HANDBOOK

APA-ACCREDITED PSYCHOLOGY POSTDOCTORAL

FELLOWSHIP PROGRAMS 2019-2020

Long Island Jewish Medical Center Zucker Hillside Hospital

Cohen Children’s Medical Center Northwell Health

Division of Psychological Services

FELLOWSHIP PROGRAMS

Clinical Psychology with Geropsychology Emphasis

Asha Patel, PhD, Director

Clinical Child Psychology Specialty Program Peter J. D’Amico, PhD, ABPP, Director

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 2

TABLE OF CONTENTS Table of Contents ................................................................................................................ 2 Overview ............................................................................................................................. 3 Educational Goals, Their Assessment, and Assessment of the Fellowship ........................ 5

Fellowship in Clinical Psychology with Emphasis in Geropsychology ......................... 5 Fellowship in Clinical Child Psychology ....................................................................... 6

Our Values Regarding Diversity ......................................................................................... 6 Assessing Your Progress..................................................................................................... 7 Criteria for Successful Completion of the Fellowship ........................................................ 7 Supervision Requirement .................................................................................................... 8 Work Load .......................................................................................................................... 8 Record Keeping .................................................................................................................. 8 Due Process ......................................................................................................................... 9 Grievance Procedure ........................................................................................................... 9 Employee Conduct .............................................................................................................. 9 Extended Training Policy ................................................................................................. 10 Certificate of Completion ................................................................................................. 10 Feedback about the Fellowship from Fellows .................................................................. 10 Administrative Issues ........................................................................................................ 11

Timekeeping ................................................................................................................. 11 Vacation Time ............................................................................................................... 11 Sick Time ...................................................................................................................... 11 Conference Time ........................................................................................................... 12 Benefits ......................................................................................................................... 12 Medical and Psychiatric Emergencies .......................................................................... 12 Telephones .................................................................................................................... 12 Long Distance Phone Calls ........................................................................................... 13 Pagers ............................................................................................................................ 14 Using Your Computer ................................................................................................... 14 Parking .......................................................................................................................... 15 Mailboxes ...................................................................................................................... 16 Payroll ........................................................................................................................... 16 Food .............................................................................................................................. 16 Text Alerts .................................................................................................................... 16 Fire Alarms ................................................................................................................... 17 Keys .............................................................................................................................. 17 Access to Inpatient Units at ZHH ................................................................................. 17 Credit Union.................................................................................................................. 17

APPENDIX ....................................................................................................................... 18

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 3

OVERVIEW

The APA-Accredited Fellowship Programs at Long Island Jewish Medical Center afford an opportunity for training in diverse clinical settings located at Zucker Hillside Hospital, Cohen Children’s Medical Center, and Long Island Jewish Hospital. All these settings are part of Northwell Health. There are currently integrated accredited psychology fellowship training programs in

• Clinical Psychology with an emphasis in Geropsychology (henceforth referred to as The Clinical Psychology Fellowship), and

• Clinical Child Psychology

Each of these fellowship programs was accredited by the American Psychological Association in 2005 and accreditations were renewed in 2017 through 2027. Questions related to the program’s accredited status should be directed to the Commission on Accreditation at:

Office of Program Consultation and Accreditation American Psychological Association

750 First Street, N.E., Washington, D.C. 20002-4242 Tel: 202-336-5979

http://www.apa.org/ed/accreditation/contact.aspx

The psychology training programs at Long Island Jewish Medical Center are based at Zucker Hillside Hospital which was initially founded in 1927 in Hastings-on-Hudson as Hastings Hillside Hospital. Looking to expand its facility, the Hospital moved to Queens in 1942 and opened on the Glen Oaks campus where it resides today. In 1972 Hillside merged with Long Island Jewish Hospital to form Long Island Jewish-Hillside Medical Center. In 1983 Schneider Children’s Hospital was established as another division of Long Island Jewish Medical Center along with the Hillside Hospital and Long Island Jewish Hospital divisions. North Shore University Hospital and Long Island Jewish Medical Center merged in 1997 to form the North Shore – LIJ Health System. In 2002 Hillside Hospital was renamed “Zucker Hillside Hospital” in recognition of the generosity of Zucker family in the construction of a new Hillside Hospital facility. In 2010, North Shore-LIJ’s pediatric hospital, formerly known as Schneider Children’s Hospital, was renamed the Steven and Alexandra Cohen Children’s Medical Center of New York, in recognition of one of the largest single gifts ever received by the North Shore-LIJ Health System. In 2016, the North-Shore LIJ Health System, already comprising more than 21 hospitals, was renamed Northwell Health.

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 4

The Fellowship Programs are part of a larger network of psychology training programs that includes externships and internships. Our externship programs are highly sought after by the regional doctoral programs that send over 40 externs to fulfill clinical practica in the areas of neuropsychology, child psychology, geropsychology, trauma, and adult psychology (within specialized settings) each year. The internship program began in 1966 with one half-time intern at Hillside Hospital and grew in size to 11 interns. Over thirty licensed psychologists provide supervision and other training experiences for the psychology training programs. Post-doctoral fellowship training began in 1988. The Clinical Child Psychology postdoctoral fellowship program began with one fellow in that year and currently offers two fellowship positions. The Clinical Psychology postdoctoral fellowship program began in 1993 and currently has one fellowship position. A Pediatric Neuropsychology Specialty Postdoctoral Program operated from 2001 and until 2008.

