The Neurobehavioral Institute of Miami is a private, international, non-profit organization dedicated to the scientific study of brain-behavior relationship and the training of graduate and undergraduate students in the field of clinical neuropsychology. Through its clinical services branches and affiliates, Neurobehavioral Services, Inc., Neuro Cognitive Rehab, Inc. and Neuro Rehabilitation Associates, LLC, the Neurobehavioral Institute of Miami provides diagnostic and intervention services for patients with a variety of neurological conditions including, but not limited to, traumatic brain injury, multiple sclerosis, cerebro-vascular accidents, primary degenerative dementias (including Alzheimer’s related dementia), vascular dementia, AIDS related dementia, and mild cognitive impairment. A Clinical Neuropsychology Internship Program is implemented at the Neurobehavioral Institute of Miami. The Neurobehavioral Institute of Miami is a member of the Association of Psychology Post-Doctoral and Internship Centers (APPIC).
CLINICAL NEUROPSYCHOLOGY INTERNSHIP PROGRAM
The Clinical Neuropsychology Internship Program at the Neurobehavioral Institute of Miami is designed to be an intensive, clinically-rich experience, complimented by an academic curriculum which includes lectures, seminars, literature reviews, and case studies. It is a 12 month program, with 2000 hours of intern participation. On going supervision while services are being performed by the clinical neuropsychology interns is a very important feature of the program. Two hours of face to face supervision with the Director of Clinical Training and one of the Clinical Supervisors is provided weekly to the interns.
GOALS OF THE CLINICAL NEUROPSYCHOLOGY INTERNSHIP PROGRAM
The primary goal of the Clinical Neuropsychology Internship Program at the Neurobehavioral Institute of Miami is to train highly qualified clinical neuropsychologists, who will have very well developed expertise in the selection, administration, and interpretation of neuropsychological instruments, and who are able to intervene effectively on behalf of their patients and their families through the use of cognitive rehabilitation, verbal supportive psychotherapy, as well as applied behavioral analysis. The Clinical Neuropsychology Internship Program at the Neurobehavioral Institute of Miami has the following specific goals:
GOAL 1: Train doctoral level clinical neuropsychology interns in the selection, administration, scoring, and interpretation of a range of instruments that have been validated in the literature as sensitive to disorders of brain-behavior relationships with a variety of patients presenting a number of neurological disorders including, but not limited to, multiple sclerosis, traumatic brain injuries, cerebro-vascular accidents, dementing disorders of vascular and primary degenerative nature, as well as mild cognitive impairment.
GOAL 2: Develop the skills of doctoral level clinical neuropsychology interns in writing reports based on neuropsychological evaluation procedures aimed at responding specific referral questions and offer interpretation of findings based on sound knowledge of the scientific literature that supports the use of the instruments selected, consistent with the characteristics of the patient and the use of syndrome analysis.
GOAL 3: Teach doctoral level clinical neuropsychology interns to select, implement, and evaluate a number of paradigms, strategies, and programs of cognitive rehabilitation for impairments of higher cerebral functions identified through the formal neuropsychological evaluation process.
GOAL 4: Promote the development of verbal supportive psychotherapy skills in clinical neuropsychology interns aimed at assisting the patient with neurological disorders to deal more effectively with feelings of anxiety and depression.
GOAL 5: Develop and improve the skills of the clinical neuropsychology interns in the use of applied behavioral analysis to help increase desirable behaviors and decrease undesirable behaviors in patients with a variety of neurological conditions.
IMPLEMENTATION OF GOALS: NEUROPSYCHOLOGICAL ASSESSMENT
The Neurobehavioral Institute of Miami has an extensive holding of neuropsychological and psychological instruments, in both English and Spanish, which are made available to the neuropsychology interns. Interns work closely together the supervisors in determining the appropriate process oriented battery of instruments to be used in the evaluation of a particular patient. Interns have the opportunity of first, watching supervisors administer different instruments and, subsequently they have the opportunity of administer them to other patients under the supervision of the doctoral level psychologists. As the interns develop expertise in the administration of the instruments, opportunities for independent administration of the instruments are also provided.
