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Trauma, Risk, and Resiliency (TRR) Postdoctoral Fellowship

Training Philosophy and Model

The WRP Fellowship in Trauma, Risk and Resiliency is a two-year, post-doctoral traditional clinical psychology fellowship that trains civilian and active duty Army psychologists in advanced knowledge and competencies in psychological trauma, suicide risk mitigation, and psychological resilience, who upon graduation, will be capable of serving in clinical and administrative leadership roles in the areas of treatment, consultation, and program development and management within the Army medical system. The program is guided by the Practitioner-Scholar model, with an emphasis on clinical practice that is validated by empirical research. Ideally, the successful Fellow will be able to apply evidence-based methods to treat trauma and trauma-related disorders as well as other conditions often found in the military population (e.g., depression, anxiety disorders) and supervise and consult with other behavioral health providers in those methods, mitigate risk, particularly suicide behavior, and promote psychological resilience through education and intervention within the military environment. Fellows will also gain knowledge, experience, and leadership skills that will allow them to influence Army behavioral health initiatives, programs, and policies. Furthermore, although not a specific concentration area, the Fellow will gain advanced knowledge and competencies in the broad area of clinical military psychology.

Training Experience

Fellows will be offered diverse clinical opportunities with active duty populations to include training in tele-behavioral health and traditional outpatient settings. Fellows will also be offered opportunities to participate in program management, development, and evaluation efforts of the organization as available. Fellows will be educated through an academic curriculum (e.g., focused readings, didactics, and journal club) and hands-on clinical activities for which individual supervision will be provided. Fellows will be provided opportunities to see how a number of different professions (clinical psychology, psychiatry, social work) contribute to clinical outcomes, resiliency promotion, and risk mitigation. Best clinical practices are supported through greater understanding of clinical outcomes research and program evaluation to promote optimization and advancement of the three essential concentrations of the Fellowship: effective tertiary care for trauma and associated conditions, resilience enhancement, and suicide risk mitigation.

Fellows are expected to demonstrate core knowledge and competencies within each of the three essential concentration areas. The scope of training within these areas will include components of: (a) Theories and effective methods of psychological assessment, diagnosis, and interventions; (b) Consultation, program evaluation, supervision, and/or teaching; (c) Strategies of scholarly inquiry; (d) Organization, management, and administration issues pertinent to psychological service delivery and practice, training, and research; (e) Professional conduct, ethics, and law, and other standards for providers or psychological services; and (f) Issues of cultural and individual diversity that are relevant to all of the above. See below for a sample of the goals, objectives, and competencies related to the "suicide risk management" concentration area.

Fellows are expected to demonstrate core knowledge and competencies within each of the three essential concentration areas. The scope of training within these areas will include components of: (a) Theories and effective methods of psychological assessment, diagnosis, and interventions; (b) Consultation, program evaluation, supervision, and/or teaching; (c) Strategies of scholarly inquiry; (d) Organization, management, and administration issues pertinent to psychological service delivery and practice, training, and research; (e) Professional conduct, ethics, and law, and other standards for providers or psychological services; and (f) Issues of cultural and individual diversity that are relevant to all of the above.

The Fellow is also encouraged to continue development of her or his professional identity, expand cultural competencies and awareness of ethical dilemmas, and optimize involvement in professional activities and organizations. Depending on the interest of the Fellow and available opportunities, participation in scholarly activities such as professional writing, editing, and reviewing of manuscripts may be available.

First Year

The first year is focused on the development and delivery of evidence-based/informed clinical practices and integration of these experiences with available research and program evaluation data. These clinical experiences involve tele-behavioral health care delivery from the Warrior Resiliency Program as well as assignments to specific clinics and/or other departments within San Antonio Military Medical Center. By the end of Year 1, and continued into Year 2, Fellows will be able to demonstrate advanced clinical skills in treatment of posttraumatic stress reactions and commonly encountered psychiatric disorders within the military population (e.g., depression, anxiety disorders), suicide risk assessment and mitigation, and resiliency promotion. Depending on availability, Fellows will receive training and supervision in Prolonged Exposure Therapy, Cognitive Processing Therapy, Eye Movement Desensitization and Reprocessing, and/or other evidence-based treatment modalities. During the Fellowship, it is expected that Fellows will gain a level of proficiency and expertise in at least one evidence-based treatment for trauma and trauma- related conditions that allows him/her to provide expert consultation to other behavioral health providers in that modality. Fellows will gain training and supervision in the delivery of tele-behavioral health assessment and intervention services. Fellows will receive training and supervision in evidence-based/informed suicide assessment and intervention strategies as well as methods for promoting growth and resilience. Fellows may also seek to train in other treatment areas as agreed upon by Fellow and Fellowship Program Director. By the end of their first year, Fellows are encouraged to have initiated the application process for licensure in the state of their choice.

