RXPP PRACTICUM MANUAL

Revised – 09.29.2017

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 at New Mexico State

University.. Students at NMSU are encouraged to arrange to begin their two supervised clinical

experiences (practica) at the end of their training in pathophysiology and physical assessment and prior

to completing the 30 hours of classroom training.

Students should take the time to read through this training manual to orient themselves to New

Mexico’s statutory guidelines for obtaining the conditional license to prescribe and to the procedures

the NMSU Psychopharmacology for Practicing Psychologists Program has developed to assure that

students have undertaken the required training and secured the required documentation to obtain the

conditional license and to meet the degree requirements for the Masters of Science in Clinical

Psychopharmacology.

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

of Psychologists and Code of Conduct (www.apa.org/ethics/code.pdf). As post-doctoral degree

students of New Mexico State University, it is also expected that they will comply with the Student Code

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

2

Overview

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

(practica) 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. Psychopharmacology- Four-hundred (400) Hour Practicum

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

they are to be supervised by a physician and are to practice the basic physical assessment and laboratory

interpretation skills they have been taught in class..

The second practicum is requires monitoring the psychobiosocial treatment of 100 patients for a

minimum of 400 hours with psychotropic medication along with psychotherapy.

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 detailed 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

Students must arrange for adequate 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.

3

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 be covered by a New Mexico State University

insurance policy. A copy of that insurance policy is available in an Appendix to this Practicum Manual.

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 $100,000 /

$300,000 liability for psychological services including prescribing (not all insurers will). The Trust

Sponsored Professional Liability Program (http://www.trustinsurance.com or toll-free (800) 477-120) is

presently covering prescribing psychologists and has given their commitment to continue to do so.

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 through the academic and regulatory

requirements is dependent upon multiple factors including:

1. Knowledge of the academic and practicum requirements

2. Knowledge of the regulatory requirements

3. Thoroughness and accuracy of documentation

4. Timely submission of required forms

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

should be well prepared to apply for conditional license to prescribe when they have completed their

practicum requirements.

4

I. CLINICAL ASSESSMENT AND PATHOPHYSIOLOGY PRACTICUM

SETTING UP 80-HOUR PRACTICUM

Upon completion of Unit 3, Pathophysiology for Psychologists, students may begin the 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 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 this eighty-hour practicum to aid you in 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 under the

supervision of a physician. You may have a secondary supervisor; however, the primary supervisor must

be a physician.

COMPLETION TIME

The 80-hour practicum 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 assessment

5. Successfully completed the 80-hour practicum

The Physician and Director of Training must sign the final evaluation form. The Director of Training will keep a

copy of the 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 Master of Arts which trains post-doctoral students in Psychopharmacology. New Mexico 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 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 physician. The Psychologists complete this supervised clinical experience after a series of Master level courses, taught be physicians, 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 as deemed appropriate by the physician. The Board of Psychologist Examiners requires the supervising physician to complete 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 possible psychological concerns. 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 provides meaningful assistance to many underserved populations in New Mexico, as well as throughout the United States, in the Indian Health Service and all branches of the military.

Sincerely,

Psychopharmacology Training Staff New Mexico State University Las Cruces, NM 88004 (575) 646-2120

8

FORM 80-2: PLAN FOR THE 80 HOUR PRACTICUM

9

Students may want to begin completing the 80 Hour Physical Assessment Practicum

before their plan for the 100 patient/400 hour Prescribing Practicum has been finalized.

In that case, students should send the Training Director an email with the following

information:

1) Who is the physician that will be supervising you, for the 80 hour practicum

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

in NM)

3) What is his/her contact information (email, mail, phone)

4) What the kind of practice does he/she have that you will be shadowing (e.g., provides

primary medical care to patients who have been admitted to NM State Behavioral Health

Institute).

5) 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 2016)

6) Include a statement confirming that during that time you will see diverse group of patients

(age, sex, racial and ethnic) with a broad range of medical diagnoses

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

requirements of the practicum, that he/she is aware 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.

8) 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

11

State Board of Psychologist Examiners CONDITIONAL PRESCRIBING PSYCHOLOGIST CERTIFICATE APPLICATION

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

PLEASE NOTE: to be completed by the supervisor SUPERVISOR 80-HOUR 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. We would appreciate you providing the Board with the information requested and return this form directly to the Board office at the above address.

