Third-Year Practicum in Psychosocial Oncology
Externship in Psychosocial Oncology
Simms/Mann -- UCLA Center for Integrative Oncology
Formerly Ted Mann Family Resource Center
200 UCLA Medical Plaza, Suite 502
In association with the
UCLA Neuropsychiatric Institute
SimmsMannCenter.ucla.edu
310 794-6644
About the Center
The Simms/Mann -- UCLA Center for Integrative Oncology at UCLA is part of the Jonsson Comprehensive Cancer Center at the David Geffen School of Medicine. It is affiliated with the UCLA Neuropsychiatric Institute for the purpose of training professionals in psychology and is located in the 200 UCLA Medical Plaza building Suite 502. The Center was established in 1994 under the direction of Anne Coscarelli, Ph.D., a licensed psychologist and researcher in the area of psychosocial oncology.
The Center and its mission have grown in scope over the last decade. Initially, the Center was designed to identify and serve the psychosocial needs of women with cancer. In 2000, the mission was expanded to assist both men and women with cancer and their families to cope with the impact of the diagnosis and its treatment. The Center provides a variety of services to patients with cancer and their families including consultation with medical staff, individual counseling, family counseling, an array of support groups, individual educational consultation with an integrative medicine specialist regarding appropriate nutritional and supplements support for individuals with cancer, psychiatry services , a library of resources, an educational lectures series entitled “Insights Into Cancer” and a web site, CancerResources.mednet.ucla.edu. The Center also supports the Reflections boutique located in 200 Medical Plaza . Many of the services are available to patients at UCLA and affiliated practices, as well as from other oncology sites around the area.
The staff of the Center is made up of a variety of clinicians from the fields of clinical psychology, medical social work, integrative medicine, psychiatry and chaplaincy. Clinicians with other expertise are also involved in providing specialized groups to help patients process their experiences associated with cancer. Specialists include individuals who run the art therapy group, the QiGong class and the meditation and mindfulness groups. The staff also includes specialists for the Reflections boutique, administrative support and outreach to the community.
Patients and their families receive care without fees. Clinicians provide services through direct patient contact within the clinic settings, through individual and family appointments at the Center, as well as through telephone and email support. The Center operates on a donation basis, and thus, sees patients from a wide range of economic backgrounds. Because of the nature of the UCLA patient population, individuals from many diverse ethnic, religious and cultural communities are served by the Center. Students who have bicultural and bilingual skills are appreciated, and may have some unique opportunities to fill voids in patient care.
The patients that are served by the Center come from a variety of ages and developmental phases. The majority of patients are in their middle years (ages 55-70, mean, 53), however, individuals range in age from 18 to 90+. More women are seen in the Center than men, although the number of men has been steadily increasing both as patients and as family members. There is a diverse range of religious backgrounds and twenty-five percent of our patients are from non-Caucasian backgrounds. The Center most typically serves the needs of patients with breast and lung cancer diagnoses; however, patients with other solid and hematologic diseases are also seen.
The Center’s Mission
• To augment and complement the medical care provided to individuals with cancer at UCLA through the provision of comprehensive psychosocial resources and services.
• To establish a model center in which the psychosocial needs and personal comfort of individuals with cancer and their families are anticipated, recognized and responded to as the highest priority.
• To provide staff and programs that strive to improve the quality of life of individuals with cancer through compassion, innovation, and the highest quality of service delivery utilizing contemporary theories and practices to guide them.
• To educate the public and professionals about the impact of cancer on patients and their families so they can promote quality of life within their own families and communities.
The Center’s Goals
• To establish and promote a Center at UCLA for individuals with cancer and their families.
• To create a physical space and an ambiance that is comfortable and soothing to individuals suffering from the discomforts of cancer and its treatments, and that allows patients' concerns and needs to be attended to with privacy and confidentiality.
• To inform and educate physicians and other medical-care staff about the Center and how it can be used to facilitate the quality of life of their patients.
• To provide a comprehensive and diverse psychosocial support program to improve quality of life for individuals with cancer.
• To provide emotional support to individuals with cancer and their families.
• To educate individuals with cancer and their families about the cancer experience and to prepare them to manage the situations that result from the disease and its treatments.