The first year of the Fellowship is also dedicated to the development of broad, foundational knowledge concerning trauma, risk, and resiliency topics. Fellows participate in a brisk curriculum involving readings, topical didactic presentations and a journal club exploring research and practice related to the three concentration areas. Additionally, Fellows will gain exposure to the development, implementation, and sustainment of military behavioral health programs within the catchment area of Southern Regional Medical Command. This will be accomplished by pairing the Fellow with a staff/faculty member who is involved in these activities within the Region as well as integrating them into Regional level processes and activities focused on shaping Regional level BH programs and policies.

Second Year

The emphasis during year two is on the expansion and application of the initial year’s training. In addition, the second year Fellow will be expected to establish a more self-directed course of training and study in the area of trauma, risk, and/or resiliency to reflect professional aspirations. The Fellow will identify a second year project related to his or her chosen area, which can be related to program development, management, evaluation, enhancement, or other area as agreed upon by Fellow and Fellowship Director. A capstone requirement is associated with the second year project and will include, at a minimum, presentation of the project to a professional audience. Fellows will have the opportunity to choose which staff/faculty member to work with based on interest and availability. Weekly readings are still required, but the second-year Fellow is asked to work with her/his chosen and approved supervisor(s) to identify worthy readings and didactic topics focusing on the chosen area of emphasis. Clinical experiences are also required in the second year with greater emphasis placed on supervision of interns and/or residents as available. Tasks of increasing difficulty and complexity are given to Fellows throughout the course of their training as they demonstrate their ability and readiness to take on new responsibilities. Supervision is expected to match the needs of the Fellow in a way that facilitates professional development and progression. The Fellow will continue to gain exposure to Regional level initiatives and further develop his/her leadership and administrative skills.

Training Activities

Patient Contact: TRR Fellows complete approximately 15 hours per week for 50 weeks of clinical training during the first training year and approximately 750 (15 hours per week for 50 weeks) hours during the second year in order to meet licensure requirements in most U.S. jurisdictions. Training hours encompass direct patient care in individual and group formats, the running of psychoeducational classes involving direct, face-to-face patient care, and relevant onsite training, supervision, charting, report writing and myriad administrative duties directly associated with patient care.

Psychological Assessments: Psychological assessment is required during the training experience. The minimum will vary, depending on the demands of the site, the Fellow's past experience in assessment, and individual training goals. Potential assessment opportunities include Administrative Separations, Special School Evaluations, Sanity Boards, MEB Evaluations, and various psychodiagnostic evaluations.

Didactic Training/Education: Fellows are required to attend bi-weekly didactic/education trainings, which are provided by subject matters experts within one or more of the three program concentration areas. Trainings are provided by Department of Defense, Department of Veterans Affairs, and university representatives allowing a diversity of perspectives.

Journal Club: The TRR Fellowship Journal Club is a weekly opportunity to discuss contemporary and landmark readings in trauma, risk, resiliency, and clinical military psychology topics with select TRR faculty. Issues such as contributions to the field and scientific rigor of the articles will be discussed. In general, articles will be no more than 5 years old (except for cases when landmark articles are reviewed) in order to ensure Fellows are abreast of current research and theories.

Reading Seminar: The TRR Fellowship Reading Seminar is a weekly opportunity to discuss readings relevant to the three program concentration areas with TRR fellowship faculty and guest experts. Readings are primarily textbook based; however, some weeks may be supplemented with journal articles and/or popular press writings. The readings from the weekly seminar support the biweekly didactic training.

Supervision and Teaching: Supervision and teaching of others by Fellows are important components of the training program. Fellows are expected to serve as supervisors for pre-doctoral psychology interns and/or psychology residents within a layered/tiered format. Fellows will be expected to prepare presentations based on the three concentration areas and teach professional staff throughout the two-year program. It is also expected that Fellows will participate in the training of other military behavioral health professionals for at least one evidence-based treatments for trauma and trauma-related conditions. The point in the Fellowship in which this training occurs will depend on the Fellow’s progression through the program.