Zucker Hillside Hospital has an enviable history of prestigious research contributions in psychiatry and psychology. In 1954, a Department of Experimental Psychiatry was established under the direction of Max Fink, M.D. In 1959 Donald Klein, M.D. began his tenure as Director of Research during which time some of the most influential psychopharmacological research of that era were conducted. In 1978 John Kane, M.D. became Director of Research. During the years that he directed the program he and his colleagues garnered million of dollars in funding from the National Institute of Mental Health primarily to support research on Schizophrenia and other psychiatric disorders. In 1988 Dr. Kane became Chairman of the Department of Psychiatry at the Medical Center. He remains actively involved in the wide ranging research studies at Zucker Hillside. In 2009, the federal government announced an innovative study to test the impact of the best available treatments for Schizophrenia. Through this study, called RAISE, the government funded $40 million over six years -- of which about $25 million has been earmarked for scientists at Zucker Hillside Hospital campus of The Feinstein Institute for Medical Research. The project involved two independent teams of researchers, one being led by Zucker Hillside/Feinstein scientists and another at Columbia University’s New York State Psychiatric Institute.

From the origins of Hillside Hospital to what has now evolved into the 23 hospitals that constitute Northwell Health, psychologists have played an integral role in clinical services and research. We are delighted that you chose Long Island Jewish Medical Center, Zucker Hillside Hospital for fellowship training. You join a group of distinguished individuals who have trained with us. We trust you will have a productive and satisfying fellowship training experience.

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 5

EDUCATIONAL GOALS, THEIR ASSESSMENT, AND ASSESSMENT OF THE

FELLOWSHIP Fellowship in Clinical Psychology with Emphasis in Geropsychology The overall aim of the program is to promote the development of competent Clinical Psychologists with emphasis in Geropsychology. While not a specialty program, the program provides advanced training in Clinical Psychology and promotes development of skills pertinent to the practice of Professional Geropsychology. Such practice uses psychological methods and knowledge to help older persons and their families stay healthy, overcome problems and maximize their potential during later life. The program appreciates the wide diversity among older adults, the complex ethical issues that can arise in geriatric practice and the importance of interdisciplinary models of care. Guidelines for Psychological Practice with Older Adults were developed by representatives of APA Division 20, Division 12-Section II, and the Office on Aging and were approved by APA in 2003 a copy of which may be found in the Appendix. The training competencies for this program are based on the recent Standards of Accreditation: Postdoctoral Residency Programs as well as on ideas promulgated by the above-mentioned Guidelines and on Foundational Knowledge Competencies in Geropsychology as promulgated by the Council of Professional Geropsychology Training Programs (CoPGTP) which may be found in the appendix. The competencies for the program follow. (A more elaborated version which includes the implementation and elements of these competencies may be found in the evaluation tool in the Appendix.)

Level 1: Advanced Competencies (REQUIRED for ALL Postdoctoral Residency Programs)

• Ethical and Legal Standards • Individual and cultural diversity • Integration of science and practice

Level 2: Program-Specific/Area of Focus Competencies (advanced competencies

relevant to the program’s aims or area of focus): • Advanced Competency in the Role of a Clinical Psychologist with

Emphasis in Geropsychology • Advanced Competency in the Assessment and Treatment of Older Adults • Competency in Supervision and Teaching

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 6

Fellowship in Clinical Child Psychology The overall aim of the program is to promote the development of competent Clinical Child Psychologists. Clinical Child Psychology is a recognized specialty by APA. Training goals of this program are based on the recent Standards of Accreditation: Postdoctoral Residency Programs as well as on published guidelines and recommendation for training in Clinical Child Psychology as articulated by the APA Division 53’s Board of Directors and a Division 53 Task Force on Postdoctoral Accreditation in Clinical Child Psychology. In the Appendix, Division 53’s outline of specific competencies is included along with information on how these are addressed in the Program. The competencies for the program follow. (A more elaborated version which includes the implementation and elements of these competencies may be found in the evaluation tool in the Appendix.)

Level 1: Advanced Competencies (REQUIRED for ALL Postdoctoral Residency Programs)

• Ethical and Legal Standards • Individual and cultural diversity • Integration of science and practice

Level 2: Program-Specific/Area of Focus Competencies (advanced competencies

relevant to the program’s aims or area of focus) • Competency in Supervision and Teaching

Level 3: Specialty Competencies • Advanced Competency in the Role of Clinical Child Psychologist • Advanced Competency in the Evaluation, Consultation, and Practice of

Clinical Child Psychology

OUR VALUES REGARDING DIVERSITY The Medical Center provides services to a diverse clientele that mirrors the cultural richness of the New York City metropolitan area. Medical Center clientele are diverse with respect to race, ethnicity, religious faith, sexual orientation, age, disability status, and life experience. We believe that diversity is a rich resource for personal and professional development. We value the diversity of our staff and trainees and believe that their many backgrounds strengthen our Medical Center. In the Appendix you will

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 7

find copies of Guidelines for Psychotherapy with Lesbian, Gay and Bisexual Clients, Guidelines for Psychological Practice with Transgender and Gender Nonconforming People, Guidelines on Multicultural Education, Training, Research, Practice, and Organizational Change for Psychologists, and guidance on Enhancing Your Interactions with People with Disabilities.

ASSESSING YOUR PROGRESS We understand that receiving constructive feedback about your performance is important. This feedback includes assessment of your strengths as well as areas in which we feel you need further development. Within the first month your Director will assemble an individualized training plan based on observation and discussion of your entry level skills as well as input from your supervisors. The aim of this plan is to establish a baseline assessment of the relevant competencies, to clarify competency goals and to tailor your experiences to meet these goals. For fellows in the Clinical Psychology Program with Geropsychology Emphasis, the baseline assessment will be informed by the Pike’s Peak Model for training in Geropsychology and the Pike’s Peak Evaluation Tool (see appendix). Supervisors are encouraged to provide you with regular verbal feedback. Fellowship supervisors discuss your progress informally within the first three months and more formally towards the end of the six-month rotations (March and August). At the latter times you will be given a written evaluation of your performance by each of your placement supervisors. The format of the evaluation mirrors the educational and training goals specific to each of the fellowship programs. Progress is assessed using Likert scales as well as narrative information. Supervisors are asked to discuss the written evaluation with you and provide verbal feedback. You will be asked to sign the evaluation acknowledging that it has been discussed with you. A copy of the evaluation forms are in the Appendix.

