rxpp practicum manual revised 0719...rxpp practicum manual revised 07.19.2019 dept. of counseling...

RXPP PRACTICUM MANUAL

Revised 07.19.2019

Dept. of Counseling & Education Psychology

Postdoctoral Psychopharmacology Training for Practicing Psychologists

(RXPP)

Master's of Science in Clinical Psychopharmacology (MSCP)

American Psychological Association Designated Education & Training Program in Clinical

Psychopharmacology

INTRODUCTION ...............................................................................................................................................................1

OVERVIEW .........................................................................................................................................................................2

SUPERVISED CLINICAL EXPERIENCE SEQUENCE .........................................................................................................2

KNOWING THE LAW AND THE REGULATIONS ...........................................................................................................2

USEFUL RESOURCES FOR STAYING CURRENT: ...........................................................................................................2

LIABILITY COVERAGE ......................................................................................................................................................2

CONCLUSION ....................................................................................................................................................................3

I. CLINICAL ASSESSMENT AND PATHOPHYSIOLOGY PRACTICUM ...................................................................4

SETTING UP 80-HOUR PRACTICUM .................................................................................................................................................................... 4

REQUIREMENTS ..................................................................................................................................................................................................... 4

SUPERVISION .................................................................................................................................................................................................... 4

COMPLETION TIME ......................................................................................................................................................................................... 4

EVALUATION AND VERIFICATION OF COMPLETION ........................................................................................................................ 4

INFORMED CONSENT ................................................................................................................................................................................... 5

SAMPLE FORMS FOR 80-HR PRACTICUM.............................................................................................................................................. 5

FORM 80-1: LETTER TO PHYSICIAN.................................................................................................................................................................... 6

FORM 80-2: PLAN FOR THE 80 HOUR PRACTICUM ......................................................................................................................................... 8

FORM 80-3: EVALUATION FORM REQUIRED BY THE BOARD ........................................................................................................................ 10

FORM 80-4 : EVALUATION FORM REQUIRED BY NMSU .............................................................................................................................. 13

II. PSYCHOPHARMACOLOGY PRACTICUM .......................................................................................................... 15

FORM 400-1: LETTER TO INSTITUTION DESCRIBING 400-HOUR PRACTICUM REQUIREMENTS ............................................................ 16

FORM 400-2: 400-HOUR MODEL PRACTICUM PLAN ................................................................................................................................ 18

FORM 400-3: 400-HOUR PRACTICUM FORM TO LOG TIME SPENT WITH PATIENT ................................................................................. 21

FORM 400-4 400-HOUR PRACTICUM FORM TO LOG CONTACT TIMES WITH SUPERVISOR ................................................................... 23

FORM 400-6 400-HOUR PRACTICUM FORM REQUIRED BY THE BOARD TO DOCUMENT COMPLETION .............................................. 27

FORM 400-7 NMSU FORM TO BE COMPLETED BY THE SUPERVISOR TWO TIMES .................................................................................. 32

V. APPLYING FOR THE CONDITIONAL LICENSE TO PRESCRIBE ............................................................................ 39

VERIFICATION OF SPECIFICS OF 100 PATIENTS/400 HOUR PRACTICUM (NMSU VERIFICATION FORM 1) ............................................ 40

VI. MOVING FROM THE CONDITIONAL TO UNCONDITIONAL LICENSE TO PRESCRIBE ................................... 44

VII. GETTING AN ABMP DESIGNATION .................................................................................................................... 45

1

INTRODUCTION

The Practicum Training Manual is intended to be a source of information and guidance

for post-doctoral students in the Psychopharmacology for Practicing Psychologists

Program (RXPP) at New Mexico State University (NMSU). It also provides forms for proper approvals, documentation, and evaluation. Students at NMSU are encouraged to arrange to plan their practica and submit for approval well before they are permitted to begin. The 80hr practica in physical assessment may begin when all didactic coursework in pathophysiology and physical assessment has been completed. Whereas the 100 patient, (across) 400 hour practica may start just prior to the final class (#25). The final class provides a review of the Program; and is designed to prepare students for taking the Psychopharmacology Examination for Psychologists (PEP).

Students should take the time to read through this training manual thoroughly; and where applicable, to orient themselves to New Mexico’s statutory guidelines for obtaining the conditional license to prescribe. The NMSU Psychopharmacology for Practicing Psychologists Program has developed procedures to assure that students have undertaken the required training, secured the required documentation to obtain the conditional license, and have met the degree requirements for the NMSU Masters of Science in Clinical Psychopharmacology (MSCP).

As professional psychologists, it is expected that students will comply with the APA’s Ethical

Principles of Psychologists and Code of Conduct (https://www.apa.org/ethics/code/). As post-

doctoral degree students of New Mexico State University, it is also expected that they will

comply with the Student Code of Conduct (https://arp.nmsu.edu/5-10/)

At the end of this manual you will find a form; which you will sign/date in attestation that you have read, acknowledge, and comprehend the information and direction provided in this manual.

http://studenthandbook.nmsu.edu/student-code-of-conduct

https://www.apa.org/ethics/code/

https://arp.nmsu.edu/5-10/

2

Overview

As an overview, students will be required to complete two (2) supervised clinical training

experiences (practica). Completion of practica is a degree requirement. Moreover, practica is in

accordance with the Professional Psychologist Act (N.M.S.A. 61-9-1) and New Mexico

Administrative Code (N.M.A.C. 16.22.1) . In addition to the description and requirements of each

practica, this manual has copies of forms that are required by the New Mexico State Board of

Psychologist Examiners in order to issue the conditional license to prescribe. This manual also includes

copies of the forms required by the NMSU program in order to grant academic credit for the practica.

Supervised Clinical Experience Sequence

1. Clinical Assessment and Pathophysiology- Eighty (80) Hour Practicum

2. Combined Psychotherapy & Psychopharmacotherapy- Four Hundred (400) Hour Practicum

The first practicum requires the student to complete eighty hours in a health care setting. During that

time they are to be primarily supervised by a licensed physician; at first shadowing, then participating the basic vitals, physical assessment, and laboratory interpretation skills they have been taught in class. During this time, other diagnostics (e.g. imagining studies), differential diagnoses, clinical medicine, and instrumentation may be reviewed. Students will be evaluated at the end of their completed hours.