Year II Project: Each Fellow is expected to actively participate in scholarly activities throughout the year. Completion of a second year project is required for graduation. Fellows may fulfill this requirement by participating in an already existing program initiative or by creating an original project that will directly benefit patients, enhance or improve care in the WRP or designated clinical service areas/clinics, or in the area of training, consultation, program development, management, or evaluation. Individual projects are approved by the TRR Fellowship Program Director as a written proposal and must be turned in no later than Year I for final approval. Projects must be relevant to the mission of the WRP, SAMMC, SRMC, Department of Army, or Department of Defense. The project will culminate in a formal presentation or professional or informational publication.

Distinguished Visiting Professor Workshops: Throughout the training year, workshops on topics related to trauma, risk, resiliency, and clinical military psychology will be presented by notable persons in the field of psychology or other related fields. These workshops are typically one day in length, and attendance is required. The Fellow will be afforded the opportunity to spend time in a small group format with the expert.

Faculty

Fellowship Program Director (PD): The Program Director maintains primary responsibility for the TRR Fellowship including administration, recruitment and program evaluation. At a minimum, the PD meets monthly with all Fellows to discuss administrative issues, core training events, and receive reports from Fellows about any concerns they may have with the program, with the department, or any of their training experiences. The TRR PD plans the specialty curriculum and training schedules with the input of faculty and Fellows.

Assistant Program Director (APD): The Assistant Program Director oversees the day-to-day training activities of the Fellows. The APD supports the PD in his or her duties and identifies and reports training concerns. APD also attends meetings and serves on training committees on behalf of the PD.

Primary Supervisor: Each Fellow is assigned a Primary Supervisor, for the duration of the 2-year training program. Primary Supervisors are principally responsible for the design, implementation, and performance evaluation of the Fellow's training experiences. These supervisors will meet weekly for one hour with the Fellows to review and explore the Fellow's progress and development. These supervisors provide oral feedback and written summary feedback for each quarter (6 months) of the Fellowship or earlier as needed. The quarterly Fellowship progress evaluations are reviewed with Fellows and commentary documented before submission to the TRR Program Director for review.

On-Site Clinical Supervisor: Each Fellow is assigned an On-Site Clinical Supervisor. This supervisor provides the primary clinical oversight of cases seen in that given clinic. Fellows will receive a minimum of one hour a week of individual supervision from their Clinical Supervisor. These supervisors will train, consult and provide clinical guidance on patient care. Clinical supervisors will provide oral feedback on an ongoing basis. Written feedback on evaluations will be provided to the Fellow every six months. Fellows may have more than one Clinical Supervisor depending on number of practice locations.

Core Faculty: Fellows will be exposed to several core faculty on a regular basis. Core faculty participate in the reading seminars, journal club, and many other core training activities of the Fellowship. Depending on interests of the core faculty and Fellow, a faculty member may provide supervision and consultation as needed. Core faculty serve on the TRR Training Committee and are important to the maintenance and development of program standards. Each core faculty member will sign a training agreement form which outlines their responsibilities to the trainees and the program. The development of core faculty skills is supported through time off for continuing education training, consultation from subject matter experts, and onsite training from Distinguished Visiting Professors.

Adjunct Faculty: Adjunct faculty support the TRR fellowship through various training functions. The adjunct faculty members may or may not be located at the WRP. Adjunct faculty may provide clinical supervision, ongoing didactics, consultation, and various administrative functions. Each adjunct faculty member will sign a training agreement form which outlines their responsibilities to the trainees and the program.

Currently Approved Clinical Rotations

Warrior Resiliency Program (WRP)-Lincoln Center: The Warrior Resiliency Program (WRP) provides comprehensive mental health services to active duty Army service members (Soldiers) via a tele-behavioral health delivery model. During training at the WRP, Fellows will gain experience in conducting administrative and special school evaluations and individual therapy via tele-behavioral health. Opportunities to participate in forensic evaluations may be available.

San Antonio Military Medical Center - Warrior Clinic/IOP Program: The San Antonio Military Medical Center Warrior Clinic provides comprehensive mental health services to active duty Army service members (Soldiers), often focusing on PTSD, depression and other psychiatric disorders. TRR Fellows will provide evidence-based interventions for clinic patients as well as conduct intake evaluations and psychological testing as needed. Fellows may work within the associated Intensive Outpatient Program providing evidence-based treatments for PTSD.