CRITERIA FOR SUCCESSFUL COMPLETION OF THE FELLOWSHIP Each of the competencies and associated objectives are outlined in the Psychology Fellow Competency Assessment Form, a copy of which for each of our programs may be found in the appendix. The assessment rates your competency in each area as: Intermediate or below (1), High Intermediate (2), Competent (3), Advanced (4), or Expert (5). We expect that all of the relevant competency areas will be rated at a “Competent” level or higher at midyear. If by midyear a competency area is rated lower than

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 8

“Competent”, we will work with the trainee to develop a remediation plan. The goal for fellow evaluations done at the end of the fellowship is that all of the relevant competency areas will be rated at an “Advanced” level or higher. Please review the competencies and if you have any questions, speak with your program director.

SUPERVISION REQUIREMENT

At least 2 hours per week of individual supervision focused on the fellow’s professional activities will be conducted by an appropriately trained and licensed doctoral level psychologist. Supervisors will maintain an ongoing supervisory relationship with the fellow and will have primary professional clinical responsibility for the cases for which they provide supervision. A postdoctoral fellow will have an appropriately trained and licensed doctoral level psychologist serving as primary supervisor to ensure continuity of the training plan. The program director also serves as the primary supervisor and will maintain overall responsibility for all supervision, including oversight and integration of supervision provided by other health professionals.

WORK LOAD

The fellow is expected to devote 32-40 hours per week (80% time) to clinical service delivery (in the form of direct patient contact, documentation and related service such as consultation with colleagues) and 8-10 hours per week (20% time) in educational activities in the form of didactics, receiving supervision, and supervision of other trainees. Some weeks may exceed the above range, however, we aim for an average that is reflected in a 40-50 hour work week.

RECORD KEEPING

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 9

Each program documents and permanently maintains accurate records of the fellows’ supervised training experiences and evaluations for future reference, certification, licensing, and credentialing purposes. Each program is responsible for maintaining records of all formal complaints and grievances against the program of which it is aware that have been submitted or filed against the program and/or against individuals associated with the program since its last accreditation site visit.

DUE PROCESS In the event that there are serious problems in the fellow’s progress toward achieving training goals, Due Process procedures have been outlined. A copy of these is in the Appendix section of this handbook. In essence, the procedures are designed to provide formal feedback to the fellow on what actions are required to help remediate identified problems in a series of graded steps that involve relevant fellowship training staff. Involvement of the Department of Human Resources and/or other regulatory agencies may occur as needed.

GRIEVANCE PROCEDURE While we hope that problems that might arise for fellows will be resolved informally, there may be circumstances in which the fellow feels an issue needs to be addressed in a formal way. A Grievance Procedure has been detailed, a copy of which is in the Appendix section of this handbook.

EMPLOYEE CONDUCT Psychology trainees are expected to follow the American Psychological Association’s Ethical Principles of Psychologists and Code of Conduct (APA, 2002, amended 2010 and 2016) a copy of which is in the Appendix of this handbook. Further, as employees, trainees are expected to follow the Northwell Health policies which are contained in the Employee Handbook you receive during the “Beginnings” orientation (a copy is also accessible on the employee website named “Healthport” as are all policies applicable to employees). During orientation, the Program Directors will broadly review Health System policies and procedures.

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 10

EXTENDED TRAINING POLICY It is recognized that on occasion a postdoctoral fellow may not be able to complete all requirements for the fellowship during the one year of paid employment because of medical problems or extraordinary personal circumstances. Our policy regarding this may be found in the Appendix.

CERTIFICATE OF COMPLETION

At the successful conclusion of the fellowship, each fellow will receive a certificate attesting to completion of the “Postdoctoral Fellowship in Clinical Psychology” or “Postdoctoral Fellowship in Clinical Child Psychology”.

FEEDBACK ABOUT THE FELLOWSHIP FROM FELLOWS Feedback from fellows about the fellowship has helped us to strengthen the program. Fellows are asked to send a fellow representative to monthly meetings of the Psychology Education and Training Committee where fellowship and other training matters are discussed. The Fellow representative solicits issues of concern from other fellows that can be shared with the committee. Seminars are also evaluated. At the completion of a fellowship seminar, seminar evaluation forms are distributed. Information gathered from these evaluations is aggregated, shared with the Program Directors and fed back to the seminar leaders. Intermittently throughout the fellowship year, the Director of Psychology Training and fellowship program directors will informally request feedback on issues of concern. At the end of the training year, each fellow will have an exit interview with the Director of Psychological Services or his designee at which further feedback on the fellowship program is sought. At that time, fellows will also complete written evaluations of their supervisors which will be used in aggregate form to improve training. Finally, at least one year after their graduation, fellows are surveyed about their progress and the usefulness of the program in helping them to achieve the stated objectives.