• To provide staff with professional degrees in psychosocial support services and experience in the field of oncology.
• To screen, assess, and provide feedback to the medical team regarding the psychosocial and rehabilitation needs of individual patients with cancer and to promote the transfer of this knowledge to broader populations of patients and family members.
• To provide educational, inspirational and other resource materials.
• To maintain a detailed database of resources available at UCLA and surrounding communities that can be used by patients to improve the quality of their lives.
• To promote caring, compassion, communication, commitment, dignity and respect in all interactions between patients with cancer, their family and the medical environment.
• To train all staff within the Center to listen and be responsive to patients' needs and concerns.
• To help patients manage the UCLA medical care system.
• To help medical staff to perceive the psychosocial needs of patients and their family members and to listen and be responsive to their needs and concerns.
• To facilitate the training of professionals in understanding the psychosocial needs of patients with cancer and their families.
• To facilitate the public's knowledge about cancer and the quality of life for patients and their families.
Background and Content of Externship Training
The externship will facilitate developing mental health professionals’ understanding of the interaction of medical, psychological and physical variables on the patient and the family. Cancer is the second most common cause of death in the United States. There are currently approximately 8.5 million cancer survivors in the United States. Because of the frequency of occurrence of a cancer diagnosis, most everyone will be affected by cancer in some way through his or her own personal diagnosis or through the experience of a family member. Whether in private practice, a mental health setting, an organizational/business setting, or in a medical environment, psychologists and other mental health professionals will have the opportunity throughout their careers to assist individuals and/or family members cope with the crises created by cancer and its treatments. We believe that it is essential for mental health professionals to develop some degree of experience and expertise with the myriad of problems and needs that arise as a result of this disease.
It should be noted that one of the reasons that the Center invests in the training process is because it is an opportunity to expand the work that we do now and to plant seeds for the growth of others who can do this work in the future. By working with professionals in their early development, we hope to train professionals to have a greater respect for the cancer patient as a whole person, and to foster an understanding of the interaction between medical and psychological variables as a cornerstone for interventions that promote optimal well-being. We have designed this externship experience to assist developing mental health professionals to obtain this background and understanding. We hope that we may also stimulate others to become passionate about this work, and in this process choose to develop their careers in this arena.
In order to effectively work with this population it is essential that mental health professionals be grounded in some fundamental content areas. The content areas that will be addressed throughout the externship through supervision, clinical work, readings, observations, case conference and lectures will include the following:
• Understanding of cancer as a medical illness
▪ Biology of cancer
▪ Different types of cancers
▪ Stages of disease
▪ Medical terminology
▪ Common treatments
▪ Common side effects
▪ Role of clinical trials
• Understanding of the impact of cancer on psychosocial functioning
▪ Psychological impact
▪ Sexual impact
▪ Existential concerns
▪ Role of spirituality
▪ Financial and work changes
▪ Quality of life concerns
▪ Family and social changes
▪ Developmental phase and its interaction with disease process
▪ Grief and loss
• Curative versus palliative goals of treatment
• End of life
▪ Hospice
▪ Pain management
▪ Life review
• Psychological interventions at the different phases of disease
▪ Relaxation training and stress management skills
▪ Guided imagery
▪ Cognitive re-framing/other cognitive behavioral techniques to facilitate coping
▪ Role of group interventions and types of group support
▪ Problem-solving
▪ Family education and interventions
▪ Management of family dynamics
▪ Advocacy in the medical environment and self-empowerment
▪ Permission giving
▪ Life review and acceptance
• Comprehensive psychosocial interviewing in a medical environment
▪ Past medical experiences
▪ History of losses
▪ Barriers to effective communication with medical team
▪ Family relationship and coping styles
▪ Cultural and diversity issues
▪ Strengths and challenges to optimal patient quality of life
• Politics of working in a medical environment
▪ Understanding the structure
▪ Communication with the medical team
▪ Confidentiality and facilitation of care
• Treating the whole person, not just the disease
▪ Nourishing hope
▪ Accepting realities
Structure of Externship
There are a variety of learning opportunities and situations that form the overall externship experience. Some of the experiences will be required, e.g., weekly didactic training meetings, case conference and supervision, and others will be selected based on the needs of the Center and the desired experience of the externs and their program. Our goal is to provide the most complete experience possible within the constraints of time. Externs will meet with staff members during their first week to identify the areas that they would like to pursue and develop a schedule for each quarter. These schedules will be reviewed and modified as necessary at the beginning of each quarter.