The second practicum entails monitoring the psychobiosocial treatment of 100 patients, for a minimum of 400 hours, whilst combining psychotropic medication along with psychotherapy. Here, the student is practicing enhanced patient education; and making psychotropic medication recommendations, management, and/or consulting with, as needed, allied health professionals.

In the sections of this manual that follow, there is a more detailed description of the 80-hour practicum

with a physician, along with the forms related to it. Following that there is a more expanded description

of the 400-hour practicum and forms related to it.

Knowing the Law and the Regulations

In order for psychologists to qualify for a conditional license to prescribe in the state of New Mexico, they

must carefully adhere to the requirements of the Prescribing Psychologist Act. The forms and submission

guidelines can change over time. Therefore, students should regularly check the New

Mexico Board of Psychologist Examiners website to stay abreast any changes.

Useful Resources for staying current: 1. NM Licensing and Regulation Department

http://www.rld.state.nm.us/boards/Psychologist_Examiners_Rules_and_Laws.aspx

2. NM RxP Law House Bill 170

http://cep.education.nmsu.edu/academic-programs/clinical-psychopharmacology/new-mexico-rxp-law/

Liability Coverage

As practicing psychologist, students should already be carring professional liability coverage during

the practicum experiences. Students who will be completing their practica in institutional settings

where they are currently employed and are receiving professional liability coverage by their employer

may not need to purchase private liability insurance. However, students who will be completing their

practica in host institutions may have to purchase private professional liability policies. In addition,

http://www.rld.state.nm.us/boards/Psychologist_Examiners_Rules_and_Laws.aspx



3

NMSU does provide students on supervised practice with a Medical Malpractice liability coverage. Please see Appendix A for a copy of this policy.

Students who will be completing their practica in institutional settings where they are employed should

be covered by their employer’s workmen's compensation and physical liability insurance. However, any

physical injuries that students incur or cause at host sites will have to be covered by their own health insurance policies. NMSU does not cover student's health, physical damage, or any general liability.

When students apply for their conditional license to prescribe they will need to provide the Board with

the policy number of the professional liability insurance that will cover the minimum of

$1,000,000 / $3,000,000 liability for psychological services including prescribing (not all insurers will). The Trust Sponsored Professional Liability Program can be found at (https://www.trustinsurance.com/Insurance-Programs/Professional-Liability) or toll-free (800) 477-1200. The Trust presently the only agency covering prescribing psychologist; and they have given their

commitment to continue to do so. The Trust is the only known carrier that providers a Prescribing Psychologist Rider.

Conclusion

The Director of Training will work closely with each student to ensure that all required documentation is

completed. However, it is ultimately the student’s responsibility to make sure that appropriate material is

sent to the Training Director and the Board. A smooth progression, with the goal of graduation and degree obtainment, is dependent upon multiple factors, including, but not limited to:

1. Your knowledge of the academic and practicum requirements; including navigating academic systems

2. Your knowledge of the regulatory requirements (in any state with RxP legislation)3. Your thoroughness and accuracy of documentation

4. Your timely submission of required forms

5. Our vigilance in scheduled contact; ideally through video/audio teleconference calls

Students who are familiar with the law, the regulations, and the procedural steps outlined in this manual

should be well prepared to apply for a conditional license to prescribe after they have completed their practicum (and overall degree) requirements. Applying and being eligible for prescriptive authority is also contingent on passing the PEP.

https://www.trustinsurance.com/Insurance-Programs/Professional-Liability

4

I. CLINICAL ASSESSMENT AND PATHOPHYSIOLOGY PRACTICUM

SETTING UP 80-HOUR PRACTICUM

Upon completion of Unit 3, Pathophysiology for Psychologists, students may begin their 80-

hour supervised clinical experience. The goal of the 80-hour practicum is to provide the student an

opportunity to observe and demonstrate competence in physical and health assessment techniques

within a medical setting, under the supervision of a physician.

Each student is responsible for securing their own appropriate placement for the 80-hour practicum. A

sample letter to the supervising physician is included in this manual. The sample letter describes the

objectives of the eighty-hour practicum, which will aid you in negotiating and setting up the

appropriate experience.

REQUIREMENTS

(Based on NMAC 16.22.23 Requirements for Education and Conditional Prescription Certificate)

SUPERVISION

The 80- hour practicum shall provide the opportunity for the applicant to observe and demonstrate

competence in physical and health assessment techniques within a medical setting, ONLY under the

primary supervision of a licensed physician (MD/DO). You may have a secondary supervisor; however,

the primary supervisor must be a physician. Any supervisor's license must be verified by YOU that their state board of medicine as active and unrestricted. This is easily achieved by sending a screen shot.

COMPLETION TIME

The 80-hour practicum must be completed as a degree requirement. For NM RxP applicants (post degree), it shall be completed in a time frame of full-time over two (2) weeks to thirty (30) weeks.

If the applicant cannot complete the 80-hour practicum within the time frame designated because of

illness or other extenuating circumstances, the student may request an extension from the Board

explaining in writing the extenuating circumstances and the additional time requested.

EVALUATION AND VERIFICATION OF COMPLETION

The Supervising Physician and the Director of Training shall certify in writing that the student:

1. Assessed a diverse and significantly medically ill patient population

2. Observed the progression of illness and continuity of care of individual

patients

3. Adequately assessed vital signs

4. Demonstrated competent laboratory, diagnostic, or imaging assessment

5. Successfully completed the 80-hour practicum

The Physician and Director of Training must sign the final (Programmatic) evaluation form. The Director of

Training will keep a copy of the State Board verification form. The student will retain the original verification

form and submit to the New Mexico Board when applying for Conditional Prescriptive Authority.

5

INFORMED CONSENT

With permission of the physician, the psychologist in practicum training and the physician identify the

psychologist as ______________________________ and request the patient’s permission to review protected

health information and participation to the extent the physician deems appropriate.

The psychologist in practicum training is responsible for informing the patient (or the patient’s legal

guardian) of their role unless there is a procedure already in place at the institution.