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 11

ADMINISTRATIVE ISSUES

The fellows have designated office space in Zucker Hillside Hospital Ambulatory Care Pavilion building. Timekeeping Northwell Health recently implemented automated workforce operations using Kronos® as part of a plan to eliminate its manual paper-based timekeeping and scheduling processes. Kronos® utilizes daily identification (i.e., badge swipe and finger imaging) to record work attendance, document time-off, adjust work schedules and automate record-keeping for Payroll and Benefits purposes. Directors will instruct fellows how to enroll in and use this process. All communication regarding time out or changes to time records should take place between the fellow and the appropriate time keeper. The time keeper for Clinical Psychology fellows is: Ms. Eliana Space at 718-470-8140. The time keeper for Clinical Child Psychology fellows is: Ms. Christine Keene at 718-470-8437. Vacation Time Fellows are allocated a total of 20 days of “paid time off” and 8 designated national holidays. (See the hospital’s employee “Healthport” website for listing of the national holidays.) Fellows accrue their paid time off at an even rate throughout the year (i.e., approximately 0.38 days per week) however, the institution’s policy is that new hires may not access paid time off during their first three months of employment. We ask that you try to distribute the time evenly to the extent possible and that you not take more than a day or two of vacation during the last two weeks of fellowship. Fellows must be at work on their last day of employment. If there are extenuating circumstances, please speak with your program director. Personal time must be requested in advance and the procedures will be further explained by the clerical staff in charge of your timekeeping. In general, we ask that you discuss with your placement supervisors which dates you would like to take for vacation and obtain their approval in advance. The time off form should be filled out and left with your respective fellowship Director. (A time off request form is available for download on the Healthport website in the HR Forms section a sample of which is included in the Appendix.) Sick Time Details regarding salary continuation during sick leave will be provided during your orientation. If you are ill, you must notify the individual who is your designated time keeper and let your site supervisors know that you will not be in. Note that if the sick time you take is substantial, you may not meet the fellowship’s requirement of residence

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 12

training. In the event of a required leave, efforts will be made to accommodate if operationally feasible by extending the training; this will be at the discretion of the fellowship director and in consultation with the Education and Training Committee and relevant institutional departments. A copy of the current Extended Training Policy may be found in the appendix of this handbook. Conference Time At the discretion of the Director of your fellowship program, up to five days of conference time may be granted to fellows to attend professional meetings and conferences. Make this request in advance with supporting documentation (i.e., copy of a description of the conference). Benefits A variety of health and medication insurance coverage plans are offered, most of which are subsidized by the hospital. Details of the health benefits program will be discussed with you by the Department of Human Resources, Benefits Office during the orientation period. Benefits eligibility begins on the first day of employment although it may take some time to complete administrative matters before you obtain necessary benefit documentation (e.g., health insurance card). Medical and Psychiatric Emergencies In the appendix you will find a document containing the Health System-wide standardized hospital safety codes. Note, you are expected to use these terms when calling the operator for any emergency, so it is imperative that you are consistent with system terminology. For example, a medical emergency would be called in as a "rapid response." Many of these codes are not applicable to our operation here at ZHH. Furthermore, ZHH does not have overhead paging in all areas, as is the case in other locales. However, it is still important that you have a working knowledge of these codes, even those that are not applicable at ZHH, because you may be present in another facility when they are utilized. Telephones When making calls outside the hospital system, dial 9, wait for a dial tone, and dial the telephone number needed. ZHH telephone numbers are 718 or 516 470-####. If you are calling an extension in the same hospital, you only need to dial the four-digit extension number. A voice mail system is available to take messages when you are not available to take a call. As a general rule, fellows should give their designated office phone number as the best place to be reached during working hours. If you are away for any extended period

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 13

of time during regular business hours, you can and should access your phone messages from another phone.

To Establish an Outgoing Message dial 5800 within the hospital; (If calling from someone else’s phone, enter # followed by your full 10-digit telephone number when prompted and then) enter your password (please use “12345" as your password); Press 8 (or “U”) to change your setup options. Please record the following greeting (by pressing 4 on the previous menu): “Hello, this is the office of (names). Please leave a message. If you believe this is

an emergency, dial 911 or go to the nearest emergency room. If you need to speak with a staff person during regular business hours push zero.”

Note: trainees with offices/extensions in the child psych clinic will also need to include clinic-specific information in their phone messages To Retrieve Messages: You will know you have a message because a red light at the top of the phone is illuminated and the phone reads “message waiting”. From Your Own Office Phone: Dial 5800, then password (”security code”).

Press 7 to listen to messages. From Another Phone: Dial 5800, enter #, your 10—digit extension number,

then password. Press 7 to listen to messages. From Outside the Hospital: Dial 718-470-5800, enter #, your 10-digit

extension number, then password. Press 7 to listen to messages. If you don’t want to be disturbed: Lift receiver, press “FWDA” button, enter 5800, and then hang up. Your calls will automatically be directed into your voice mail box without ringing your telephone. For patients to whom your phone number is given the following should be told: Emergency messages should not be left on your Voice Mail since there is no

guarantee that you will receive the message quickly during the day nor will the system be accessed necessarily after hours or on weekends. Discuss with each of your placement supervisors what instructions should be given to patients for emergencies during the day, after-hours, and on weekends.

In the Appendix section you will find a summary of features of the phone message system. Long Distance Phone Calls

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 14

In the course of the fellowship year, if necessary you may be given a PIN number through which you can make long distance business calls. Press 20, then the PIN, then 9-1- and the long distance phone number. Hospital placed long distance phone calls – as all other calls - should only be made for Hospital business. Pagers Fellows may be assigned pagers. Most currently issued pagers are dual use; they function as long-range as well as within-hospital pagers. You will receive instructions about using your pagers. Be sure to check that your pager’s battery is functioning and that it is activated each day; discuss expectations regarding after-hours availability with your placement supervisors. You are expected to respond promptly when paged. Using Your Computer Offices are equipped with a desktop computer. The operating system is Windows XP or Windows 7 and the work-stations are networked through a series of servers throughout the institution. You will be assigned a username and password which will be required when you log on to the system. You will be able to log in from any computer in the network. Files should be saved on designated space on a shared (network) drive. Hospital policy limits the distribution, duplication and destruction of electronic information. Please familiarize yourself with see the policies governing electronic information and communication which may be accessed online through Healthport (as you will be instructed during orientation). Report any error messages to Information Systems (IS) (at extension 7272) or to designated psychology staff. You will find that your computer already has essential software installed and available from the desktop. This includes the programs which are part of Microsoft Office (i.e., Word, Excel, Access, Outlook) as well as Internet Explorer. There are limitations on users’ privileges which restrict installation and remote access. Zucker Hillside Hospital uses proprietary software for creating and reading medical records (i.e., the Avatar Clinical Work Station and the Chart Viewing Module). You will learn about this system and receive more detailed documentation during the orientation period. Each fellow will have broadband access to the internet from the desktop. The browser that is already installed on the computer is Microsoft's Internet Explorer. Try exploring our ZHH and Northwell hospital websites: and. Please note that computer use (like use of any hospital equipment) is intended for work purposes only. The Health System blocks access to certain websites and monitors internet use. Hospital policy limits the distribution, duplication and destruction of electronic information. Please familiarize yourself with Information Services (IS) policies:

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 15

https://intranet.northwell.edu/NSLIJ/departments/IS/Toolbox/Pages/default.aspx. A copy of the email policy of Northwell Health is in the Appendix. Report any error messages to Information Systems (IS) (at extension 7272). IS service requests can be made here: https://intranet.northwell.edu/NSLIJ/departments/IS/Pages/SubmitISTicket.aspx. Additionally, fellows are encouraged to familiarize themselves with the institution’s intranet that is dedicated to staff which may be accessed by typing “Healthport” into the browser address field. This website also affords remote access to Outlook email and calendar (with or without the use of a remote access token). You may apply for remote access which will enable you to retrieve and send email from any non-network computer. You may also apply configure your smartphone to receive email. IS service requests can be made here: https://intranet.northwell.edu/NSLIJ/departments/IS/Pages/SubmitISTicket.aspx. E-mail: As part of your setup, you will be issued an email account. Once an email id is activated (usually the first initial followed by the first seven letters of your last name and “@northwell.edu”), Microsoft Outlook will automatically configure your profile when you log in. You are expected to check your Outlook email regularly; in some settings, you will be expected to keep your schedule current on Outlook as well. Please contact IS staff at telephone extension 7272 (or externally at 718-470-7272) if you require help in this matter. There is a “global directory” available in Outlook which is useful for accessing any networked staff member via email. Library Services: The hospital also provides access to several searchable academic and medical databases using OVID, Micromedex, MDConsult, Cochrane, Up-to-Date, PubMed and other resources. There are numerous journals with full text articles available online through this service. Additionally, search results indicate which items are available at Zucker Hillside and LIJ libraries and allows the search results to be E-mailed, printed or saved. More extensive information is available through the library services if needed. Parking There are several options for parking. To park in any of the designated Zucker Hillside parking lots you must get a sticker for your car. You can obtain a sticker from Zucker Hillside Hospital Security unless otherwise directed. (Your program’s assigned staff will be glad to direct you in this regard.)

• The Parking Garage: A seven-floor indoor parking garage is available for the use of staff at LIJ, Zucker Hillside Hospital and the Cohen Children’s Medical Center.

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 16

This garage is accessed via 74th avenue (east of 263rd Street). Your ID Badge will be needed for you to drive in and out of this garage. This is the preferred parking area for staff.

• On-Campus Parking: The On-Campus Parking Lot is located in the large open area on the east side of the Kaufmann Building. A guard checks to make sure those cars entering this lot have the required sticker. Be sure to park only in designated spaces. (There is reserved parking for those with handicapped permits as well as reserved parking for licensed medical staff.) If you park in a space that is not for your use, Security may attach a hard-to-scrape off notice on the driver’s side indicating you have parked illegally! There are parking spots in other areas of the campus but it is important to confirm with Security that it is permissible for you to park in those areas before doing so.

There is also parking available on the local streets. Mailboxes You may have mailboxes at different clinical sites. Please check mail regularly. Payroll Employees and trainees are paid twice a month: on the 7th and 22nd of the month. During orientation you will be directed to arrange for direct deposit of your paycheck. The institution also maintains an online Employee Self Service program to enable monitoring of your paycheck and printing paystubs. Food There is a small food service area in the Au Bon Pain located on the main floor of the Ambulatory Care Pavilion. Its hours of operation are 8:30AM – 4PM on Monday through Friday. There are also vending machines there and in locations at the Littauer Building. The Cohen Children’s Medical Center has a large cafeteria on the lower level and there is a kosher cafeteria at the Parker Jewish Geriatric Center (located past Long Island Jewish Hospital on Lakeville Road). A refrigerator and microwave may be available for use in your primary service areas. Text Alerts Fellows may sign up at https://nslijhp.northshorelij.com/NSLIJ/departments/HSIDE/Lists/TextAlertRequest/TextAlertReq_Form.aspx?source=/NSLIJ/Utilities/SubmittedFormResults.aspx?formsstatus= sent to receive text messages of hospital news, announcements and upcoming events.

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 17

Fire Alarms When a fire alarm is sounded, you must evacuate the area. If you are located in an inpatient area, you will be directed by a manager to either exit or to assist in the management of patients. An all-clear bell will sound when the building may be re-entered. The policy regarding fire safety may be found on Healthport. Keys You can obtain relevant keys from your program director for the area to which you are assigned. Access to Inpatient Units at ZHH All fellows will have access to - and egress from - the inpatient units on the ZHH campus. Entry to the units is achieved via the ID badge swipe. Egress from units is via ID badge swipe and keypunch of the trainees’s PIN (i.e., mmdd from your Date of Birth) followed by the pound (#) sign. Inpatient units are equipped with double doors which must be opened and closed in sequence to prevent patient elopement. Trainees will also be briefed about precautions taken while entering and exiting patient units. Credit Union You are eligible to use the services of the Northwell’s credit union which recently merged with the Bethpage Credit Union (http://www.nslijhsfcu.org) including direct deposit of your check into the credit union. Bethpage is one of the country’s leading community credit unions and the largest in New York State, serving the Long Island community for 75 years. If you open an account, you will have full access to all Bethpage branches as well as the Bethpage call center and Bethpage Online Banking. Bethpage has 33 full-service branches across Long Island and one in midtown Manhattan. To learn more about Bethpage products and services, visit https://www.bethpagefcu.com/ or any Bethpage branch. To find a local Bethpage branch, visit http://www.bethpagefcu.com/branches-atms.aspx?src=top_nav.