Case Conferences
Case conferences are opportunities for staff and externs to present their work and seek assistance on individual cases. Twice per month a staff or extern will be asked to present a patient or family with whom they have worked. A written outline will be prepared consisting of the following information:
▪ Background/demographic information, including previous psychological history
▪ Important medical issues related to disease and treatment
▪ Presenting psychological concerns/concrete needs
▪ Types of interventions
Information presented in the case conference is done in such a way as to protect the confidentiality of the patient. The extern or clinical staff helps to facilitate discussion about the case. It is also an opportunity for the presenter to learn from the collective clinical experience of the staff and obtain feedback/suggestions around areas of difficulty.
Oncology Clinics
We serve a variety of oncology based clinics both at the Westwood UCLA medical center and UCLA oncology practices in Santa Monica. Our staff actively participates in these clinical environments to meet patients and family members and to assist in educating them about the services of the Center. When meeting patients and discussing the programs, support and resources are offered to patients with particular needs. Assessment of patients’ needs often takes place in this environment. Externs will participate in these clinical situations by shadowing a designated staff member. As clinical skills are developed, the extern will be invited to participate in the assessment and intervention process with patients and family members, and may become responsible for some follow-up with the patients. Some of the clinics in which we currently have an active presence include the thoracic (lung cancer) clinic, the multi-disciplinary breast cancer clinic, the follow-up breast cancer clinic and the general oncology practice in Santa Monica. In addition, we provide on-call service to other general oncology clinics. On-call service is a response to a health care provider who has identified that they have a patient or family member in acute crisis or with particular needs. Staff will often go to the patient in these circumstances and provide assessment, support or information about needed resources. It is important to learn to work in this multi-disciplinary environment in which coordination of care among multiple specialties and professionals is essential, e.g., nurses, doctors, social workers, administrative staff and spiritual care staff.
Patient Assessments
Brief assessments are a regular part of the work that we do in a variety of clinics. In addition, we are establishing a more systematic procedure in which new patients are seen by a member of the Simms/Mann -- UCLA Center for Integrative Oncology as a means to introduce our services and to assess potential areas of need or risk for crises. Externs will initially shadow a staff member in conducting these assessments. As the externs’ skills develop, they will be encouraged to conduct these assessments on their own with subsequent supervision. Assessments will identify previous psychiatric history, availability and limitations of family support, transportation difficulties as barriers to treatment and financial support such as disability filings as well as any other dynamics which may be important barriers in the well-being of the patient. Follow-up and intervention will be done by staff members and externs. Decisions regarding the externs’ involvement in follow-up will depend on their development of clinical skills.
Externs will receive training, in group supervision settings, in conducting more comprehensive psychosocial interviews and in the basics of developing treatment plans for patients seen at the Center. Issues covered will include assessing the patient and family’s previous experiences with medical systems, history of loss, understanding of medical diagnoses, treatment options, side-effects and potential difficulties in communication with medical staff. Externs will also learn to assess strengths and challenges presented by the patient and family’s coping styles, relationship styles and cultural variables. Some strategies for how to address these issues within a multidisciplinary setting will be presented.
Individual and Group Supervision
Quality supervision is an important part of any training experience. Supervision is an ongoing and continuous process that is both formal and informal. All externs will have a minimum of one hour of face-to-face supervision per week with an appointed supervisor.
For externs in the pre-doctoral program this supervision will be with either Anne Coscarelli, Ph.D or Kauser Ahmed, Ph.D. The primary supervisor will be designated at time of entry into the externship and the other will serve as a back-up supervisor in the other’s absence (e.g., during vacations or if sick).
For the MSW students individual supervision will be from Tom Pier, LCSW. The primary supervisor will be designated at time of entry into the externship and the other will serve as back-up supervisor in the other’s absence (e.g., during vacations or if sick).