The name and role of the supervisor and sufficient information of the expectation and requirements of

the practicum shall be provided to the patient or the patient’s legal guardian at the initial contact

necessary to obtain informed consent and appropriate releases. The psychologist in practicum training

shall provide additional information requested by the patient or the patient’s legal guardian concerning

the applicant’s education, training and experience.

SAMPLE FORMS FOR 80-HR PRACTICUM

Form 80-1 Letter to Physician

Letter you may give to the physician explaining the purpose of the practicum.

Form 80-2 Plan for the 80 Hour Practicum

Information to be provided by the student to the training director prior to starting the

80 hour practicum

Form 80-3 Evaluation Form Required by the Board

Evaluation form to be completed by the supervising physician at completion on the 80-

hour supervision. This evaluation form is the official form the New Mexico Board of

Psychologist Examiners. A copy of this completed form must be returned to the Training

Director. The student must retain a copy and submit the original to the Application

Committee of the New Mexico Board of Psychologist Examiners when applying for the

Prescribing Psychology License.

Form 80-4 Evaluation Form Required by NMSU

This more detailed assessment should be completed by the supervisor of the 80 hour

practicum and will be used along with the formal assessment of the student’s first 50

patients/200 hours to grant academic credit for RXPP 611.

6

FORM 80-1: LETTER TO PHYSICIAN

7

New Mexico State University

Psychopharmacology Training

Date: ______________________

Re: Introduction Letter about NMSU Program 80-hour Supervised Clinical Experience

Dear Medical Colleague:

Thank you so much for considering supervising one of the Post-Doctoral students in New Mexico State University’s advanced Master of Science degree which trains post-doctoralstudents in Clinical Psychopharmacology. New Mexico was the first state to pass a law in whichpsychologists with appropriate postdoctoral training and measured competency may prescribe psychotropic medications for their patients in consultation with the physicians.

The Prescribing Psychologists’ Act of New Mexico requires Post-Doctorate Students to have an 80-hour supervised clinical experience under the direction of a licensed physician. ThePsychologists complete this supervised clinical experience AFTER an intensive series of Masterlevel, hands-on, experential courses in Pathophysiology and Physical Assessment.

The supervised clinical experience is similar to that of a first year medical student in which the Psychologist in training is offered the opportunity to shadow physicians for 80 hours. During this time, the student may review patient records and participate in any activity as deemedappropriate by the physician.

The NM Board of Psychologist Examiners requires the supervising physician tocomplete an evaluation form upon completion of the 80-hour supervision. Psychologists’ training in psychopharmacology should be able to demonstrate competence in the areas identified on the evaluation form attached to this letter.

Physicians that have participated in the clinical supervision have reported the experience to be quite helpful with their patients in addressing probably psychological concerns. In this vein, you will have direct and immediate access to licensed Behavioral Health Consultant.

If you would consider being one of the supervisors in our program, New Mexico State University in conjunction with Southwestern Institute for the Advancement of Psychotherapy, provides continuing education credit for supervisory hours. We would greatly appreciate your participation in our program, which ultimately promotes and effects access to and the continuity of care for many underserved populations in New Mexico, as well as throughout theUnited States, in the Indian Health Service ,and all branches of the military. Even without Prescriptive Authority, Psychologists with this advanced MSCP degree are able to make medication recommendations, engage in enhanced patient education, and serve as excellent consultants.

Sincerely,

Psychopharmacology Training DirectorNew Mexico State University Las Cruces, NM 88004 (575) 646-5739

8

FORM 80-2: PLAN FOR THE 80 HOUR PRACTICUM

9

Students should begin the 80 Hour Physical Assessment Practicum well before their plan for the 100 patient/400 hour Practicum has been finalized. Prior to starting their 80 Hour practica, students are required to email the Training Director

with the following information:

1) What is the primary supervising physician's name for the 80 hour practicum:

2) Will there be a secondary or even third supervisor? If so who?

3) What are his/her credentials (e.g. Board Certified in Internal Medicine, licensed to practice

in NM) and license number(s)? Also please send a screen shot from their state board ofmedicine, that a license to practice is active and unrestricted.

4) What is his/her contact information (email, mailing address, phone):

5) What the kind of practice does he/she have that you will be shadowing (e.g., familypractice, internal medicine, ER, inpatient, etc.):

6) What is your basic plan (e.g. I will shadow Dr. XXX for four hours daily, five days a week,

for four weeks for a minimum of 80 direct patient hours between 1 February and 28

February 2019):

7) Include a statement that describes the diverse group of patients (age, sex, racial and

ethnic) with a broad range of medical diagnoses in the setting you'll be completing thispractica.

8) Please include a statement that the Dr. has seen the letter from NMSU describing the

requirements of the practicum, that he/she is aware and attests of the stipulations

regarding the 80 hour practicum in the NM State Law, and that he/she is aware that

when you have completed the 80 hour practicum he/she will need to complete the

evaluation form for NMSU as well as the form that you will ultimately submit to the state

when you apply for provisional prescribing authority.

9) Please note the stipulations in the NM law regarding the 80 Hour Practicum are:

● The 80 hour practicum shall provide the opportunity for the applicant to observe and

demonstrate competence in physical and health assessment techniques within a

medical setting under the supervision of a physician.

● The 80 hour practicum shall be completed in a timeframe of fulltime over two (2)

weeks to thirty (30) weeks.

Typically the Training Director will respond to the email within 24 hours. In most cases

the Training Director will authorize the student to begin the 80 hour practicum

immediately.

10

FORM 80-3: EVALUATION FORM REQUIRED BY THE BOARD

State Board of Psychologist Examiners CONDITIONAL PRESCRITION CERTIFICATE

APPLICATION

New Mexico Regulation and Licensing Department BOARDS AND COMMISSION DIVISION

Page 6 of 27 Revision date: 1/2017

VERIFICATION BY SUPERVISOR OF 80-HOUR PRACTICUM IN PRIMARY HEALTH CARE

PLEASE NOTE: This form is to be completed by the supervisor and sent to the Board office

SUPERVISOR 80-HOUR PRACTICUM

The Board of Psychologist Examiners has received an application for a conditional prescription certificate as a prescribing psychologist from the applicant named below. (To be filled out by Applicant and forwarded on to the Director of the training program)

Applicant:

Address:

City & State:

Telephone No.