The Division of Psychological Services is happy to welcome you to what we hope is an enjoyable and stimulating year. This handbook has been designed to help you cope with

all the information you will be getting at the beginning of the fellowship. It does not provide the answers to all of your questions, but we hope it will orient you and help you

know where to find answers. It is always good to start with your supervisors or the Fellowship Director. Do not be embarrassed to ask questions or request help with

clinical or administrative problems.

APA-Accredited Postdoctoral Psychology Fellowship Handbook: 2019-20: Page 18

APPENDIX Table of Organization for Psychology Training 1

Grievance Procedure for Trainees 2

Due Process Procedures for Psychology Fellows 4

Extended Training Policy 9

Fellowship Competency Assessment Forms 11

Guides Distributed Electronically 18

• APA Division 53 Child Residency Curriculum Summary • APA Ethical Principles of Psychologists and Code of Conduct including

Amendments in 2010 and 2016 • Guidelines for Psychotherapy with Lesbian, Gay, and Bisexual Clients • Guidelines for Psychological Practice with Transgender and Gender

Nonconforming People • Guidelines on Multicultural Education, Training, Research, Practice, and

Organizational Change for Psychologists • Enhancing Your Interactions with People with Disabilities • Guidelines for Psychological Practice With Older Adults • Pike’s Peak Evaluation Tool • Foundational Knowledge Competencies in Professional Geropsychology

Phone System Information 19

Vacation Request Form 21

Fire Safety Information 23

Ambulatory Psychiatric Emergencies 31

Hospital Safety Codes 34

Zucker Hospital Appearance Guidelines 43

Map of Zucker Hillside Hospital 46

Dire

ctor

of

Psyc

holo

gy

Trai

ning

Dr.

Elih

u Tu

rkel

FELL

OW

SHIP

(APA

)

INTE

RN

SHIP

EXTE

RN

SHIP

SER

VIC

E FE

LLO

WS

SER

VIC

E FE

LLO

WS

Dire

ctor

: Clin

ical

Ps

ycho

logy

Pro

gram

(Ger

oEm

phas

is)

Dr.

Ash

a P

atel

Neu

rops

ycho

logy

Dr.

Pau

l Mat

tisD

irect

or: C

linic

al

Chi

ld P

rogr

amD

r. P

eter

D’A

mic

o

Neu

rops

ycho

logy

Tr

ack

Dr.

Pau

l Mat

tis

Chi

ld P

sych

olog

y Tr

ack

Dr.

Ste

phan

ie S

olow

Adul

t Psy

chol

ogy

Trac

kD

r. E

lihu

Turk

el

Chi

ld P

sych

olog

yD

r. S

teph

anie

Sol

ow

Ger

opsy

chol

ogy

Dr.

Rita

Rya

n

Adul

t Psy

chol

ogy

Dr.

Jim

my

Kim

SU

PE

RV

ISIN

G

PS

YCH

OLO

GIS

TSS

UP

ER

VIS

ING

P

SYC

HO

LOG

ISTS

SU

PE

RV

ISIN

G

PS

YCH

OLO

GIS

TSS

UP

ER

VIS

ING

PS

YCH

OLO

GIS

TS

Fello

w

5 E

xter

ns

12 E

xter

ns

4 E

xter

ns

3 E

xter

ns

Inte

rnIn

tern

Inte

rnIn

tern

Inte

rnIn

tern

Inte

rn

SU

PE

RV

ISIN

G

PS

YCH

OLO

GIS

TS

Inte

rnIn

tern

Inte

rnIn

tern

ETP

Dr.

Kris

ten

Can

dan

Col

lege

Dr.

Can

dice

La

Lim

a

OC

D &

Bip

olar

Dr.

Ant

hony

Pin

toD

r. A

liosn

Gilb

ert

Trau

ma

Dr.

May

er B

elle

hsen

2 E

xter

ns

10 E

xter

ns

4 E

xter

ns

2 E

xter

ns

Fello

wFe

llow

Sub

stan

ce A

buse

Dr.