All supervisors have had training in supervision. Staff at the Simms/Mann -- UCLA Center for Integrative Oncology are expected to take courses in supervision as an ongoing part of their continuing education. These supervisors have also had the initial 15 hours of supervision required to supervise MSW students.
Externs will not see patients alone until it has been determined through direct observation and supervision that the extern is capable of seeing a patient on their own. This will evolve as a gradual process and the amount of time required will depend on each individual extern. All externs will begin by shadowing their primary supervisor in addition to other members of the staff in clinical situations. These observed sessions will then be discussed as another form of individual supervision at the time that they occur. As the extern begins to understand the clinical issues and medical issues, they will begin to be the initiator of the contact with the patient with a supervisor in the room to provide support and education. Following these sessions, externs will receive feedback and supervision about the experience. This is also conducted on an individual basis. Once the extern has demonstrated on several occasions that they are capable of providing the clinical contact without the primary supervisor intervening, they will be allowed to interact with patients on their own. Follow-up in the clinic situation will also occur with a supervisor as supervision. Eventually, externs will begin their own work with clients and will be expected to discuss each patient seen on a weekly basis in individual supervision. Because of the nature of the work that we do, externs often receive a considerable amount directly supervised training.
Externs who participate in leading groups, will receive one-on-one supervision with the group leader following the groups. This may be 30 minutes to 1 ½ hours depending on the situation. Externs may occasionally have the opportunity to substitute for the leader once they have established themselves in the groups. Supervision will be provided by the group leader or primary supervisor. Group leaders are expected to report to the extern’s primary supervisor about their experiences with the extern in group situations. This may occur in the presence of the student, but is not required.
Externs typically receive a ratio of 1:1, in the early weeks. As the year progresses the ratio increases but never exceeds 1:4 (one hour of supervision to 4 hours of clinical hours). Supervision for groups is sometimes done by facilitators who are not part of our full-time staff. All of these clinicians are licensed practitioners.
Group supervision occurs in case conferences (once every two weeks) or on an as needed basis, as a consultation with a primary supervisor and another staff person or sometimes with more than one extern. We work in a model in which staff often seek out peer supervision or supervision from the Director on difficult cases. We make an effort to include externs in these supervision circumstances as an adjunct to their learning.
Staff are always available for additional supervision as needed onsite, through email and telephone to support externs in their learning and provide excellent care to patients and their families. Externs receive all contact information for their primary supervisors, back-up supervisors, the Director of the Center and clinicians at the time they enter the program. Externs are counseled to contact supervisors to check out concerns at anytime they occur.
Professional Reading
Throughout the training period, suggestions for reading will be made by the clinical staff. Structured opportunities will be scheduled to discuss the readings. The readings will include psychological literature relevant to the role and recent therapeutic research, as well as medical information regarding the disease and its treatments. Externs will also be expected to read the Center’s newsletters during their training and a minimum of nine previously published newsletters to provide an overview of many relevant topics.
Insights Into Cancer Lectures
One Tuesday evening each month, the Center sponsors a lecture in which an expert presents information to patients and their family members. The lecture series began in 1994 and has been a hallmark of the program here. These lectures are highly educational for anyone working in this field. It is required that externs participate in these lectures. If an extern is unable to attend one of the lectures, arrangements must be made in advance with their supervisor and a plan developed to review the taped lecture. The lectures will broaden the externs’ depth of knowledge and experience. It is also recommended that externs select a minimum of six past lectures to review on their own. Video and audiotapes are available in the Center for this purpose. These lectures are essential in developing an understanding of this field.
Self-directed Learning/Resource Development
The Center offers many materials in the library that relate to the experience of cancer. The library contains videotapes, books, pamphlets and a web site. Externs will be expected to review materials on an ongoing basis, especially in the early part of the training to develop knowledge that will more rapidly prepare them to converse knowledgeably with patients.
The Internet offers another useful and powerful tool for patients and staff to access information pertinent to patient care. Given the great volume and variable quality of materials available through the Internet, it is imperative that individuals working within this field have some understanding of the materials that patients can access and have tools for helping patients to evaluate the usefulness of the information that they find. In maintaining current and accurate information resources, staff members at the Center regularly use the Internet in their research and provide updates to links available through our website. Within their supervision contexts, externs will generate topics to investigate through Web research on a monthly basis, and will develop the skills to identify two to three resources on the Internet that are good sources of information for patients. Externs will discuss their findings, evaluate the resources discovered, and create two to three sentence write-ups of the most relevant and reliable websites to create new links in the Community Resource section of the Center web site.
Participation in Patient Groups
Twenty-five percent of our contacts with patients in the Center are group contacts. Some of the groups are coping skills based and are more didactic, while others are more experiential. Some of the experiential groups use tools such as art or journaling. Externs will have the opportunity to observe and potentially help facilitate a group for a period of time. The amount of time devoted to the group will vary depending on whether the group is ongoing or time-limited.
Some of our regular groups include:
▪ Lung Cancer Support Group
▪ Women with Metastatic Disease
▪ Breast Cancer Support Group-Newly diagnosed, early stage on treatment
▪ Mind-Body Approaches to Coping with Cancer
▪ Women Post Treatment, No evidence of disease
▪ Healing Through Art
▪ Meditation
Observance and participation in groups provides externs with the opportunity to learn about a broader range of treatment approaches and to observe different therapists’ clinical interventions. Exposure to different therapists can be helpful to externs in identifying and developing their own clinical style.
Record Keeping
There are two types of records that externs will be expected to keep while working at the Center, training records and patient records. Externs will learn our system of record keeping for patients and family members. They will record all contacts with patients in our electronic data based system. Important information such as where the contact occurred, length of time, who initiated the contact and the content of the contact, including psychological assessments and interventions, are necessary components. These contacts must be recorded within 24 hours of seeing the patient. They serve as our chart. Because patients often have multiple contacts and know more than one staff member, it is essential that these records are up-to-date and record relevant information so that other staff members have knowledge of interventions when a patient returns. Externs review all contacts with their supervisors who will read and initial them in the electronic record.
Externs will also keep a weekly log of their educational experiences. The log lists the types of activities, amount of time spent and clinical staff who attended. Supervision, case conference and any lectures or readings will also be recorded. The log sheets will be signed each week by the primary supervisor and will serve as a permanent record of the clinical experience. We recommend that externs keep a notebook with their log sheets and bring it to their supervision meetings each week.
Ethical Standards and Legal Practice
Externs will be expected to abide by the ethical standards of their profession and these standards will be reviewed during the first week of the training. During the course of their training, externs will become familiar with the laws governing the practice of psychology and social work and there will be opportunities in supervision to discuss how these guidelines apply within medical clinical settings. There are several areas that are particularly important including confidentiality and privacy, release of information, disclosure of expertise, child and elder abuse and warnings of dangerous patients.
Externs should pay particular attention to issues around client therapist relationships and confidentiality. We expect all clinical interactions to be kept confidential and the patients’ rights to privacy respected. Since externs will have access to patients’ medical and psychological records, it is expected that they only review information that is necessary to their work with patients and not utilize records for any other purpose. Patient information must be confidential and protected, and these rules apply to both written and verbal communications. Externs will need to become familiar with the Health Insurance Portability and Accountability Act (HIPAA) as it relates to privacy.
Patient material that is shared in supervision/training settings with supervisors is protected and does not violate confidentiality guidelines. Externs should not under any circumstances agree to keep information from staff. This would undermine the treatment of the patient and the therapeutic relationship, and is also inappropriate in a teaching environment.
Externs are not to engage in any relationships with patients outside the context of the Center. These relationships would be considered “dual relationships” and are not sanctioned by the Center or by the ethics of the profession. Externs are encouraged to be aware of the ethical and legal concerns in their training and to discuss these with their supervisor on an ongoing basis. Externs will receive additional information at the beginning of their externship regarding child abuse reporting and services available at UCLA, abuse of the elderly and dependent adults, warnings of dangerous patients, and how to advise patients of their role in the Center with regard to training and supervision. Externs will never be responsible for the release of information. Externs who do not adhere to these standards will be counseled and can be terminated from the externship experience as a result of their actions.