Please provide requested information and return this form directly to the Board office as indicated on the bottom of the next page.

SUPERVISOR

Name:

Address:

City & State:

Telephone No.

Supervisor, please describe the area of practice in which you are formally trained, certified, or licensed?

NEW MEXICO LICENSURE

Is your medical license current and unrestricted? Yes � No � Date New Mexico medical license was issued: License Number and Type of License:

11


APPLICATION



Do you hold any other professional licenses in this or any other jurisdiction? Yes � No � If you answered ‘yes’ please list: License No. Type State Status (Active/Inactive)

Name and Address of Applicant’s Training Director:

Date Practicum Began: Date Practicum Ended:

1. Have you sent an evaluation form about this applicant to the Director of Training discussingthe student’s adequate development of skills in:

a. Assessing a diverse and significantly ill medical population? Yes � No � b. Observing the progression of illness and continuity of care of

individual patients? Yes � No � c. Adequately assessing vital signs? Yes � No � d. Demonstrating competent laboratory assessment? Yes � No � e. Demonstrating competence in physical and health assessment

techniques? Yes � No �

2. Has the student successfully completed the eighty-hours of supervised experience with youas specified in the Prescribing Psychologist Act? Yes � No �

Please provide any comments you might have regarding this applicant’s practicum. Include any information you consider relevant regarding this applicant.

As the Clinical Supervisor of the 80-Hour Practicum, I certify that all of the statements made in this document are true, complete, and correct to the best of my knowledge and belief and are made in good faith. ____________ Date Signature of Clinical Supervisor

Please mail completed form directly to the Board Office at: New Mexico Board of Psychologist Examiners P. O. Box 25101 Santa Fe, New Mexico 87504

12

13

FORM 80-4 : EVALUATION FORM REQUIRED BY NMSU

14


Psychopharmacology Training Eighty-Hour Practicum

Student____________________________________________Site:______________________________

Evaluator: _________________________________________Position: __________________________

Dates of Practicum: _________________________________Date of Evaluation: ________________

I. INTERVIEWING/HISTORY TAKING

Establishes good rapport with patient Yes No

Can interview patient skillfully about: Chief complaint Yes No

Present problems Yes No Symptom analysis of each present problem Yes No

Past history Yes No Family history Yes No Review of System Yes No

II. PHYSICAL EXAMINATION/LABORATORY SKILLS

Observes and participates in physical examination as situation dictates Yes No

Recognizes range of symptoms and manifestations of abnormal findings Yes No Demonstrates adequacy in assessing vital signs Yes No

III. EXPERIENCE IN ASSESSMENT

Differentiates relevant from irrelevant diagnostic cues Yes No Formulates assessment at highest diagnostic level which data support Yes No Formulates prioritized risk/health-maintenance-needs list Yes No

Can plan diagnostic studies judiciously Yes No Can plan non-pharmacologic strategies when appropriate Yes No

Plan recommended follow-up/referral when appropriate Yes No Demonstrates competent laboratory assessment Yes No Demonstrates competency in physical and health assessment techniques Yes No Assesses a diverse and significantly medically ill population Yes No

IV. GENERAL (appropriate to limits of practice)

Applies Current Theoretical Knowledge to Clinical Setting Satisfactory Unsatisfactory

Seeks Assistance Appropriately Satisfactory Unsatisfactory Takes a Patient’s Family Situation in Consideration Planning Care Satisfactory Unsatisfactory Communicates Clinical Goals/Objectives Clearly To Supervisor Satisfactory Unsatisfactory

Retains Composure under Stress Satisfactory Unsatisfactory Recognizes and Seeks to Remediate Weak Areas Satisfactory Unsatisfactory

____________________________ __________

Student Date ____________________________ __________

Supervisor Date

____________________________ __________

Training Director Date

15

II. Combined Psychotherapy & Pharmacotherapy PRACTICUM

SAMPLE FORMS FOR 400-HOUR PRACTICUM:

FORM 400-1 Letter to an institution describing 400-Hour Practicum Requirements

FORM 400-2 400-Hour Model Practicum Plan

FORM 400-3 400-Hour Practicum form to log time spent with patient

FORM 400-4 400-Hour Practicum form to log contact times with supervisor

FORM 400-5 400-Hour Practicum Letter to patient Regarding Student Status

FORM 400-6 400-Hour Practicum Form required by the Board to document completion

FORM 400-7 NMSU Form to be completed by the supervisor two times: 1) when the student is

halfway through the practicum (50 patients/200 hours) so that student can be awarded academic

credit for RXPP-611, and 2) when the student has completed the entire 100 patient/400 hour

requirement so that the student can be awarded academic credit for RXPP-612

Supplementary materials are available in an Appendix to this Practicum Manual. This Appendix

is available to NMSU postdoctoral students upon request. This Appendix includes a copy of the

insurance policy NMSU carries to cover student’s medical malpractice liability at clinical rotation and fieldwork sites: and a template for a formal institutional between NMSU and the practicum

site if this is required by the practicum site. The Appendix also includes a number of paper

forms that were designed for use by students doing their 100 patient/400 hour practicum in a

private practice setting prior to the widespread use of Electronic Health Records. Use of the

paper forms does assure that students will have documented all of the information that is

required by the Prescribing Psychologists’ law.

The material in the Appendix includes:

FORM 400-8 Template for Institutional Agreement

FORM 400-9 NMSU Medical Malpractice Liability Policy

FORM 400-10 400-Hour Practicum Patient Intake Form to be completed by adult patients

FORM 400-11 400-Hour Practicum Intake form to be completed for child patients

FORM 400-12 Sample 400-Hour Practicum Initial Patient Chart form to be completed by prescribing psychologist student.

FORM 400-13 400-Hour Practicum form for Patient follow-up sessions to be completed by prescribing psychologist trainee.

FORM 400-14 Symptom Checklist to be completed by adult patients at initial before the beginning of each follow-up session.