SUPERVISOR

Name: Address: City & State: Telephone No. Describe the supervisor’s area of practice in which he or she is formally trained and/or certified/licensed? NEW MEXICO LICENSURE

Is your medical license current and unrestricted? Yes No Date New Mexico medical license was issues:

License Number and Type of License:

New Mexico Regulation and Licensing Department BOARDS AND COMMISSION DIVISION

Page 5 of 26 Revision date: 11/2012

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State Board of Psychologist Examiners CONDITIONAL PRESCRIBING PSYCHOLOGIST CERTIFICATE APPLICATION

Do you hold any other professional licenses in this or any other jurisdiction? Please list below: 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 discussing

the 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 you as specified in the Prescribing Psychologist Act? Yes No

The Board would appreciate any comments you might have regarding this applicant’s practicum. Please 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. Please mail directly to the Board Office upon completion. New Mexico Board of Psychologist Examiners P. O. Box 25101, Santa Fe, New Mexico 87504

New Mexico Regulation and Licensing Department BOARDS AND COMMISSION DIVISION

Page 6 of 26 Revision date: 11/2012

Signature of Clinical Supervisor

Date

13

FORM 80-4 : EVALUATION FORM REQUIRED BY NMSU

14

New Mexico State University

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)

_________________________ ______________________ Supervisor Date

______________________ ____________________________

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

15

II. Psychopharmacology PRACTICUM

SAMPLE FORMS FOR 400-HOUR PRACTICUM:

FORM 400-1 Letter to 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. Thes Appendix includes a copy of the

insurance policy NMSU carries to cover student’s physical liability at internship 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 Physical 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 student.

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 INSTITUTION DESCRIBING 400-HOUR PRACTICUM REQUIREMENTS

17

New Mexico State University 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 Master’s program. As you are probably aware, New Mexico 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 consultation with the physicians. The Prescribing Psychologists’ Act of New Mexico requires students to complete several practica. The psychologist is asking for your assistance in the practicum that involves working with 100 patients for a minimum of 400 hours in the evaluation and treatment with psychotherapy and possible psychotropic medication. The psychologist does not have a license to prescribe at the point of this practicum, so much of the experience involves shadowing the supervisor’s work and then assisting the supervisor in conducting evaluations, follow up therapy, follow up phone calls, and other activities as the preceptor and student deem as appropriate. The student is 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. Attached to this letter is the evaluation form that the Board of Psychologist Examiners requires the 400 hour supervisors to complete. A review of this form should help explicate the specific skills that the psychologist should practice and demonstrate. 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 provides meaningful assistance to many 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) 646-2120

18

FORM 400-2: 400-HOUR MODEL PRACTICUM PLAN

19

New Mexico State University

Psychopharmacology Training

400 HOUR PRACTICUM PLAN FOR REVIEW BY THE

BOARD OF PSYCHOLOGIST EXAMINERS Name of applicant: _____________________________________________________ Date at which applicant will finish the 450 didactic hour training program of NMSU _________________ Information about the primary supervisor. Name of supervisor:____________________________________________________

Summary of supervisor’s medical training: _____________________________________________________ _____________________________________________________ _____________________________________________________

Supervisor’s area of specialization: _____________________________________________________

Information about 1

st secondary supervisor

Name of supervisor: _____________________________________________________

Summary of supervisor’s medical training: _____________________________________________________ _____________________________________________________ _____________________________________________________

Supervisor’s area of specialization: _____________________________________________________

Information about 2

nd 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 in a 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, disorders, 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

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___________ __________________ _______________

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

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SUPERVISORY LOG

400-Hour PRACTICUM FOR PRESCRIBING PSYCHOLOGISTS

Date Name of Supervisor Method of Supervision Patients Reviewed Hours

_____ ________________

____________________ __________________ ___________

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

26

SAMPLE LETTER FOR PATIENTS

Dear Patient or Legal Guardian:

This letter is to inform you of my status as a doctor of psychology participating in a postdoctoral program

training psychologists to prescribe psychotropic medications for their patients. My program at New

Mexico State University Program, leads to a post-doctoral Master’s Degree.

In order to obtain 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 one hundred patients with psychotropic medication.