Evaluation
Feedback and instruction are an integral part of the externship and occur throughout the training with supervisors in the clinical environment. We believe that students benefit from a summary feedback session that will review their experiences and progress in the content and clinical areas. Students will meet with their primary supervisor at the end of each academic term to assess strengths and weakness, areas for increased concentration and future goals. The session will be interactive with the student participating with reflective self-assessment as well as the supervisor’s assessment. Assessment is meant to provide opportunities to evaluate the process and to recognize that skill development is an ongoing process along a continuum. Some of the areas to be assessed and addressed include knowledge about cancer and psychosocial impact on the patient and family, interpersonal clinical skills including interviewing, expressing empathy, reflective statements and interventions, and professionalism in the work environment.
Additional evaluations may also be done depending on the requirements of the originating educational institution/program. These may be substituted for our in-house evaluations if they are deemed comparable.
Externs also provide feedback about what has been helpful to them in their training program and suggest areas and ways that we can improve the experience. Our goal is to continuously improve the training that we offer. Externs complete a formal written evaluation at the end of the externship.
It is the responsibility of the extern to bring difficulties to their supervisor or the Director should difficulties arise. Our goal is to identify problems early so that they can be ameliorated in a way that is satisfactory for the extern and the Center. The Director of the Center also is available on an appointment basis to discuss any difficulties with the training or supervision.
Facilities
The Simms/Mann -- UCLA Center for Integrative Oncology is located in the 200 UCLA Medical Plaza Building, Suite 502. We have a suite of six offices that are used by clinical and administrative staff. The space is nicely decorated and houses six offices, one small conference room, a work room/kitchen and a library. Space is a premium commodity at UCLA and we, like many programs, function in an environment that is not optimally spacious. While clinical staff have their own offices, externs will be required to share the clinicians’ offices for individual sessions and rotate between the conference room and a public computer for note-taking purposes. Since clinicians often see patients in clinics on-site and off-site for the UCLA Westwood campus, efforts will be made to schedule externs and staff to maximize space usage. The 200 UCLA Medical Plaza has other conference rooms available which can be scheduled and there may be times when these must be utilized for individual sessions with patients and families. The Simms/Mann -- UCLA Center for Integrative Oncology will take responsibility for providing externs with the necessary space and equipment needed to perform the responsibilities of their work. A telephone line will be dedicated to externs where they can receive messages. The Center telephone lines will also be available for use. Pagers will be issued as necessary, depending on the externs’ ability to work independently.
Applying and Questions
We have a strong interest in training students in the area of oncology and look forward to receiving applications. Students who would like more information about the externship may contact the Simms/Mann -- UCLA Center for Integrative Oncology to discuss their interest or ask questions. The Center is open to the public and the students may make an appointment to come to the Center or to visit one of our case conferences prior to beginning the externship. We also encourage interested students to attend the Insights Into Cancer lecture series to learn more about our program and services as well as cancer.
Externs who are interested in applying should submit a letter of interest stating their current status in school, their future goals and a curriculum vitae (resume). Included should be any relevant work or clinical experiences. Potential externs should also submit two to three references. Faculty members may serve as references. In addition, the training director or contact person from the appointed graduate program should provide information attesting to the student’s enrollment, standing in the program, and readiness to do clinical work. Once an extern has been accepted, the training director must also provide a letter stating the program’s provisions for providing malpractice coverage for students in clinical externship settings.
Students who submit information should familiarize themselves with the Center’s web site SimmsMannCenter.ucla.edu. Applications will be accepted after January of the year in which the externship will begin.
Acceptance and Termination
Once accepted for externship, students must agree to follow the program as outlined above. Students agree to work with their supervisors to develop their individualized rotation through different clinics, groups, etc. Students also agree to inform the externship of any changes in their educational status during the externship. Students in the MSW program will terminate at the end of their prescribed externship year, however, students in psychology have the opportunity to continue their experience beyond one year. Termination will be done in writing at the beginning of the student’s last quarter of externship.
It should also be noted that students who participate in this program should identify their work experience as an “Externship in Psychosocial Oncology at the Simms/Mann -- UCLA Center for Integrative Oncology at UCLA’s Jonsson Comprehensive Cancer Center and the UCLA Neuropsychiatric Institute.”
I agree to follow the guidelines set forth in this document.
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Student Signature Date
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Supervisor Signature Date[pic]
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