FORM 400-15 Symptom Checklist to be completed by child patients (with parent if help is necessary) at initial and follow-up sessions

16

FORM 400-1: LETTER TO AN INSTITUTION DESCRIBING 400-HOUR PRACTICUM REQUIREMENTS

17


Date:_______________________

Re: Introduction Letter about NMSU Program 400 hour practicum

Dear Medical Colleague:

Thank you so much for considering supervising one of the postdoctoral students in New Mexico State University’s postdoctoral advanced degree Master’s program. As you are probably aware, NewMexico was the first state to pass a law in which psychologists with appropriate postdoctoral training and measured competency may prescribe psychotropic medications for their patients in supervisory consultation with the physicians.

The Prescribing Psychologists’ Act of New Mexico requires students to complete significant practical experience. The license and insured psychologist is asking for your assistance in the practicum thatinvolves working with 100 patients, for a minimum of 400 hours, in the evaluation and treatment withpsychotherapy and, when indicated, (pharmacotherapy) psychotropic medication. The psychologistdoes not have a license to prescribe at the point of this practicum, so much of the experience involves discussing the supervisor’s work, possibly assisting the supervisor in conducting evaluations, follow uptherapy, follow up phone calls, and other activities as the preceptor and student deem as appropriate.A great deal of the trainees experience is to provide enhanced patient education and possible medciation recommendations, under your review. Moreover, the trainee is responsible for consulting with every patient/client's primary care provider and pharmacologists; whenever, wherever, applicable. Thestudent is ideally to have one hour of supervision for every eight hours of seeing patients. However,this supervision time can include the time that the student spends with you in a session with the patient, as well as time in between sessions discussing cases, along with concentrated one on one time. By NM State law, supervision may be conducted face-to-face, telephonic, or via other electronic communciation (e.g. Skype, Zoom).

Attached to this letter is the evaluation form that the NM Board of Psychologist Examiners requiresthe 400 hour supervisors to complete. A review of this form should help explicate the specific skills that the psychologist should practice and demonstrate; my mid and endpoint.

If you would consider being one of the supervisors in our program, we want you to know that the New Mexico State University program, in conjunction with the Southwestern Institute for the Advancement of Psychotherapy, provides continuing education credit for being a supervisor that perhaps will be useful to you in maintaining your license CE requirements. We would greatly appreciate your participation in our program, which ultimately will provide increased access to and continuity of care tomany underserved populations in New Mexico, as well as throughout the United States, in the Indian Health Service ,and all branches of the military.

Please feel free to contact me at any time.

Sincerely,

Director of Psychopharmacology Training New Mexico State University MSC 3 C EP, PO Box 30001 Las Cruces, NM 88003-8001 (575) 646-5739

18

FORM 400-2: 400-HOUR MODEL PRACTICUM PLAN

19

New Mexico State University Psychopharmacology Education and

Training Program

______________

100 Patient/Client, 400 HOUR PRACTICUM PLAN

Name of applicant: ________________________________________________

Estimated date at which applicant will finish the 450 didactic hour training program of

NMSU: Name of supervisor: __________________________________

License #(s; include state): __________________________________

Via email or attachment, please include a screen shot verifying license is active/unrestricted from their state's licensing board of medicine. This request applies to all supervisors on the proposed pratica plan.

Summary of supervisor’s medical training: _____________________________________________________ _____________________________________________________ _____________________________________________________

Supervisor’s area of specialization: _____________________________________________________

Information about 1st secondary supervisor

Name of supervisor: _____________________________________________________

Summary of supervisor’s medical training: _____________________________________________________ _____________________________________________________ _____________________________________________________

Supervisor’s area of specialization: _____________________________________________________

Information about 2nd secondary supervisor

Name of supervisor:

_____________________________________________________

Summary of supervisor’s medical training:

_____________________________________________________

_____________________________________________________

_____________________________________________________

Supervisor’s area of specialization:

______________________________________________

State Board of Psychologist Examiners

CONDITIONAL PRESCRIBING PSYCHOLOGIST CERTIFICATE APPLICATION

20

Information on additional supervisors should be included on an attached sheet.

Sites of practicum placement:

Location Type of Facility Time to be spent in Facility

____________________ ______________________ ________________________

____________________ ______________________ ________________________

____________________ ______________________ ________________________

Description of the 400 hour practicum outpatient, private practice, or integrated primary care setting. Alternatively (or subsequently) the setting treating the acutely ill or seriously mentally ill; in which the level of care is more restricted than in an outpatient setting (such as an acute mental health treatment program, a residential treatment center, a general hospital, an inpatient mental health facility, a substance abuse treatment center, day or residential geriatric treatment center, or center for the homeless):

____________________________________________________________________

____________________________________________________________________

_____________________________________________________________________

Explanation of how the supervisee will gain experience with a diverse patient population, including patients of different genders, ages, conditions, ethnicity, sociocultural, and economic background:

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

This plan has been reviewed and agreed upon by:

_________________________________ ________________________ Applicant Date

_________________________________ ________________________ Supervising Physician Date

_________________________________ ________________________ Director of Psychopharmacology Training Date New Mexico State University

21

FORM 400-3: 400-HOUR PRACTICUM FORM TO LOG TIME SPENT WITH PATIENT

22

PATIENT LOG

(Note: This will be easiest to follow if you keep a separate log sheet for each of the 100 patients)

400-HOUR PRACTICUM FOR PRESCRIBING PSYCHOLOGISTS LOG OF

CONTACT HOURS WITH ATIENT

Patient ID Patient DOB Working Diagnosis Date(s) Seen Time(s) Seen

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

_______________ ___________ __________________ _______________ _______________

23

FORM 400-4 400-HOUR PRACTICUM FORM TO LOG CONTACT TIMES WITH SUPERVISOR

24

SUPERVISORY LOG

400-Hour PRACTICUM FOR PRESCRIBING PSYCHOLOGISTS

Date Name of Supervisor Method of Supervision Patients Reviewed Hours

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

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_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

_____ ________________ ____________________ __________________ ___________

25

FORM 400-5 400-Hour Practicum Letter to patient Regarding Student Status

26

SAMPLE LETTER OF INFORMATED CONSENT FOR PATIENTS

Dear Patient or Legal Guardian:

This letter is to inform you of my status as a Doctor of Psychology who participating in a postdoctoral education and training program. in clinical psychopharmacology. The Program is Designated by the American Psychological Association; and is located within a Regional Accredited University (New Mexico State University). My Program trains psychologists to make medication recommendations, discontinue unnecessary prescriptions, and ultimately prescribe psychotropic

medications for their patients. My Program leads leads to a post-doctoral advanced degree; a Master's of Science in Clinical Psychopharmacology. The ultimate goal of this training is to improve the access to and continuity of care for undeserved treatment populations.