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 mental health goals, 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 but also assures you the highest quality of care, and so I hope you will not feel

encumbered by it. 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

Patient’s Signature

______________________ __________________________

Date

Date

27

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

COMPLETION

28

VERIFCATION 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.

We would appreciate you providing the Board with the information requested and return this form

directly to the Board office at the above address.

SUPERVISOR

Name:

Address:

City & State:

Telephone No.

Please describe the area of practice in which you are formally trained and/or certified/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 issues:

License Number and Type of License:

Do you hold any other professional licenses in this or any other jurisdiction? Please list below:

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License No. Type State Status (Active/Inactive)

Name and Address of Applicant’s Training Director:

SECONDARY SUPERVISOR

Name:

Address:

City & State:

Telephone No.

Is your license current and unrestricted? Yes No

Date New Mexico license was issues:

Do you hold any other professional licenses in this or any other jurisdiction?

Yes No

Please list below:

License No. Type State Status (Active/Inactive)

Please describe the area of practice in which you are formally trained and/or certified/licensed.

30

1.Was the 400-Hour Practicum part of the psychopharmacology training program from which

the applicant obtained his/her certification or degree?

2. Did the practicum meet the following requirements?

Yes No

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 in collaboration with treating healthcare

providers? Yes No

e. Was there diversity including gender, ages throughout the life-cycle, various

ethnicities, socio-cultural backgrounds, & various 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 6 months and no more than three years?

Yes No

9. Was the practicum completed within the 5 years preceding this application?

Yes No

10. Did the applicant, during the initial contact with patients or legal guardians, adequately

explain his/her status as a licensed psychologist receiving specialized training in

psychopharmacology and being under supervision? (Please enclose copies of any printed

material)

Yes No

11. Did the applicant maintain a log, without patient ID, which included basic identifying data?

Yes No

12. Did you, as a supervisor, write at least two formal evaluations of the applicant, preferably at

the midpoint and at the end of the practicum, assessing progress, competence, and description

of any deficiencies where competency had not been achieved? Yes No

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13. Did you, as supervisor, submit copies of these evaluations to the applicant & Training

Director? Yes No

14. Were you and any secondary supervisors in consultation regarding the applicant’s progress,

competence, and any deficiencies? Yes No

15. Do you, as primary supervisor, certify that the applicant has successfully completed the

400Hour/100-Patient practicum, as specified in the Prescribing Psychologist Act and is

competent to obtain a conditional prescription certificate, all other requirements being

satisfactorily completed? Yes No

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.

Signature of Clinical Supervisor Date

Please mail to:

New Mexico State Board of Psychologist Examiners

P.O. Box 25101

Santa Fe, NM 87504

32

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

33

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 performance 2. Performs satisfactorily at times, has specific deficiencies 3. Meets expected level of performance 4. Exceeds expected level of performance 5. 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 alternate

diagnoses: 1 2 3 4 5

Comments: ___________________________________________________________________________

___________________________________________________________________________ 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/or

radiological): 1 2 3 4 5

Comments: ___________________________________________________________________________

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

thorough and clear manner: 1 2 3 4 5

Comments: ___________________________________________________________________________

___________________________________________________________________________

7) Is responsible in monitoring psychotropic drug effectiveness and recommending appropriate

changes: 1 2 3 4 5

Comments: ___________________________________________________________________________

___________________________________________________________________________ 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 condition or 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, reading

recommended 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 prescribing psychotropic 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 10 course/30 hour

academic 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 anticipates that the new test will be

available in early 2018.

● This manual will be updated at that time to include up-to-date instructions for applying to take

the PEP

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 10 core courses (RXPP 601 -RXPP 610)

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 one month 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 cashier and

to pay the examination fee for taking the master’s exam without thesis. The fee for this will be one

graduate credit at the tuition rate for NMSU residents.

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.

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 (no 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.

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

40

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

VERIFICATION FORM 1)

41

POST-DOCTORAL MASTER’S OF ARTS 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 under

supervision?

____YES ____NO

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

primary supervisor?

____YES ____NO

5. Please describe the population parameters with whom you hope to practice with your

conditional 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 patients

throughout 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 direct

service?

____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 to

request clinical records from the applicant or the Training Director. Do you certify, that if

requested by the Board of Psychologist Examiners, you can and will make available to the

Training Director of NMSU or the Board of Psychologist Examiners clinical records that

support all of the experiences described

above?

____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/