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Chapter 2
Training and Scope of Practice
2.1 Training and Education
At the University of Vermont Department of Psychiatry/UVM Medical Center Inpatient psychiatry Unit, psychotherapy-based interventions, whether in the form of individual or group sessions, are planned, structured, and lead by the inpatient psychiatry group therapists. Their work is mainly subdivided into direct patient care, indirect patient care, and group activities:
Group Related Work
Developing and updating Group Therapy and Inpatient Psychiatry Patient Handbooks
Preparing group material/plan
Ordering Supplies
Giving/checking homework
Leading groups
Inviting patients to groups
Checking in on a patient if they left group early and upset
Writing progress notes
Writing up Focus group information
Meeting with and updating volunteers on necessary information before volunteer-led groups (pet therapy and recovery group)
Screening potential volunteers for Recovery Group
Recovery Group oversight including coordination of quarterly volunteer meetings, working with volunteer office, getting and ordering appropriate books and materials for patients, and coordinating/managing groups as they occur.
Checking in with Registered Nurses (RNs) on status of patients to inform us about which patients are currently appropriate to attend group
Assisting RNs and Mental Health Technicians (MHTs) with the Fresh Air break and Garden groups for patients
Mentoring nursing and medical students by allowing them to observe the group process and then meeting with them afterwards to discuss their experiences
Supervision of other treatment team members (both within Inpatient psychiatry as well as in other departments or units) in patient care and other tasks
Other Tasks Related to Patient Care1:
Interviewing patients and conducting the psychotherapist assessment
Reading patients’ charts
Attending Rounds Monday through Friday
Fulfilling requests from staff (attendings, social workers, nurses) regarding patients, such as talking to them, getting them special supplies, which could be workbooks, information, art supplies, writing supplies, getting information off the internet for patients, etc.
Calling FAHC Pastoral Care when requested by patients to see a minister or priest
Attending Monthly Quality Council Meeting and giving feedback from patient surveys
Attend bi monthly Emergency event work group meetings
Helping to plan special celebrations for patients on holidays
Attending meetings on the unit related to individual patient care
Attending meetings after the death of a patient
Assisting patients (when not MD or RN specific) with their needs when they come to the team station or elsewhere on the milieu
Assisting team with various codes that are called: Fire drills, code 8s (violent situations), etc.
Individual psychotherapy sessions and meetings with patients
Furthermore, Group Therapists are responsible for their work with various volunteers and other organizations in creating resources for patients as well as for clinical research studies in the fields of psychotherapy, psychiatry, psychology, mind-body/CAM medicine, exercise and rehabilitation/movement sciences, etc:
University of Vermont (multiple departments and programs)
Disability Rights
Burlington City Arts/“Art from the Heart” program
Pet Therapists
Psychiatric Survivors
The Wellness Co-op
Alcoholics Anonymous
Pathways and Peer Support Groups
Recovery Groups (further discussed in the dedicated section)
Tasks Not Directly Related to Patient Care:
Auditing the initial treatment plans and update treatment plans 7 days per week on each floor
Timing Rounds 5 days per week (updated to 4 days per week with the newest implementations, given that clinical rounds only happen on Monday, Tuesday, Thursday and Friday) on each floor
Creating weekly group schedules and monthly staffing schedules
Scheduling for per diem group therapists/psychotherapists
Attending the University of Vermont Medical Center Green Team Meeting
Organizing the University of Vermont Medical Center Psychiatric (Inpatient Psychiatry Unit) Green Team Meeting
Organize and help organize special occasions like retirement parties, baby showers, and other staff-related events (both multidisciplinary treatment team members and others) etc.