In order to complete my degree requirements, and later apply for a license as a prescribing psychologist, I must complete 450 hours of postdoctoral coursework in basic biological sciences,

pathophysiology, physical assessment, and advanced coursework in the treatment of medical and

mental disorders. In addition, I must also complete an eighty-hour practicum with a physician in

which I have learned about medical illnesses, interpretation of lab tests, and appropriate drug

treatment. My work with you is part of a practicum in psychopharmacology in which I work with

_______________________________;_____________________________________ (names of preceptors) to treat, manage, or educate one hundred patients with psychotropic medication (across 400+ hours).

As a part of my ongoing learning experience, it is important that I keep very careful records of

the medications prescribed, your progress in reaching your goals in health and well-being, and your views of how your treatment is progressing. This may necessitate my requesting you to complete a

number of forms as well as to sign off on some forms as we progress through your treatment. I believe

that this monitoring will increase my effectiveness; and also assures you the highest quality of care. Finally, you respect, dignity, cultural background, and personal values are important to me and your care. I promised to do my best to uphold the high standard of care. In signing this letter of

which we will each keep a copy, you are indicating your understanding of the level of my training

and the procedures involved.

________________________________

RxP Student’s Signature

________________________________Date

_________________________________

Patient’s/Client's Signature

_________________________________Date

27

FORM 400-6 400-HOUR PRACTICUM FORM REQUIRED BY THE BOARD TO DOCUMENT

COMPLETION


APPLICATION



VERIFICATION BY SUPERVISOR OF 400-HOUR PRACTICUM TREATING A MINIMUM OF 100 PATIENTS

WITH PHARMACOTHERAPY

PLEASE NOTE: To be completed by the supervisor

PRIMARY SUPERVISOR 400-HOUR/100-PATIENT PRACTICUM

The Board of Psychologist Examiners has received an application for a conditional certificate as a prescribing psychologist from the applicant named below. (To be filled out by Applicant and forwarded on to the Director of the training program)

Applicant:

Address:

City & State:

Telephone No.

Please provide requested information and return this form directly to the Board office as indicated on the bottom of the next page.

SUPERVISOR

Name:

Address:

City & State:

Telephone No.

Supervisor, please describe the area of practice in which you are formally trained, certified or licensed. If you are not a psychiatrist, please indicate your experience and training in prescribing psychotropic medications:

NEW MEXICO LICENSURE Is your medical license current and unrestricted? Yes � No � Date New Mexico medical license was issued: License Number and Type of License:

28


APPLICATION



Do you hold any other professional licenses in this or any other jurisdiction? Yes � No � If you answered ‘yes’ so, please list: License No. Type State Status (Active/Inactive)

Name and Address of Applicant’s Training Director:

SECONDARY SUPERVISOR, if applicable: Name:

Address:

City & State:

Telephone No.

Is your license current and unrestricted? Yes � No � Date New Mexico license was issued:

Do you hold any other professional licenses in this or any other jurisdiction? Yes � No �

If you answered ‘yes’ please list: License No. Type State Status (Active/Inactive) Please describe the practice area in which you are formally trained, certified and/or licensed.

1. Was the 400-Hour Practicum part of the psychopharmacology training program from whichthe applicant obtained his/her certification or degree? Yes � No �

2. Did the practicum meet the following requirements?a. A minimum of 100 separate patients? Yes � No � b. A range of disorders listed in the DSM? Yes � No � c. Both acute and chronic conditions? Yes � No � d. Did the 400 hours include only time spent with patients to provide

evaluation and psychopharmacotherapy and time spent incollaboration with treating healthcare providers? Yes � No �

29


APPLICATION



e. Was there diversity including gender, ages throughout the life-cycle,various ethnicities, socio-cultural backgrounds, economic backgrounds,

as much as possible within the psychologist’s area of practice Yes � No �

3. Was the primary or secondary supervisor onsite? Yes � No � 4. Did the applicant consult with your or any secondary supervisors, as appropriate,

before making decisions about the pharmacological treatment of patients? Yes � No � 5. Did the primary/secondary supervisor(s) review the charts & records? Yes � No � 6. Was there at least one hour of supervision for every eight hours of Patient

contact ? Yes � No �

7. Did the applicant keep a log of the dates & times of supervision? Yes � No � 8. Was the practicum completed in no less than six months and no more

than three years? Yes � No �

9. Was the practicum completed within the 5 years preceding thisapplication? Yes � No �

10. Did the applicant, during the initial contact with patients or legal guardians,adequately explain his/her status as a licensed psychologist receivingspecialized training in psychopharmacology while under supervision?(Please provide copies of any printed material) Yes � No �

11. Did the applicant maintain a log, without patient ID, which includedbasic identifying data? Yes � No �

12. Did you, as a supervisor, write at least two formal evaluationsof the applicant, preferably at the midpoint and at the end of thepracticum, assessing progress, competence, and describingany deficiencies where competency had not been achieved? Yes � No �

13. Did you, as supervisor, submit copies of these evaluations tothe applicant & Training Director? Yes � No �

14. Were you and any secondary supervisors in consultation regardingthe applicant’s progress, competence, and deficiencies, if any? Yes � No �

15. Do you, as primary supervisor, certify that the applicant has successfullycompleted the 400-Hour/100-Patient practicum, as specified in the PrescribingPsychologist Act and is competent to obtain a conditional prescriptioncertificate, all other requirements being satisfactorily completed? Yes � No �

30


APPLICATION



As the primary clinical supervisor of the 400-Hour/100-Patient practicum, I certify that all of the statements made in this document are true, complete, and correct to the best of my knowledge.