In addition to the selection and administration of appropriate neuropsychological instruments, the clinical neuropsychology interns at the Neurobehavioral Institute of Miami are also supervised in the scoring of the findings obtained in them. As skill in scoring increases, opportunities for independent scoring of the results are provided. However, the final responsibility rests on the supervisor, who is required to conduct a final review of the results before the information is used to generate clinical neuropsychological interpretations.
Critical reviews of neuropsychological testing instruments are regularly conducted with and by the neuropsychology interns. The focus of these reviews is to make the clinical neuropsychology interns familiar with the scientific literature that backs each instrument in terms of the age, condition presented, and characteristics of the patient, in order to facilitate the configuration of process oriented batteries, as well as the interpretation of the findings obtained through them.
In addition to neuropsychological instruments, an array of psychological instruments of frequent use with neurological patients is also made available to the clinical neuropsychology interns. A process similar to that implemented with neuropsychological instruments is followed for the selection, administration, scoring, and interpretation of psychological instruments.
Report writing and the communication of findings is another valued skill included in the training of clinical neuropsychology interns at the Neurobehavioral Institute of Miami. Interns work closely with the supervisors in choosing and implemented different formats of report writing according to what information is needed from the neuropsychological evaluation, and who the intended recipients of the information are.
IMPLEMENTATION OF GOALS: INTERVENTION
Intervention is conceptualized at the Neurobehavioral Institute of Miami as a multimodal three pronged activity, consisting of cognitive rehabilitation, verbal supportive psychotherapy, and behavior modification.
For the cognitive rehabilitation component of intervention with the patients at the Neurobehavioral Institute of Miami, the latest and more trusted suites of software have been assembled and are made available to the clinical neuropsychology interns. During the process of case conceptualization, and based on the results obtained by means of formal neuropsychological evaluations, a determination is made, together with the Clinical Supervisors, as what components of different higher cerebral functions are adversely affected in each patient being treated.
The clinical neuropsychology interns have the opportunity of observing the implementation of these procedures at the hands of the Clinical Supervisors and senior cognitive rehabilitation staff. Subsequently, and in a progressive fashion, the responsibility for case conceptualization and the determination of which procedures to follow is given to the clinical neuropsychology interns, under the guidance of the Clinical Supervisors. The same is true for the implementation of the cognitive rehabilitation procedures using appropriate computer mediated programs.
An important part of the cognitive rehabilitation component of intervention with patients at the Neurobehavioral Institute of Miami is the measurement of progress and adequate documentation of progress. To this effect, the clinical neuropsychology interns learn the use of key indicators of progress in cognitive rehabilitation, such as the reduction of reaction time, the increase in levels of difficulty in the exercises, and the increase in the endurance of the patient in performing them. Analysis of errors made by the patients is also conducted by the clinical neuropsychology interns, another strategy to improve performance and the restoration of functions.
Verbal supportive psychotherapy is another important aspect of intervention at the Neurobehavioral Institute of Miami. Patients who suffer from different neurological disorders frequently suffer from anxiety and depression. In addition to this, contemporary research in applied cognitive neuroscience has shown that the involvement of the brain in behavioral dysfunction is not only cognitive in nature, but also has definite emotional correlates. The clinical neuropsychology interns participate in verbal supportive psychotherapy intervention conducted by the Clinical Supervisors and subsequently carry out the intervention in the presence of the Clinical Supervisors and independently with appropriate supervision.
Given the nature of the concerns usually addressed by the patients at the Neurobehavioral Institute of Miami, the verbal supportive psychotherapy approach used is cognitive-behavioral in nature. The aim of the verbal supportive psychotherapy component of intervention is to help the patient cope with the changes, limitations, and adverse consequences brought on by neurological disorders, as well as to help them be less anxious regarding their future or loss of status or self-esteem.
Another important dimension of intervention at The Neurobehavioral Institute of Miami is the use of applied behavioral analysis. To this effect, a Certified Behavior Analyst is on the staff and participates actively in the formulation of treatment plans aimed at increasing adaptive and appropriate behaviors and decreasing maladaptive and in-appropriate behaviors in the patients with neurological conditions.
