COGNITIVE PROCESSING THERAPY (CPT) TRAINING OPPORTUNITY

An empirically-supported treatment for

Veterans with PTSD “A new way for veterans to handle distressing thoughts and gain an

understanding of traumatic events”

When and Where June 4 & 5, 2015 Sheraton Hotel

400 Oxford Valley Road Langhorne, PA 19047

Phone: 215 – 547-4100 June 11 & 12, 2015 Holiday Inn Grantville

604 Station Rd, Grantville, PA 17028

Phone: 717- 469-0661 June 25 & 26, 2015 Sheraton Pittsburgh Airport Hotel

1160 Thorn Run Road Coraopolis, PA 15108 Phone: 412 - 262-2400

Target Audience Clinicians who are licensed or license-eligible

(Psychologists, Licensed Counselors, Social Workers, NPs, and CNSs) to provide psychotherapy for Veterans with

PTSD are welcome. We are looking for clinicians who are enthusiastic about learning and implementing CPT, which is

an evidence-based psychotherapy.

Expectations • Attending one of the 2-day CPT workshop offerings

• Participating in weekly telephone consultation calls for a period of 6 months (at least 75% attendance is required),

• Completing 2 individual case consultations according to the CPT model and approved by the CPT Implementation Team

FUNDED BY PA DEPARTMENT OF HUMAN SERVICES /

OFFICE OF MENTAL HEALTH & SUBSTANCE ABUSE SERVICES COORDINATED BY

DREXEL UNIVERSITY/BEHAVIORAL HEALTHCARE EDUCATION

Specific Training Requirements 1. Complete the registration form for one of the 2-day Basic

CPT Workshop offerings and attending 100% of the training.

2. Within two weeks following the training you will be asked

to participate in weekly phone case consultation for one hour per week for a period of 6 months (you must attend at least 75% of the calls). During the consultation calls you are expected to actively discuss your CPT cases.

3. Please keep track of the number of consultation calls you attend as well as the date and name of the consultant for each call. Note: You may be asked by a consultant to complete additional cases and/or participate in more than 6 months of calls depending on your training needs.

4. Complete case consultations according to the CPT model and approved by the CPT Implementation Team staff. For individual CPT this means completing 2 cases (defined as completing all 12 sessions of the protocol).

5. Although not required, we strongly recommend that you complete the following steps to obtain CPT Provider Status. Upon obtaining CPT Provider Status, you are encouraged to join the roster of community providers at CPTforPTSD.com. a. For each of the two successfully completed cases,

with personal identifiers removed, submit two progress notes with detailed descriptions of the session and treatment, and either a treatment summary or final CPT session note. Also, submit the CPT Fidelity Checklist identifying the format of CPT used in these cases and the elements you delivered. Submission of completed CPT patient information is for evaluation purposes.

b. For all patients receiving CPT, complete a Patient Demographic Form and a Patient Evaluation Summary Form (with weekly PCL5 scores and PHQ9 scores) and submit the forms to CPT staff.

Note: The tape review is not included as part of the

requirement toward becoming a CPT Provider.

SEATING IS LIMITED ~ REGISTER EARLY TWO WAYS TO REGISTER: 1- Mail this completed form with a check made payable to Drexel University/BHE or 2- Fax this

completed form with credit card payment information below to 215-827-0236. Duplication of this form is permitted. Please type or print clearly on this form.

Please indicate the training you wish to attend: Registration Deadline is May 22, 2015

June 4 & 5, 2015 June 11 & 12, 2015 June 25 & 26, 2015

Sheraton Hotel 400 Oxford Valley Road Langhorne, PA 19047 Phone: (215) 547-4100

Holiday Inn Grantville 604 Station Rd,

Grantville, PA 17028 Phone: (717) 469-0661

Sheraton Pittsburgh Airport Hotel 1160 Thorn Run Road Coraopolis, PA 15108

Phone: (1)(412) 262-2400 Name __________________________________________ Degree ________________________ Employed by _____________________________________________________________________ Title/Position ____________________________________ Department _______________________ Work Address _____________________________________________________________________ City ____________________________________________________ State ___________________ Zip_______________________ Email Address _________________________________________ Day Phone: (___)________________Evening Phone:(___) ______________Fax:(___) ___________ TYPE OF CREDIT DESIRED (Please check one)

_____ APA _____ LSW/LCSW/LPC/MFT _____NBCC _____PSNA SPECIAL REQUESTS: If you require special assistance - please contact us at 215-831-4055 PAYMENT: ___ Check for the total amount of $100.00 payable to: Drexel University College of Medicine/BHE ___ Charge $100.00 to my: ___Visa ____ MasterCard ___ Discover Card Cardholder’s Name________________________________________________________________ Credit Card Number Expiration Date ___/___/_____ Security Code ____________________

(Numbers on back of card) Mail or Fax Registration Form with Payment to: Anna Auch • Drexel University College of Medicine/BHE Friends Hospital • P.O. Box 45357 • Philadelphia, PA 19124 or Fax: 215-827-0236.

FOR FURTHER INFORMATION CALL: 215-831-4055 or toll-free 877-243-3033

Please Note! Refunds will be made up until five (5) workings days prior to the training minus a $35.00 administrative fee.

All refund requests must be submitted in writing and sent to Anna Auch, Drexel/BHE at AAuch@DrexelMed.edu

REGISTRATION FORM

APA (Psychology):

Drexel University College of Medicine, Behavioral Healthcare Education is approved by the American Psychological Association to sponsor continuing education for psychologists. Drexel University College of Medicine, Behavioral Healthcare Education maintains responsibility for the program and its content. This program is being offered for up to 14 hours of continuing education.

NBCC (National Counselors):

“Drexel University College of Medicine/BHE is an NBCC-Approved Continuing Education Provider (ACEPTM) and may offer NBCC approved clock hours for events that meet NBCC requirements. The ACEP solely is responsible for all aspects of the program.” We can award a maximum of 14 hours of CE Credit.

PA Nurses:

Drexel University College of Medicine, Behavioral Healthcare Education is an approved provider of continuing nursing education by the PA State Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Participants will be awarded a maximum of 14 contact hours for attending this program.

LSW/LCSW/LPC/LMFT (PA SBSWE Licensed Social Workers in Pennsylvania):

Drexel University College of Medicine is a preapproved provider of continuing education for Social Workers and Clinical Social Workers. This program is being offered for up to 14 hours of continuing education.

CONTINUING EDUCATION