SELECTION CRITERIA

To be considered for the postdoctoral Fellowship in Trauma, Risk and Resiliency, the applicant must be a citizen of the United States and must have completed or be enrolled in an APA accredited graduate program in Clinical or Counseling Psychology. The candidate must complete an APA accredited internship program. Prior experience as a military service member, a military psychologist, or as a civilian working in a military setting is not required. The Army beneficiary population includes a wide range of cultural and ethnic groups. The candidate's level of knowledge and experience in cultural and individual diversity is therefore a consideration in candidate selection. All requirements for the doctoral degree must be completed by Sept. 1 of the year in which the candidate enters the program. Candidates who do not meet this requirement will not be accepted into the program. Application materials consist of a letter of interest, curriculum vitae, two work samples, three letters of recommendation and official graduate school transcripts. After all the materials are reviewed by the Fellowship Director, applicants who meet the criteria will be offered an interview. In-person interviews are preferred, but telephone interviews may be considered on a case-by-case basis. The Fellowship faculty members and Fellows participate in this process. The candidate's qualifications and interests as indicated by the application materials and interview information are then reviewed by faculty members and a selection is made. The United States government is a non-discriminatory, affirmative action employer.

Potential active duty Fellows participate via the Long Term Health Education and Training (LTHET) program.

Competency-based Curriculum: Goals, Objectives, and Competencies

Concentration Area II: Suicide Risk Management

TRR Fellowship Table (Only the Goals, Objectives, and Competencies of Concentration Area II are provided below as an example)

