. Lists the names of five (5) faculty members from among whom the Chair of his/her examination committee will be selected.

2. The Director of Clinical Training will select the student's Chair from the list of five names submitted, and will assign a second member of the eligible faculty to serve on the examination committee, exclusive of previous supervisors or others who are excluded (see Section A regarding eligibility). Both faculty and student will be informed of the assignment by the end of the Winter semester.
3. The student confers with committee members to determine an examination date. Before agreeing to the date so identified, the Director of Clinical Training checks the student's transcript to be certain that all prerequisites have been, or will be, successfully completed by the scheduled date.
4. Students intending to take the CCE in a given semester must schedule the exam a minimum of four (4) weeks in advance of the exam date. An examination room will be reserved at the time of this scheduling.
5. Three (3) copies of the written presentation are required: one for the Director of Clinical Training and one for each of the committee members. Students are responsible for submitting their CCE materials NO LATER than three (3) weeks before the examination date.
6. The student makes arrangements to audiotape the entire oral examination and is responsible for ensuring adequate listening quality of the tapes. Students should use new, high quality audiotapes and a recorder with an external microphone. Deliberation by the committee following the oral examination and subsequent feedback to the student shall not be recorded. These tapes become the property of the Center for Psychological Studies.
7. The student presents his/her case material orally during the examination. The presentation is open to all faculty and registered students who wish to attend. (Students who wish to attend another student's CCE need only be registered for classes during the regular academic year; they do not need to be registered for summer classes, even if the CCE is scheduled during the summer session.) Due to the confidential and clinical nature of the material, examinations are open only to faculty and currently enrolled students.
8. Under the Chair's direction, the Committee conducts an examination regarding the case and relevant issues. Comments or questions from the floor may be entertained at the Chair's discretion. At the close of the examination, the candidate and any observers are dismissed while the Committee deliberates and evaluates the written and oral case materials.

C. Duties of Committee Members

To equitably distribute the workload, the number of examination committees on which faculty members serve will be limited. The limit will be adjusted each year according to the number of students requesting examinations and the number of eligible faculty members available to serve.

It is the responsibility of the Committee members to study the student's written and taped materials prior to the examination date, to query the student in a manner relevant to the case, to evaluate the student's written and oral presentation using the standard evaluation form to render an independent pass or remediate decision, and to provide recommendations for remediation where warranted. Immediately after the examination, the Chair informs the student and the Director of Clinical Training of the student's pass, remediate, or split decision status.

Within 10 working days of the examination date, the individual committee members are responsible for submitting in writing to the Director of Clinical Training his/her CCE Rating Scale. In addition, each member should return all taped and written materials to the student, unless other arrangements have been made with the student on an individual basis.

D. Role of the Case Supervisor

The case supervisor, or any other professional person included within the case’s limits of confidentiality, may provide consultation and supervision with regard to any aspect of management of the case. However, the student holds sole responsibility for organizing, conceptualizing, and communicating the case presented. There should be no input from supervisors or others into the preparation of the written examination documents. The supervising clinician may not serve as an examination committee member, nor may he/she attend or participate in the examination process. Faculty members may advise students about the CCE cases, but must do so in a manner consistent with the principle that it is the students’ work. Faculty members may discuss with the student the case he/she would like to present for the CCE, but may NOT read or comment directly on the document. Faculty may listen to and give feedback on the tape.

Case Presentation Content Guidelines

A. General Content Description and Case Selection

The student should select a case for presentation that permits an adequate sampling of his/her knowledge and skill in the treatment modality used. The student must have served as the primary service provider.

The case should demonstrate adequate pre-treatment evaluation, conceptualization, treatment planning, intervention, progress assessment, termination management, and outcome assessment. Students are not limited in their choice of client characteristics or problems, type of treatment modality, treatment setting, or duration of treatment. Treatment duration, however, must be consistent with the empirically supported treatment literature. The principal guideline for choosing a case should be that it fits within the framework of applied clinical psychology.

For example, the student may choose a case that is an interactive, evidence-based intervention, but is not limited to relaxation therapy, play therapy, a lecture, or a psychoeducational intervention. Any questions regarding the appropriateness of a particular case may be posed to the Director of Clinical Training.

C. Length of Written Presentation

The written portion of the CCE may not exceed twenty-five (25) double-spaced typewritten pages (approximately 6250 words). The margins must correspond to those of the current APA editorial style.

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In printing the document, no typeface smaller than Courier 10cpi or font smaller than Times New Roman 12pt can be used.

Examples of acceptable fonts are shown below:

This is an example of Times New Roman 12-point.

• The lengths of all documents MUST be approved by the Clinical Training Office before distribution to committee members.

************************************************************************The 25 page limit does NOT include title page, table of contents, lists of tables or figures, reference lists, transcript, or copies of progress notes, test protocols, copies of pertinent outcome studies, or other supporting documents. Such supporting documentation may not include extended reviews of literature or supplemental case analyses; pertinent literature review and case analysis, if presented, must be included within the 25 page limit. Students submitting CCE documents which exceed these page limits will not be permitted to conduct their examinations until their documents have been revised to conform to these guidelines. As a general rule, the written portion of the CCE should present in relatively concise form what the student intends to present in more extensive form in the oral presentation.