________ ______________ Date Printed Name and Signature of Clinical

Supervisor Please mail completed form to the Board Office at: New Mexico State Board of Psychologist Examiners P.O. Box 25101 Santa Fe, NM 87504

32

32

FORM 400-7 NMSU FORM TO BE COMPLETED BY THE SUPERVISOR TWO TIMES

33

400-7: New Mexico State University Psychopharmacology Training

PERFORMANCE EVALUATION FOR PRESCRIBING PSYCHOLOGIST 400 HOUR PRACTICUM

Date:___________________________

Psychologist’s name: _______________________________________

Preceptor’s name: _________________________________________

Midpoint and Final Evaluation - please indicate: 50 patients_____ 100 patients_____

Please use the following to guide your evaluation:

1. Has failed to demonstrate expected level of performance2. Performs satisfactorily at times, has specific deficiencies3. Meets expected level of performance4. Exceeds expected level of performance5. Exceptional performance

If a student receives a one or a two, please include any comments about what would improve his/her performance.

1) Obtains appropriate psychological and medical history:

1 2 3 4 5 Comments:

___________________________________________________________________________

___________________________________________________________________________

2) Uses appropriate processes to establish diagnostic criteria to determine primary and alternatediagnoses:

1 2 3 4 5Comments:

___________________________________________________________________________

___________________________________________________________________________

3) Recommends referral for medical evaluation when necessary:

1 2 3 4 5 Comments:

___________________________________________________________________________

___________________________________________________________________________

34

4) Initial goals are appropriate for patient’s diagnosis:1 2 3 4 5

Comments:

___________________________________________________________________________

___________________________________________________________________________

5) Is knowledgeable about when tests (laboratory, psychometric, and/or radiological) should be ordered:1 2 3 4 5

Comments:

___________________________________________________________________________

___________________________________________________________________________

5) Demonstrates appropriate knowledge in interpreting tests (laboratory, psychometric, and/orradiological):

1 2 3 4 5Comments:

___________________________________________________________________________

___________________________________________________________________________

6) Demonstrates an ability to explain a drug’s benefits, side effect profile, and risk to patients in athorough and clear manner:

1 2 3 4 5Comments:

___________________________________________________________________________

___________________________________________________________________________

7) Is responsible in monitoring psychotropic drug effectiveness and recommending appropriatechanges:

1 2 3 4 5Comments:

___________________________________________________________________________

___________________________________________________________________________

8) Is systematic in checking for drug interactions:

1 2 3 4 5 Comments: ___________________________________________________________________________

___________________________________________________________________________

35

9) Is systematic in assuring that drug selection is not contraindicated with patient’s medical conditionor other medical treatment:

1 2 3 4 5 Comments:

___________________________________________________________________________

___________________________________________________________________________

10) Gives patients written information when appropriate:

1 2 3 4 5 Comments:

___________________________________________________________________________

___________________________________________________________________________

11) Using all available data, identifies the most appropriate treatment alternatives including medication,psychosocial, and combined treatments:

1 2 3 4 5 Comments:

___________________________________________________________________________

___________________________________________________________________________

12) Sets appropriate long term goals:

1 2 3 4 5 Comments:

___________________________________________________________________________

___________________________________________________________________________

14) Keeps timely and thorough notes:

1 2 3 4 5 Comments:

___________________________________________________________________________

___________________________________________________________________________

15) Is an active participant in the learning process by asking appropriate questions, readingrecommended material, etc.:

1 2 3 4 5

36

Comments:

___________________________________________________________________________

___________________________________________________________________________

16) Demonstrates proficiency in writing valid and complete prescriptions:

1 2 3 4 5

Comments:

___________________________________________________________________________

___________________________________________________________________________

17) Demonstrates and ability to work with others in an advisory fashion when appropriate:

1 2 3 4 5

Comments: ______________________________________________________________________

___________________________________________________________________________

18) Demonstrates and ability to work with others in a collaborative manner when appropriate:

1 2 3 4 5

Comments:

__________________________________________________________________________

___________________________________________________________________________

19) In your professional opinion, this psychologist is ready to assume the responsibility for prescribingpsychotropic medications for his/her patients in an independent manner? YES NO

________________________________________________ ____________________ Signature Date

PLEASE RETURN TO: New Mexico State University Department of Counseling & Educational Psychology Director of Psychopharmacology Training MSC 3CEP, P.O. Box 30001 Las Cruces, NM 88003-8001

37

III. Psychopharmacology Exam for Psychologists (PEP)

● Students are encouraged to take the PEP when they have completed the 11course/33

academic credit hour sequence; and before they have completed their practicum requirements.

● The American Psychological Association has contract with the American Society of State and Provincial Psychology Boards to rewrite the PEP. ASPPB has made available this new test will in

early 2018.

● Details for applying and studying for the PEP can be found out: https://www.asppb.net/page/PEPExam

https://www.asppb.net/page/PEPExam

38

IV. Graduating from NMSU

Students should notify the Training Director as early as possible when they are ready to graduate.

To graduate students must have completed and satisfactorily passed:

1. each of the 11 core courses (RXPP 601 -RXPP 610; and 698)

2. each of the two practica (RXPP 611 and RXPP 612)

3. The Capstone Examination

The Capstone Examination is a take home exam. Students are given two weeks to complete the exam; which is then reviewed and graded by a committee approved by the Dean off the NMSU graduate

school. The committee is comprised of a minimum of three graduate faculty one of whom is from an

outside discipline and serves as the Graduate Dean’s representative. The members of the committee

grade the exam according to an established rubric.

Students planning to take the Capstone Examination will be advised to contact the NMSU Graduate School and to pay the examination fee for taking the master’s exam without thesis. Forms and fees can be found at: https://gradschool.nmsu.edu/graduate-forms/

Students should complete the required form (Graduate Form 1) included with this manual. Students

should then scan the completed form and a copy of the receipt they received for paying the

examination fee into a PDF. Those scans should be sent to the training director who will forward them

to the Graduate School.

At the same time, students should apply to graduate through myNMSU. There is a $35 graduation fee.