Mon

ica

Thom

asTB

A

CEN

TER

S FE

LLO

W

CEN

TER

S FE

LLO

W

CEN

TER

S FE

LLO

W

CEN

TER

S FE

LLO

W

INPA

TIEN

T FE

LLO

W

Division of Psychological Services

Long Island Jewish Medical Center, The Zucker Hillside Hospital Northwell Health PSYCHOLOGY TRAINEE GRIEVANCE PROCEDURE Informal Problem Resolution: It is the policy of the training program and of Northwell Health to foster sound trainee/supervisor relations by encouraging open communication and reconciliation of work-related problems or concerns. It is the training program’s belief that most complaints about working conditions, supervision, co-workers or other work-related problems can best be handled through informal and private discussion between the trainee and his/her supervisor or track director. A trainee or supervisor may request that the Training Director (TD) provide informal consultation to assist in determining the appropriate course of action. Such consultation may serve to resolve the conflict or may result in the trainee choosing to escalate the matter to a more formalized intervention. In the event that more formal resolution is needed, the following procedure should be used. Step 1: The trainee is encouraged to discuss any complaint with his/her immediate psychology supervisor in person. This should take place within 10 working days of the occurrence which triggered the complaint although consideration will be given if there are personal reasons for longer delays. The supervisor is expected to give his/her decision within 10 working days of receiving the complaint. If an issue does not arise in a setting where the trainee is being supervised, it should be addressed first to the Program Director, Track Director or Coordinator (in the case of fellowship, internship and externship, respectively). If a trainee reasonably believes that discussing his/her complaint with his/her immediate supervisor would be futile, the trainee may move to the next step in the grievance process. The Step 2 grievance should be requested within five working days of the supervisor’s response to the initial complaint; however personal reasons for a longer delay will be considered. Step 2: In the event of the failure of the above to resolve the matter, a formal grievance should be pursued. Formal grievances should be made in writing to the TD or to another member of the Education and Training Committee (ETC) if the Training Director is the source of the trainee's grievance. The TD will notify the Director of Psychological Services of the grievance. The TD may render a decision on the grievance without consult or may constitute a Grievance Committee to hear the case and deliberate the outcome. The Grievance Committee will consist of three faculty members representing training sites. In special circumstances, the committee may be limited to representation from the site within which the trainee is placed. Individuals named in the grievance will not serve on the Grievance Committee in that matter. The trainee and relevant faculty will be notified of the date of the Committee’s review and will be given the opportunity to provide the Committee with any information regarding the grievance. The Committee will meet with the parties involved, and may do so at one time or separately. If a Committee is convened, the Committee will determine the outcome of the grievance. A

decision will be reached within five working days after the meeting of the Grievance Committee or of the TD being informed of the complaint. The decision will be presented in writing to the trainee. If the trainee is not satisfied, he/she may proceed to the next step (3) within ten business days of the rendered decision. Step 3: The Training Director will submit a written request for the trainee to meet with the Director of Psychological Services. After the grievance has been heard, the employee will receive a written decision within 15 workdays and will be communicated to all involved parties and to the Grievance Committee. If the problem has not been resolved to the employee’s satisfaction, he/she may take the grievance to Step 4 within five working days of receiving the Step 3 determination. Step 4: The Director of Psychological Services will schedule an appointment with the Vice Chairman of Psychiatry and the Human Resources designated representative. The trainee must be available to testify. After the grievance has been heard, the trainee will receive a final and binding decision in writing within 15 workdays after the meeting. _____________________________ In the event that the grievance involves any member of the ETC (including the TD), that member will recuse himself or herself from serving on the Grievance Committee due to a conflict of interest. A grievance regarding the TD may be submitted directly to the Director of Psychological Services for review and resolution in consultation with the Grievance Committee. Trainees must exercise good faith in processing complaints and cooperate in any investigation. The trainee submitting the complaint will be encouraged to provide relevant information including documents, names of witnesses, etc. A trainee does not have the right to have an attorney or other outside individual (non-employee) present during the internal investigation or during a grievance meeting. Some grievances may extend outside of the scope of the Division of Psychological Services and may require procedures governed by Human Resources policy and involve report to managers other than psychology training staff. The TD will consult with the department of Human Resources as needed to determine whether other procedures pertain and to maintain consistency with institutional policies to the extent possible. The health system will not tolerate any form of coercion or retaliation against a trainee who processes a complaint under this policy, or who cooperates with an investigation. This policy and its procedures should not, however, be construed as preventing, limiting or delaying the health system from taking disciplinary action against any individual in circumstances where such action is deemed appropriate.

Any findings resulting from a review of a grievance that involves prohibited conduct as described in the Health System Human Resources Policies and Procedure manual (Title: Conduct in the Workplace/ Progressive Discipline, Part V, Section 3), will be submitted to the Director of Psychological Services for appropriate personnel action.

Psychological Services

The Zucker Hillside Hospital Long Island Jewish Medical Center

Northwell Health

PSYCHOLOGY TRAINEE DUE PROCESS PROCEDURE Trainees are evaluated informally within their first three months and formally before the six-month and twelve-month points of the training year as well as on an ongoing basis. (The term “trainee” in this document includes psychology externs, psychology interns and postdoctoral psychology fellows.) The training program aims to develop professional competence. Conceivably, trainees could be seen as lacking the competence for eventual professional practice due to a serious deficit in skill or knowledge, or due to problematic behaviors that significantly impact their professional functioning. In such cases, the training program will help trainees identify these areas and provide remedial experiences or recommended resources in an effort to improve the trainees’ performance to a satisfactory degree. The problem identified may be of sufficient seriousness that the trainee would not get credit for the training program unless that problem was remedied. Training Review Committee Should this become a concern either due to the seriousness of the problem or its persistence despite repeated local feedback and assistance, the problem must be brought to the attention of the Training Director (TD) by the program or track leader at the earliest opportunity in order to allow the maximum time for more thoughtful remedial efforts. The TD will inform the trainee of staff concern, and convene a meeting of the Training Review Committee within ten business days of being notified of the problem. (If the trainee is an extern or intern, the TD will also apprise the training director of the trainee’s graduate program or his/her designee who will be invited to join the Training Review Committee.) The TD will consult with the department of Human Resources as needed to determine whether other actions are required and to maintain consistency with institutional policies to the extent possible. The Training Review Committee will consist of the trainee’s current and past supervisors, the leaders of his or her program or section and an unrelated member of the training faculty. The trainee will be notified of the date of the Committee’s review and will be given the opportunity to provide the Committee with any information regarding the questionable performance or behavior. The review shall not be considered a formal hearing and therefore shall not be subject to any formal rules of evidence or procedure. The introduction of any relevant information, including witnesses, shall be determined by the Training Director. Decision of the Training Review Committee If the Training Review Committee determines that the deficit or problem is serious enough that it could prevent the trainee from fulfilling the exit criteria, and