D. Recorded Session

An actual therapy session shall be presented in one of the following formats, audiotape, videotape, digital or compact disk, DVD, to the Committee at the same time as the written material (at least three weeks prior to the oral examination). Both members of the Committee should receive a copy of the therapy session in a format that they are able to listen to. A copy of the client’s signed consent form is to be presented to the Clinical Training Office, and not provided to the committee members. The consent must indicate that permission is given for the student to record sessions for educational and supervisory purposes.

The student is responsible for submitting a tape of adequate quality to enable the examiners to effectively hear the audiotaped therapy session. A written transcript will not suffice as a substitute for a therapy tape of inadequate quality. Presentation of inaudible tapes may result in postponement of the CCE until such time as an adequate quality tape can be provided.

Students may complete the Clinical Competency Examination based on therapy conducted in languages other than English. The transcript must be provided in English as well as in the other language. An audiotape must be submitted as part of the CCE materials. If a session is done in a

language other than English, then a certified transcript of the tape transcribed into English must be submitted authenticating the tape and its transcription.

The manner in which the confidentiality of ALL materials used in the preparation and presentation of the Clinical Competency Examination must be in accord with the Ethical Principles of Psychologists promulgated by the American Psychological Association. The student accepts full responsibility for ensuring such confidentiality. Specifically, he/she must safeguard the confidentiality of clients' identifying information, life circumstances, place and/or name of the treatment facility or agency, clinical problems, and ALL audiotaped or videotaped records of any interactions.

Committee members will evaluate the intervention sample in terms of the students’ listening skills, ability to communicate empathy, question, generally facilitate the clinical process, conduct the intervention(s) effectively, and adhere to the conceptual framework described in the document.

E. Oral Examination

1. Oral presentation. As the examiners will have read the written material and listened to the sample session before the examination, the oral presentation should build upon, but not repeat, the basic information conveyed in writing. The student should therefore be prepared to present and discuss an overview of his/her case. This presentation should not exceed twenty (20) minutes in length , and should emphasize the following aspects:

a. Conceptual formulation and integration. The student should be able to explain and support his/her conceptualization, and address how conclusions were drawn and what affect these had upon the management of the case. Changes in the conceptual and diagnostic formulation over time should be noted as well. Students should be prepared to discuss in the oral examination one alternative, distinct theoretical approach or set of procedures that are relevant to their case. However, the committee will not necessarily examine the student on that model nor will the student be required to present this alternative model in his/her written document.

b. Therapeutic interventions. A discussion of therapeutic interventions is central to the presentation. The student should demonstrate knowledge of the relevant literature(s), and should be able to discuss how assessment data, conceptual models, and empirical findings were integrated to formulate treatment plans. Specifically, the student should discuss treatment goals, choice of modality, specific intervention strategies employed, and the impacts of each.

c. Critical evaluation of the case. This portion of the oral examination should consist of an objective and thoughtful critique of the case. (For example, in retrospect, what "errors" were made? What other interventions might have proven more effective for the client?)

2. Defense. The majority of the time is allotted to the critical evaluation of the student's ability to handle the Committee's in-depth exploration and probing of his/her work. The student is required to "think on his/her feet," to consider and evaluate other possible interventions consistent with his/her conceptualization, to contrast modalities, and to support the approach taken. The

2. Remediate indicates an appraisal that the student's overall clinical performance is fundamentally unsound, that he or she requires additional training, and that he or she will need to be reexamined after a period of remediation, the components of which will be determined by a committee appointed by the DCT.

D. The Chair will submit to the Director of Clinical Training the Committee's decision (pass, remediate, or split) as well as ratings of the student's strengths and weaknesses in the specific categories under evaluation.

E. The Director of Clinical Training will place copies of the written summary to the student, as well as notification of his/her ultimate pass/remediate status in his/her academic and clinical training files. These copies may be obtained by the students from the Clinical Training office.

F. No student will be eligible to accept an internship placement until successfully completing the CCE.

G. Not passing the CCE on the fourth attempt results in automatic dismissal from the program.

Remediation

Should the committee’s decision be that the student remediate, the DCT will appoint within three (3) days a committee of two faculty members who will meet with the student, review the findings of the CCE committee, and develop a written plan of additional work that the student must complete in order to address weaknesses identified by the CCE committee. The remediation options include but are not limited to (1) taking additional practica and supervision, and then presenting another case, and (2) rewriting, re-presenting, re- analyzing the same case with specifics to be determined by the remediation committee. Additionally, all candidates determined to be in need of remediation by their examining committees must sit for the oral examination again, the constitution of which may be different from or the same as the prior one. The committees will be appointed by the DCT.