Goal 1 To Produce Graduates with Advanced Knowledge in Suicide Risk Mitigation Strategies for Military Personnel
Fellow Objectives Competencies Assessment of Competencies Instructional Strategies/ Specific Experiences APA Competency Goals
Explain the most salient research related to suicide behavior in military personnel Demonstrates knowledge of, to include, but not limited to, epidemiology, risk and protective factors, prevention and intervention strategies, and public health issues for and related to suicide behavior. -Evaluation forms by primary and clinical supervisors.
-Informal verbal feedback from faculty during reading and didactic activities.
-Participate in didactics.
-Participate in journal club.
-Participate in reading seminar.
-Attend quarterly DVP workshops.
-Attend CDP workshop if available.
a, c, f
Translate and synthesize salient civilian and military suicide research. Clearly articulates to other clinicians the practical application of data gleaned from suicide research into psychotherapy and psychological assessment practices. -Evaluation forms by primary and clinical supervisors.
-Informal verbal feedback from faculty during reading and didactic activities.
-Informal verbal feedback from presentation attendees.
-Participate in didactics.
-Participate in journal club.
-Participate in reading seminar.
-Attend quarterly DVP workshops.
-Identify methods and styles of expert presenters during organizational presentations.
-Present at "all-staff" meeting on latest suicide research and clinical practice.
a, b, c, d, f
Demonstrate an understanding of Joiner's Interpersonal-Psychological Theory of Suicide. Exhibit awareness of the main tenets of Joiner's theory including acquired capacity, perceived burdensomeness, and thwarted belongingness; identify how it is specifically applicable to military personnel. -Evaluation forms by primary and clinical supervisors.
-Informal verbal feedback from faculty during reading and didactic activities.
-Feedback on review/synopsis.
-Participate in didactics.
-Participate in journal club.
-Participate in reading seminar.
-Watch Joiner's recorded DVP lecture.
-Write a 1500 word review/synopsis of Joiner's theory.
a, c, e, f
Goal 2. To Produce Graduates with Expertise in Evidence-Based/Informed Suicide Assessment and Intervention Strategies for Military Personnel
Fellow Objectives Competencies Assessment of Competencies Instructional Strategies/ Specific Experiences APA Competency Goals
Apply evidence-based/informed techniques and procedures for the assessment of suicide risk. Demonstrate the ability to select, administer, deliver, and interpret validated and empirically sound assessment instruments/methods for suicide risk, to include, but not limited to, Columbia Suicide Severity Scale and Suicide Behavior Questionnaire and clinical interview with military personnel. -Evaluation forms by primary and clinical supervisors.
-Review of Fellow's assessment material.
-Role playing.
-Participate in didactics.
-Clinical supervision.
-Administration of Columbia Suicide Severity Scale and Suicide Behavior Questionnaire to a faculty/staff member.
-Clinical practice via TBH and outpatient clinic.
-Administration of the Columbia Suicide Severity Scale and Suicide Behavior Questionnaire to at least ten patients.
-Supervision of interns and/or residents as available.
a, b, e, f
Apply evidence-based/informed interventions for prevention of suicide and suicide behavior. Demonstrate the correct application of Collaborative Assessment and Management of Suicidality (CAMS) and Cognitive Behavioral Therapy for Suicide with military personnel. -Receipt of training certificates.
-Review of Fellow's clinical documentation.
-Evaluation forms by primary and clinical supervisors.
-Formal trainings in CAMS, CBT for Suicide, and other available trainings.
-Clinical supervision.
-Clinical case consultation.
-Clinical practice via TBH and outpatient clinic.
-Utilize CAMS or CBT for Suicidality with at least 5 patients.
-Supervision of interns and/or residents as available.
a, b, e, f
Exhibit advanced clinical skills in providing evidence-based/informed interventions for suicide and suicide behavior. Demonstrate advanced skills in the application of CAMS and CBT for suicide as well as the ability to supervise and consult with other behavioral health providers in these modalities. -Review of Fellow's clinical documentation.
-Evaluation forms by primary and clinical supervisors.
-Formal trainings in CAMS, CBT for suicide and/or other modalities as available.
-Clinical supervision.
-Clinical case consultation.
-Supervision of or consultation with behavioral health providers utilizing CAMS.
a, b, d
Exhibit awareness of cultural and individual differences associated with working with suicidal patients. Identify situations in which race, ethnicity, gender, religion, sexual orientation, childhood, personality, and life experiences influence suicide risk assessment and intervention with military personnel. -Evaluation forms by primary and clinical supervisors.
-Informal verbal feedback from faculty during reading and didactic activities.
-Clinical supervision.
-Participate in didactics.
-Participate in reading seminar.
-Clinical supervision.
f
Exhibit awareness of professional issues associated with working with suicidal patients. Identify the various legal and ethical issues associated with providing suicide assessment and intervention services to military personnel, to include, but not limited to, mandated reporting, duty to warn, and mitigation of professional risk. -Evaluation forms by primary and clinical supervisors.
-Informal verbal feedback from faculty during reading and didactic activities.
-Clinical supervision.
-Participate in didactics.
-Participate in reading seminar.
-Clinical supervision.
e
Goal 3. To Produce Graduates with Experience in Working with U. S. Army Suicide Programs, Initiatives, and Policies
Fellow Objectives Competencies Assessment of Competencies Instructional Strategies/ Specific Experiences APA Competency Goals
Demonstrate an understanding of suicide prevention efforts. Describe Department of Defense policies, Army Regulations and Operational Orders related to US Army Medical Command and US Army Southern Regional Medical Command suicide prevention efforts, to include, but not limited to, programs and military and civilian clinical practice guidelines. -Evaluation forms by primary supervisor.
-Evaluation information provided by SRMC suicide initiative lead.
-Participate in didactics.
-Participate in reading seminar.
c, d
Gain experience in managing a regional level suicide reduction initiative. Monitor and operate functional and administrative aspects of at least one suicide reduction initiative for the US Army Southern Regional Medical Command, to include, but not limited to, organizing and participating in trainings and meetings, developing powerpoint presentation/briefing slides and information papers, and briefing senior leaders on status of initiative; understand effective program evaluation components -Evaluation forms by primary supervisor.
-Evaluation information provided by SRMC suicide initiative lead.
-Feedback from program evaluation SME.
-Collaboration on suicide reduction initiative with SRMC suicide initiative lead and relevant faculty/staff.
-Consultation with WRP program evaluation SME.
b, d

*APA Competency Goals

  1. Theories and effective methods of psychological assessment, diagnosis, and interventions
  2. Consultation, program evaluation, supervision, and/or teaching
  3. Strategies of scholarly inquiry
  4. Organization, management, and administration issues pertinent to psychological service delivery and practice, training, and research
  5. Professional conduct, ethics, and law, and other standards for providers or psychological services
  6. Issues of cultural and individual diversity that are relevant to all of the above