The Clinical Neuropsychology Internship Program training philosophy is based on an integration of experiential, theoretical, and empirical knowledge. Clinical neuropsychology interns are provided a situation in which clinical experience, didactic training, and ongoing research components integrate to produce state-of-the-art, individualized, and sensitive patient care. Training procedures emphasize mentoring and graduated responsibility, in the context of neuropsychological evaluation, intervention, and outcome assessment. Training objectives include the following:
1. Acquiring experience and knowledge of neuropsychology as a theoretical, empirical, and applied discipline.
2. Becoming proficient in the assessment and treatment of patients with a variety of neurological disorders.
3. Developing an awareness of cultural and individual diversity issues relevant to the practice of clinical neuropsychology.
4. Learning to think and act in a manner consistent with ethical practice and professional integrity.
5. Becoming socialized in the role of the neuropsychologist and developing a professional identity.
6. Reviewing professional literature and/or helping to conduct small- or large-scale research to answer clinical questions pertaining to groups or individuals.
SUPERVISION OF INTERNS
Clinical neuropsychology interns at the Neurobehavioral Institute of Miami receive one hour of clinical face to face supervision from the Director of Clinical Training, as well as one hour of face to face supervision from another Clinical Supervisor. In addition to this, the clinical neuropsychology interns participate in on-going supervision and modeling throughout their training at the Neurobehavioral Institute of Miami.
The responsibility for all procedures implemented with the patients at the Neurobehavioral Institute of Miami rests on the member of the professional team (Chief Psychologist, Director of Clinical Training, or Clinical Supervisors) to whom the case has been assigned upon arrival at the facility.
Admission requirements include having completed the necessary course work for a doctoral degree in psychology in a regionally accredited university, having gone through two years of pre-doctoral practicum, as well as having successfully passed the appropriate qualifying examinations. Given the fact that Spanish is the primary language of the vast majority of the patients seen at the Neurobehavioral Institute of Miami, a working knowledge of Spanish as well as English is a requirement for admission into the Clinical Neuropsychology Internship Program.
All clinical neuropsychology interns are required to carry professional liability insurance in the amount of $1,000,000 per incident and $3,000,000 aggregate per year. Proof of professional liability insurance should be presented to the Director of Clinical Training upon arrival at the Neurobehavioral Institute of Miami.
The Neurobehavioral Institute of Miami is an equal opportunity employer and adheres to non-discriminatory practices including race, gender, creed, color, age, physical disability, sexual orientation, and national and ethnic origin.
EXPECTATIONS FOR INTERN PERFORMANCE
Clinical neuropsychology interns at the Neurobehavioral Institute of Miami are expected to behave ethically in their relationship with staff members, including Clinical Supervisors, patients, relatives, and other interns. To this effect, clinical neuropsychology interns should be familiar with the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct, to which the Neurobehavioral Institute of Miami adheres. In addition to this, clinical neuropsychology interns are expected to be familiar and follow confidentiality and privacy protection guidelines established by the Health Insurance Portability and Accountability Act of 1996 (HIPAA).
In addition to ethical behavior and compliance with HIPAA guidelines, the clinical neuropsychology interns at the Neurobehavioral Institute of Miami are expected to maintain regular and prompt attendance in the performance of their duties. Academic calendars, including those of the universities where the clinical neuropsychology interns may be pursuing doctoral studies, do not apply to the Clinical Neuropsychology Internship Program at the Neurobehavioral Institute of Miami. Attendance to all activities pertaining to the academic portion of the program is mandatory. A calendar of holidays observed at the program will be made available to the clinical neuropsychology interns during the initial two-week orientation and training session.
Timely and thorough completion of assigned tasks is also expected from the clinical neuropsychology interns. This includes evaluation and intervention activities with patients and report writing and preparation of treatment plans, as well as additional assignments given as part of the academic component of the Clinical Neuropsychology Internship Program.
An integral part of the philosophy of the Neurobehavioral Institute of Miami is to provide patients with a therapeutic environment, where they may feel appreciated and well cared for. Clinical neuropsychology interns are expected to behave in a professional, affable, caring, and respectful manner with the patients at all times.