There is a deadline to apply for graduation. That deadline is published in the NMSU academic calendar

which can be viewed online. https://academiccalendar.nmsu.edu/

Given that it can take psychopharmacology students so long to complete their degrees, the graduate

school often detects minor administrative issues that must be resolved prior to graduation. The

graduate school uses the student’s NMSU email to report these issues so it is imperative students

check their NMSU regularly when they are preparing to graduate. In some instances students may

need to be readmitted to the graduate school (possible fee and no more documentation required). In

other instances the program must work to resolve discrepancies the graduate school has noted

between the students formal program of study and the courses they completed. That kind of problem

can arise when students took one or more courses during the time the program offered the

Interdisciplinary Masters of Arts and have taken additional courses in the RXPP sequence.

https://gradschool.nmsu.edu/graduate-forms/

https://academiccalendar.nmsu.edu/

39

V. Applying for the Conditional License to Prescribe

• The information for applying for the conditional license is on the Board of Psychologist Examiners

webpage. That information, as well as the official form for the application, can be downloaded from

there:

http://www.rld.state.nm.us/uploads/FileLinks/b79d6951e10e4b33b97c9f67fa55cae5/Conditional_Pre

scribing_1.24.17.pdf

• You will be asked to fill out an application form and send to the Board all of the following material

(or arrange to have it sent):

▪ $75.00 non-refundable application fee

▪ Copy of Master’s transcript or Certificate of work in psychopharmacology

▪ Verification of malpractice insurance coverage

▪ Copy of New Mexico Psychologist License

▪ Verification of Experience by Training Program

▪ Supervisor verification of 80-Hour Practicum in Primary Health Care

▪ Supervisor verification of 400-Hour Practicum Treating a Minimum of 100 Patients with

Pharmacotherapy.

▪ Copy of 80-Hour Evaluation by Supervisor in Primary Health Care Setting

▪ Midterm and final evaluation forms completed by supervisor of 400-hour practicum

▪ Proposed Supervisory Plan for Conditional Prescribing Psychologist

▪ Note: The Board may, at its discretion, require additional information or documentation

• Students will also need to provide the Board evidence that they passed the PEP.

• They will ask the NMSU Training Director to complete part of the application form.. In order to do

so, the NMSU Training Director will need:

o Copies of all evaluation forms (State and NMSU-specific).

o Completed form titled “Verification of Specifics of 100 Patients/400 hour Practicum” (NMSU

Verification Form 1)

o Copies of the patient and supervisory hour logs

http://www.rld.state.nm.us/uploads/FileLinks/b79d6951e10e4b33b97c9f67fa55cae5/Conditional_Prescribing_1.24.17.pdf

http://www.rld.state.nm.us/uploads/FileLinks/b79d6951e10e4b33b97c9f67fa55cae5/Conditional_Prescribing_1.24.17.pdf

40

VERIFICATION OF SPECIFICS OF 100 PATIENTS/400 HOUR PRACTICUM (NMSU

VERIFICATION FORM 1)

41

POST-DOCTORAL MASTER’S OF SCIENCE DEGREE NEW MEXICO STATE UNIVERSITY Verification of Specifics of 100 Patients/400 Hour

Practicum

1. Attached to this form, have you included a coded log, which includes patient ID, age, gender,diagnosis, and time spent in treatment?

____YES ____NO

2. Have you also included with the form a log of the dates and times of Supervision? ____YES ____NO

3. Have you included a copy of the form you used to indicate to patients that you were undersupervision?

____YES ____NO

4. Have you submitted to the Training Director two formal written evaluations completed by theprimary supervisor?

____YES ____NO

5. Please describe the population parameters with whom you hope to practice with yourconditional prescribing license (for example, only adults, only children, severely mentally ill,etc).

______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

6. Please describe the range of disorders treated during your practicum experience.

______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

42

7. How many of these were seen for acute conditions and chronic conditions.Acute ________ Chronic________

8. In general terms, please provide evidence that you have seen a diverse set of patientsthroughout the lifecycle of various ethnicity and social/cultural backgrounds.

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

9. Do you attest that the primary or secondary supervisor was on site?____YES ____NO

10. Did your primary or secondary supervisor review charts and records?____YES ____NO

11. Will you attest that there was at least one hour of supervision for every eight hours or directservice?

____YES ____NO

12. What was the date you began your practicum and completed your practicum?Begin_____________ Ended____________

13. In evaluating your application, the Board of Psychologist Examiners reserves the right torequest clinical records from the applicant or the Training Director. Do you certify, that ifrequested by the Board of Psychologist Examiners, you can and will make available to theTraining Director of NMSU or the Board of Psychologist Examiners clinical records thatsupport all of the experiences describedabove?____YES ____NO

43

I, _________________________, swear or affirm under penalty of perjury under the laws of the State of New Mexico, that all forms requested are attached and that everything written above is complete and true.

Sworn this _____________ day of ______________________________, 20_____, at _____________________________________.

City and State

________________________________ Signature

STATE OF ________ ) )

COUNTY OF ________________ )

SUBSCRIBED AND SWORN TO BEFORE ME THIS ________________ DAY OF ________________, 20_________

SEAL ______________________________________________________ Signature of Notary Public:_______________________________ My Commission expires on:_______________________________

44

VI. Moving from the Conditional to Unconditional License to Prescribe

• During the two years of a conditional license, you must see 50 patients and you must be supervised

for four hours a month.

• There is no formal interaction with the NMSU program necessary at this point. NMSU does not

keep records of your work as a conditional prescribing psychologist.

• You can obtain the application forms on the Board of Psychologist Examiners website.

• After you apply, you will be contacted by the Board about how they will review your cases.

45

VII. Getting an ABMP designation

• The American Board of Medical Psychology offers a Diplomate that allows you to put the initials

ABMP after your name.

• You can then call yourself a “medical psychologist.”

• They had an earlier grandfathering period which is now over. You now must complete an exam as

well as document experience.

• Their requirements are online: http://amphome.org/wordpress/abmp-requirements/

rxpp practicum manual revised 0719...rxpp practicum manual revised 07.19.2019 dept. of counseling...

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