Mandatories and monthly/yearly training sessions
Self-evaluations
Assist with assembling and distributing holiday decor
Special projects, such as researching comfort rooms on the units for patient use
Participation in conducting research studies on the units, which has involved attending meetings, getting certification in ethical testing on human subjects, editing written materials, and ongoing participation in developing and eventually carrying out research
Organizing and maintaining patient libraries
Organizing our own supply/storage areas
Maintenance of Yoga and meditation supplies
Teaching PRO-ACT (Professional Assault Crisis Training)
Taking MOAB (Management of Aggressive Behavior) and PRO-ACT courses
Attending conferences and preparing/making presentations to staff
Attending workshops on the unit presented by peers
Staff meetings and other various meetings for special projects
Attending grand rounds and/or combined rounds
Interviewing candidates for open therapist positions
When applicable, training new staff as Group Therapists
Training new MHTs on staff-patient boundaries
Meeting with other departments at the University of Vermont Medical Center, the University of Vermont Department of Leadership and Developmental Sciences, the University of Vermont College of Nursing and Health Sciences, the University of Vermont Larner College of Medicine, the University of Vermont Integrative Health, the University of Vermont Department of Rehabilitation and Movement Science, and other departments or external colleges, schools and other institutions, when necessary
The very descriptor, definition, and professional title has changes over the years to define multiple tasks and clinical responsibilities, including Recreational Therapist, Activities Therapist, Group Therapist, and Psychotherapist. Currently, both titles Group Therapist, and Psychotherapist are in use, although from the legal perspective the profession requires a Master’s level degree as minimum qualification (thus beyond the Bachelor’s level qualifications generally required at a US-national level for Recreational Therapists and Activities Therapists), the State of Vermont Board of Allied Mental Health requires the title of Psychotherapist, as we previously discussed in Chapter 1. From an organizational perspective, at the University of Vermont Medical Center Inpatient psychiatry Unit, the therapy sessions offered on the unit are lead by the professional figure defined below:
Description—The Group Therapist develops and leads psycho-education, recreation, and informal socialization groups for patients. Provides patients with individual attention when needed. Reports to the Nurse Manager or designee. Has freedom to act within the parameters of the position description. Works in concert with Staff Nurses and other members of the Multi-disciplinary Treatment Team. Daily direct contact with patients. (the University of Vermont Medical Center, 2015)
Job Requirements—Education: (Minimum) Master’s Degree; Experience: Training and experience facilitating groups. Employment experience providing groups in a mental health environment preferred; Knowledge/Special Skills: Advanced skills in interpersonal interactions. Ability to plan and lead therapeutic groups. (the University of Vermont Medical Center, 2015)
2.2 Scope of Practice and patient-provider communication
a) Pre-research analysis
The psychotherapists share patient feedback on provider communication, skills, behavior, and perceived clinical efficacy vs. personal wellbeing through questionnaires administered during the “Focus Groups.” They discuss the results with the patients and follow-up with other multidisciplinary treatment team members if necessary, collect the responses and convert the feedback into statistical data. Two psychotherapist (Adoria Tudor and David Tomasi) are in charge of monitoring and analyzing the collection process and present the results to the team. The most important versions of these surveys and the underlying developmental process are described below:
Focus Group, 2010 Version2
Focus Group Summary
Date: Shep __
No. Attending: Facilitator:
Description of group:
Areas for Improvement:
Nursing:
Social Work:
Activities Therapy:
Physicians:
Food Service:
House Keeping:
Other:
Recommendations:
Things Done Well:
Focus Group, 2014–2017 Version
Month & Year Focus Group Summary for Shepardson Unit South
DATES:
date here x patients contacted, x patients attended, x patients responded, unit census: x
Full Time Therapist 1
date here x patients contacted, x patients attended, x patients responded, unit census: x
Full Time Therapist 2
date here x patients contacted, x patients attended, x patients responded, unit census: x
Full Time Therapist 3
date here x patients contacted, x patients attended, x patients responded, unit census: x
Full Time Therapist 4
DESCRIPTION OF GROUPS:
Explanation & completion of questionnaire & discussion of feedback.
1) Medication Teaching
Concerns:
Recommendations:
Things done well:
2) Pain Management
Concerns:
Recommendations:
Things done well:
3) Physician/Attending
Concerns:
Recommendations:
Things done well:
