Psychology Postdoctoral Fellowship Training

Postdoctoral Fellowship 2014-2015

The Colorado Blood Cancer Institute (CBCI) at Presbyterian/St. Luke’s Medical Center (PSLMC) offers a one-year clinical psychology postdoctoral fellowship specializing in adult oncology and blood and marrow transplant (BMT). For the 2014-2015 training year, we will have one or two fellowship positions.

 Overview

The Colorado Blood Cancer Institute (CBCI; http://bloodcancerinstitute.com) at Presbyterian/St. Luke's Medical Center (PSLMC; www.pslmc.com) is a large, regional cancer center for Colorado and surrounding states specializing in treatment of hematological disorders. Transplanting over 270 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. Patients are also followed at CBCI for non-transplant therapies.


PSLMC is a large medical center, licensed for 680 beds, serving Denver and the Rocky Mountain and Great Plains regions. There are three inpatient units at PSLMC dedicated to stem cell transplantation. A fourth inpatient unit, adult oncology, provides care for patients with hematologic and solid tumor cancers. Outpatient services for CBCI are provided in a newly opened state-of-the-art facility. Fellowship training occurs in both the inpatient and outpatient settings. The fellow is a member of the Psychosocial Oncology Department at PSLMC. The Psychosocial Oncology Department consists of psychologists, inpatient and outpatient social workers, as well as the psychology postdoctoral fellow and clinical psychology practicum students. The psychosocial team is collaborative in their approach to patient care. We encourage use of evidence-based therapies, while also being innovative and creative, to provide support to patients and caregivers.

Utilizing a multidisciplinary team approach, the transplant program provides comprehensive care to transplant patients and their family members. Psychology is integral to the multidisciplinary team, providing support to transplant patients, caregivers, and staff throughout the transplant process. In addition to members of the psychosocial oncology department, the transplant care team includes eight transplant physicians, mid-level providers (nurse practitioners and physician’s assistants), nurses, financial coordinators, nutritionists, and pharmacists. At the hospital, there are also chaplains, physical, occupational and speech therapists, and a healing arts program. Members of the psychosocial team collaborate with these additional providers on a regular basis to create a plan of care that is broad in scope to encompass the physical/psychological/emotional/spiritual aspects of care.

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 at the start of the fellowship. In addition, many fellows arrive with a strong background in health or medical psychology. The early weeks of the fellowship are spent orienting fellows to the specialty area of stem cell transplant as well as familiarizing them with the multidisciplinary team and daily procedures. As fellows develop confidence in the setting, he/she takes on more responsibility and independence, building on the competencies they have already developed. 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 to meet 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 so fellows are not overwhelmed with learning the workings of a medical center, medical terminology and clinical work with patients dealing with an illness while orienting to a new setting.
The fellow carries a clinical case load that is comprised of individual transplant patients and caregivers (usually family members) of the transplant patients. The fellow meets patients and caregivers prior to transplant for a psychosocial intake, and then follows those patients through the transplant process and during the post-transplant recovery. Patients are seen in both inpatient and outpatient settings which provides continuity of care and allows the fellow to be involved throughout the transplant process. The fellow’s caseload also often includes 1-2 patients, couples and/or families experiencing psychosocial stress because they are adjusting to a new diagnosis or because they are challenged with medical issues that sometimes extend several years following their transplant (e.g. coping with chronic graft-versus-host disease, adjusting to long-term lifestyle changes and medical restrictions, or processing end-of-life issues). Therefore, the fellow develops the skills and experience required to care for oncology patients throughout the course of their illness, from diagnosis through end-of-life. Clinical work is conducted 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 and coping. Treatment planning and case discussion between disciplines occurs during weekly multidisciplinary meetings as well as during frequent “curb-side” consults.

The fellow spends 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, 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. In addition to supervision for their clinical work, the fellow receives supervision in providing supervision because the fellow is the primary supervisor for a graduate-level psychology practicum student.

Goals and Objectives 

Goals

The primary goals of the CBCI 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, leadership, and provision of supervision;
4) Prepare fellows to obtain a position in a medical or healthcare-related setting.

A variety of clinical, administrative and didactic experiences are provided in the fellowship program to meet these goals. In addition to supervised clinical training experiences with transplant patients and their caregivers, the fellow will collaborate in multidisciplinary forums, educate patients and staff on psychosocial oncology issues, obtain experience in administrative activities (e.g., join a hospital committee, facilitate interdisciplinary meetings, spearhead change of process to enhance care or efficiency, etc.), and enhance supervision skills through provision of supervision to practicum students.

 Objectives

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

  • Expertise in assessing psychosocial factors that may impact a patient’s ability to proceed safely through the transplant process, for example coping style, psychiatric disorders, cognitive functioning, and caregiver support.
  • Refined presentation skills addressing the psychosocial risk for BMT candidates to a multidisciplinary team
  • Competence in developing 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 in BMT patients.
  • Advanced 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 assessments and therapy by practicum students. 
  • Sophistication in personal and professional understanding of diversity issues in the context of clinical practice and professional development.

Fellowship Activities

The postdoctoral fellow engages 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, adherence to treatment, and availability of a responsible caregiver throughout the transplant process 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 lives or relationships due to illness and transplant. Fellows often carry a case load of 1-2 long-term psychotherapy patients.

Professional Development:
Understanding one’s healthcare beliefs and values is deemed to be important by our team 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 to be open to exploring these issues with patients when they come up, and exploring their own feelings regarding these issues in supervision.

Group Therapy:
The fellow will have an opportunity to co-facilitate, as well as develop and facilitate, groups during their fellowship year. Groups may be co-facilitated with a staff psychologist, practicum student or staff social worker. The fellow is 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 several multidisciplinary team meetings that occur weekly. Transplant candidate eligibility (medical and psychosocial) is discussed in the weekly Pipeline meeting. There is also a weekly inpatient multidisciplinary meeting to discuss treatment planning for current patients. Finally, the fellow is assigned to work with specific BMT physicians’ patients and therefore meets weekly with other members of the physician’s “mini team.” The mini team is comprised of the physician’s nurse coordinator, psychologist, social worker and sometimes a financial counselor. These meetings allow the core team to share information about timing of transplant, issues of concern, and deadlines for need of specific assessments. The fellow and other members of the psychosocial team play an active role in multidisciplinary meetings educating the staff on patients’ psychosocial issues and needs for support, or advocating for patients.

Consultation with the BMT Team:
A large part of the fellow’s 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 relies 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 can 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 utilized as a way 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:
The fellow has many opportunities to present educational programs to patients, staff and members of the community. The transplant program requires BMT patients and caregivers to attend an educational class prior to transplant that is taught bimonthly by various members of the BMT team. The fellow is assigned to teach part of the class on stress management. In addition, the fellow is expected to present to the transplant staff on a topic of interest through a scheduled staff in-service. There is also opportunity to present at the weekly hospital medical Grand Rounds or to present to hospital personnel on a psychosocial topic of interest. Finally, the transplant program has a close relationship with the Leukemia and Lymphoma Society as well as other organizations in the community who present educational lectures to the public. The fellow may have the opportunity to present on psychosocial aspects of cancer at one of these lectures.

Supervision:
Weekly supervision is provided by two staff psychologists for a total of 2 hours of 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 videotape some of their clinical work and review it during their supervision. Finally, the fellow supervises a doctoral practicum student and meets biweekly with the staff psychologists for an additional hour of group “supervision of supervision” which includes didactics about developing competence as a supervisor.

Didactics
The fellow attends a weekly 1 ½ hour psychosocial oncology seminar series that runs throughout the year. Some of the topics include healthcare disparities, ethics, the use of genograms in understanding healthcare beliefs, cultural competencies, spirituality and cancer, family systems and response to cancer, adherence, case presentations, and review of relevant literature. In addition, there is a monthly 2 hour professional development postdoctoral seminar series with fellows from other postdoctoral training programs in the Denver metro area. This seminar focuses on career development topics such as preparing for the EPPP, leadership, preparing a resume, marketing yourself, interviewing for jobs, and other topics of relevance for launching your career. Throughout the year, there are a number of other training opportunities that arise that the fellow can attend if interested such as a monthly Psychosocial Oncology Rounds teleconference and weekly Medical Grand Rounds at PSL. In the past, fellows have also chosen to attend the American Psychosocial Oncology Society (APOS) annual conference with other members of the team using their conference travel funds.

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 perspectives from their own diverse backgrounds and life experiences. 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. We believe this personal work better prepares fellows to sit with patients’ suffering without imposing their own values and allows them to walk with patients on their cancer journey.

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. All 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 without the need for formal processes.

Licensure

Fellows will accrue a total of 2080 hours of training during their fellowship year minus three weeks of vacation time and holidays.  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 clinical psychology postdoctoral fellowship at the University of Colorado Health Sciences Center in the Bone Marrow Transplant Program at University Hospital. 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 at Rocky Mountain Cancer Centers and Presbyterian/St. Luke’s Medical Center (PSLMC) to develop psychosocial services within the transplant program. She started a postdoctoral training program in 2004. In 2010, the transplant program moved entirely to PSLMC and CBCI was created. In the transition, Dr. Simoneau accepted a position as the Director of Psychosocial Oncology at PSLMC to develop a new department within the hospital. 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. She just completed a 5-year NIH-funded study as a co-investigator assessing the efficacy of a stress management intervention for caregivers of allogeneic transplant patients.
investigator assessing the efficacy of a stress management intervention for caregivers of allogeneic transplant patients.

Andrea Maikovich-Fong, Ph.D. received her Ph.D. in Clinical Psychology from the University of Pennsylvania in 2010. She completed her internship at the University of Washington/Seattle Children’s Hospital with an emphasis in Pediatric Behavioral Medicine. She completed a clinical and research postdoctoral fellowship at Seattle Children’s Hospital with emphases on neuropsychology and pediatric/adolescent oncology. She then completed a second postdoctoral fellowship at the Colorado Blood Cancer Institute at Presbyterian/St. Luke’s Medical Center. Following her fellowship, she remained at CBCI as a full-time staff psychologist. Her clinical and research interests include parenting within the context of cancer, end-of-life issues and bereavement, and utilization of empirically-supported treatments within a hospital setting. Andrea is also involved in an interdisciplinary study with Dr. Tara Gregory at CBCI that incorporates psychosocial assessment components into the medical Frailty Assessment, which can be administered to patients pre-transplant as a predictive tool for post-transplant morbidity, quality of life, and mortality.

Benefits and Salary

Benefits include 22 days of paid time off (vacation, holiday & sick time); 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 or for other educational opportunities.  The fellowship stipend is $40,000. The fellowship starts August 25, 2014.

Facilities and Support

The fellow office is at CBCI, which is in a professional building attached to Presbyterian/St. Luke’s Medical Center. Support includes computer, phone, and cell phone. 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, the fellow must go through a background check and pass a drug screen.

Application

To apply, send your vitae, letter of interest, work sample (e.g., a de-identified intake or a treatment summary), and have 3 supervisors/mentors send letters of recommendation to: Teri Simoneau, Ph.D., Director of Psychosocial Oncology, CBCI, 1721 E. 19th Ave., Suite 200, Denver, CO, 80218, or email application to: teri.simoneau@healthonecares.com. Applications are due January 8th, 2014. Applicants will be notified by email when their application is complete. Once applications are reviewed, a select group of applicants will be invited to interview in-person with members of the multidisciplinary team. Notification of fellow selection will occur the week following the internship match..

Download a copy of the Psychology Postdoctoral Fellowship Training Brochure 2014

If you have questions about the fellowship, please contact Dr. Simoneau by phone (720)754-4850 or by email: teri.simoneau@healthonecares.com .