The Clinical Neuropsychology Internship Program at the Neurobehavioral Institute of Miami is a full time 12 month program requiring 2000 hours of participation. Clinical neuropsychology interns are given the opportunity to work on research activities in addition to participate in the provision of clinical services, as described above. Research activity can be used to work on each intern’s doctoral dissertation. Allowances are also made for eight sick leave days. Time taken, with prior authorization, for additional sick days or other activities need to be replaced berore the completion of the internship program.
If an intern has a grievance with one of the staff members of the Neurobehavioral Institute of Miami or with a fellow intern, said intern is encouraged to attempt to resolve the situation with the other person in an informal manner. If this cannot be accomplished, the intern can choose to address the grievance confidentially with one of the Clinical Supervisors, who will, with the intern’s permission, address the grievance with the staff member or intern concerned.
If the grievance cannot be informally resolved between the parties, with or without the participation of a Clinical Supervisor, the intern is requested to address the grievance with the Director of Clinical Training, who will attempt to mediate the matter informally to come to a resolution acceptable to the intern as well as to the staff member or other intern involved. Should the grievance involve the Director of Clinical Training, and if it has not been resolved informally, the intern should then address the issue with the Chief Psychologist or with a Clinical Supervisor that had been previously designated to represent the Chief Psychologist in these matters.
If the grievance cannot be resolved informally to the satisfaction of the parties involved with the intervention of the Director of Clinical Training, the Chief Psychologist or an appropriately designated Clinical Supervisor, a three member panel should be designated by either the Director of Clinical Training or the Chief Psychologist, whomever is appropriate, to address the issue in a proceeding in which the parties involved should be present. This panel should be made up of the Director of Clinical Training, the Chief Psychologist, and a Clinical Supervisor. Should the grievance involve either the Director of Clinical Training or the Chief Psychologist, they should defer being a member of the panel to another Clinical Supervisor.
Prior to convening such a panel, the intern who has brought forth the grievance should present it in writing, no less than 15 days prior to the panel being convened. The intern who has brought the grievance should have the opportunity to present it to the panel and the staff member or other intern involved should also have the opportunity to present an answer to the grievance. A written record of the proceedings of this panel should be made. The panel then makes a decision or determination regarding the grievance and this decision or determination is considered to be final and binding to both parties involved.
If a staff member, including a Clinical Supervisor, has a grievance regarding an intern, the staff member is encouraged to resolve this informally with the intern. The intervention of another staff member may be requested by either party in an attempt to informally mediate the situation. If the situation cannot be informally resolved to both parties’ satisfaction, the issue is brought to the attention of the Director of Clinical Training or the Chief Psychologist, as may be appropriate. The Director of Clinical Training or the Chief Psychologist will then rule on the matter and a corrective plan should be instituted.
If the decision involves the withdrawal or dismissal of the intern, then a three member panel should be convened to address the grievance and the pertinent consequences. The panel should include the Director of Clinical Training, the Chief Psychologist, and a Clinical Supervisor. At said panel proceeding, the staff member who initiated the grievance should present it and the intern should have an opportunity to respond to it. The panel then makes a decision or determination regarding the grievance and this decision or determination is considered to be final and binding to the intern involved. A written record of the proceedings of the panel should be made.
RESEARCH IN NEUROPSYCHOLOGY
The Neurobehavioral Institute of Miami implements an active program of research in the field of neuropsychology. At the present time, there are ongoing research projects, locally and internationally, related to the neuropsychological profiles of patients with traumatic brain injury, mild cognitive impairment, HIV/AIDS, intellectual disabilities, autism spectrum disorders, cerebral palsy, sleep apnea, substance abuse, psychopathy, and attention deficit hyperactivity disorder.
The Neurobehavioral Institute of Miami is the leading participant in a multi-nation initiative to develop normative data bases for a battery of neuropsychological instruments with Spanish speaking participants.
Clinical neuropsychology interns at the Neurobehavioral Institute of Miami are offered the opportunity to participate in the ongoing research projects being currently implemented.
CLINICAL NEUROPSYCHOLOGY INTERNSHIP FACULTY