If the CCE is not passed at the first sitting, the minimum remediation period before a second sitting is three (3) months. If the CCE is not passed at the second or third sitting, the minimum remediation period before sitting for the next examination is six (6) months. Not passing the CCE on the fourth sitting results in automatic dismissal from the program.

Appeals of CCE Decisions

Any student wishing to pursue an appeal of his/her Committee's decision should consult the Student Manual.

CCE Rating Scale

Assessment

Intake and history (each area =1/2 point)

Comprehensive intake and history includes inquiring about and recording:

______Reason for referral ______Vocational History

______Presenting problem ______Family psych/medical history

______History of presenting problem ______Past Psych/Med /SA history

______Childhood history ______Military history

______Educational history ______Legal history and issues

______Family History ______Religious/spiritual issues

______Medications ______Cultural/diversity issues

__________ (0-7 points)

Psychological Testing

While D is required for all students, a student can be given points if A, B, or C is present; only score 0-3 points for one category for A, B, or C.

A. ________ Presents at least one personality test or relevant behavior checklist with appropriate interpretation (e.g. MMPI-2, MCMI-III, Beck measures, CYCLE) (0- points) OR B. ________ Presents at least one projective test with appropriate interpretation (Rorschach, TAT, Sentence completion, Drawings) (0-3 points)

OR C. A detailed Functional Analysis of Behavior incorporating behavior excesses, deficits and maintaining factors (0-3 points)

AND D. A detailed Mental Status Examination (0-3 points)

Diagnosis

__________ Presents a multiaxial, DSM-IV Diagnosis. (0-3 points)

__________ Presents alternative diagnoses and basis for rule out. (0-3 points)

Flexibility of Approach

_______3. Is able to articulate one alternative, appropriate and distinct theoretical approach, or other empirically validated procedure(s) of their choosing to the case with a sound depth of understanding and appropriateness to the client’s situation. (4-5 points)

______2. Is able to describe an alternative approach with adequate understanding of the basic principles and some degree of applicability to the case. (1-3 points)

______1. Is unable to articulate an alternative model and/or provides no applicability to the actual case. (0 points)

Legal/Ethical Issues

3. Carefully considers legal implications of case, including reporting requirements while maintaining respect for client confidentiality and commitment to high professional standards. (4-5 points) ______2. Adequately protects client confidentiality but ignores more subtle issues pertaining to the professional relationship (i.e. boundary issues) or fails to consider possible legal complications. (1-3 points)

______1. Fails to address important legal responsibilities in the case or to protect client confidentiality. (0 points)

Diversity

3. Demonstrates a good understanding of how cultural or other diversity issues influence the case while taking them into account in both the assessment and treatment of the client. (4- points)

______2. Acknowledges the role of culture and diversity in the case, but addresses those dimensions superficially in the treatment of the client. (1-3 points)

______1. Ignores the role of diversity and culture in the case. (0 points)

Limitations/Indications

______3. Is able to clearly describe the indications and limitations of the intervention model chosen for the case as well as the alternate model that the student has chosen. (4-5 points)

______2. Has some understanding of the indications and limitations of the model, but unaware of many contraindications or has no insight into the limitations/indications of the alternate model. (1-3 points)

______1. Is unable to adequately discuss the limitations or indications of both their intervention model and the alternate model. (0 points)

Outcome/Self-Critique

______3. Clearly describes and documents client outcome and understands and is able to self- critique and explain the basis for success or failure of the intervention as well as his/her therapeutic errors or oversights. (4-5 points)

______2. Is able to describe client outcome, but is limited in the ability to self-critique and explain the basis for success or failure of the intervention. (1-3 points)

______1. Cannot clearly describe or document client outcome and is unable to self-critique and explain the basis for the success or failure of the intervention. (0 points)

Conceptualization Sub-Score ____________ (0-40)

Clinical Skills/Intervention Listening

______3. Listens effectively to client, responds to their verbalizations without introducing new questions, unless clinically indicated, and demonstrates that they are following client’s train of thought with few interruptions or digressions. (4-5 points)

______2. Follows client’s train of thought, typically responds to some last or preceding comment without introducing new data, unless clinically indicated, but has tendency to talk too much or direct the discussion too often or inappropriately. (1-3 points)

______1. Fails to listen to client, does not follow client’s lead or train of thought and directs the interview with little regard for client’s initiative. (0 points)

Understanding/Empathy

_______3. Uses reflection of feeling and content and accurately communicates an understanding of client feelings, attitudes and concerns. (4-5 points)

_______2. Uses reflection of either feeling or content and is able to communicate an adequate level of understanding, but often misses the client’s major concerns. (1-3 points)

_______1. Does not utilize effective empathy skills and is unable to communicate adequately their understanding of the client’s expressed concerns. (0 points)

Questioning

________3. Uses open-ended questions as appropriate that facilitate the client’s exploration of problems and concerns. (4-5 points)

________2. Is able to use open-ended questions appropriately, but falls back frequently upon closed ended questioning that limits client exploration. (1-3 points)