thereby prevent him or her from receiving credit for the training program, the trainee will be placed on probationary status by the Training Review Committee. If a trainee on probationary status fails to achieve stated goals within a specified time frame (which will be based on learning and performance needs) he/she will be dismissed from the program. Probation and Remediation

a. The trainee, the trainee's supervisor(s), the track Director or Coordinator, the TD, and the Training Review Committee will produce a remediation plan specifying the kinds of knowledge, skills and/or behavior that are necessary for the trainee to develop or remediate in order to remedy the identified problem. The Training Review Committee may require the trainee to participate in particular learning experiences or may issue guidelines for the type of experiences the trainee should undertake in order to remedy such a deficit. The plan will stipulate the duration of probationary status as well as the frequency and nature of supervisory meetings during that time. The members of the Training Review Committee will sign this plan; the trainee will either sign the plan or it will be noted that (s)he declined to do so. A copy of the plan will be placed in the trainee’s file along with a summary of the proceedings. If and when the problems have been resolved with no adverse action, the probation and remediation process will not be reported externally except if otherwise directed by the Department of Human Resources or the Office of Legal Affairs. In the case of an extern or intern, a copy of the remediation plan will be forwarded to the clinical training director of the trainee’s graduate program or his/her designee. If applicable as per contractual agreement, the training program will also notify and consult with Association of Psychology Postdoctoral and Internship Centers (APPIC). (See the standardized remediation plan template which follows this document.)

b. The trainee and the supervisor will report to the Training Review

Committee on a regular basis, as specified in the plan (but not less than every two months) regarding the trainee's progress. The TD may elect to convene a meeting of the Training Review Committee before the end of the probationary period.

c. The trainee may be removed from probationary status by a

determination of the Training Review Committee when the trainee's progress in resolving the problem(s) specified in the plan is sufficient. Removal from probationary status indicates that the trainee's performance is at the appropriate level to receive credit for the training program.

Actions Following Probation a. Termination: If a trainee on probation fails to make progress, or, if it

becomes apparent that it will not be possible for the trainee to receive credit for the training program (even if this precedes the end of probation), as per the determination of the Training Review Committee, the TD will so inform the trainee in writing at the earliest opportunity and (unless there is cause for more immediate action – see below) the trainee will be terminated from the program. Termination from the training program will coincide with termination of the trainee’s employee status with the Health System. (In the case of an extern or intern, the doctoral program director will be notified in writing of every decision regarding the trainee’s status.) If applicable as per contractual agreement, the training program will also notify the Association of Psychology Postdoctoral and Internship Centers (APPIC) and request release from the obligations of the national internship match. If a Trainee is dismissed before the completion of his/her academic year, the TD will determine the number of months of credit to be given the trainee for that academic year. Denial of credit may be required to be reported to future training programs, employers or licensing and administrative agencies.

b. Continued Probation: At the conclusion of the stipulated time frame or earlier if so determined by the Training Review Committee, if a trainee has met the requirements set forth by the remediation plan or has made progress deemed sufficient by the Committee, the trainee may then be monitored during a time-limited period (up to 3 months or as determined by the TD) of enhanced supervision. The TD will provide the trainee with written notice of this decision. During this period the probation is continued with further support. In this case, a revised plan will be written for this period which will be placed in the trainee’s file (and in the case of an extern or intern, forwarded to the director of his/her doctoral program). During this maintenance period, the trainee will continue to meet with supervisors and to follow the recommended goals for the new plan.

c. Reinstatement: The Training Review Committee may elect to reinstate the trainee to regular status at the satisfaction conclusion of probation. The reinstatement will be communicated to the trainee in writing and does not preclude future actions if problems arise.

Appeal: A trainee may appeal the Training Committee's decision to the Director of Psychological Services within ten business days of being terminated or of any disciplinary action taken. At the time the trainee is notified of the above outcome, the trainee will be notified of his/her right to appeal these actions. The appeal request must be in writing and shall include all information the trainee would like taken into consideration in evaluating his/her appeal as well as the trainee's

justification for the appeal. The Director shall determine the need for any additional documents or testimony from the parties.

Within ten business days from the initiation of the appeal, the Director of Psychological Services will review the appeal and render the appeal decision, which will be communicated in writing to all involved parties (including the doctoral program director if applicable), and to the Training Review Committee. Should the Director be recused from deliberation due to a conflict of interest, the Associate Chairman of the Psychiatry Department (or designee) will render the appeal decision. The Director may accept, reject or modify the action taken, or take any other action that the he deems appropriate under the circumstances. The decision of the Director will be final and binding upon all parties.

Prohibited Conduct: Prohibited conduct by a trainee should be brought to the attention of the TD in writing. Any person who observes such behavior, whether staff or trainee, has the responsibility to report the incident. Prohibited conduct is described in the Policy and Procedure Manual (Title: Conduct in the Workplace/ Progressive Discipline, Part V, Section 3) and includes but is not limited to:

• Incompetence and/or misconduct, including professional misconduct

• Insubordination

• Possession of a weapon on health system property

• Illegal use of drugs,

• Stealing, fighting, gambling or possession of gambling devices

• Abandonment of position

• Excessive tardiness and/or absenteeism

• Falsification of time record

• Sexual harassment and/or any other unlawful harassment or discrimination

• Inappropriate use of the Internet and electronic mail

• Violation of the health system’s Codes of Professional and Ethical Conduct

• The TD, the supervisor, and the trainee may address infractions of a very

minor nature. A written record of the complaint and action become a permanent part of the trainee's training file.

• Any significant infraction or repeated minor infractions must be documented in

writing and submitted to the TD, who will notify the trainee of the complaint.

Per the procedures described above, the TD will call a meeting of the Training Review Committee to review the concerns, after providing notification to all involved parties. All involved parties will be encouraged to submit any relevant information that bears on the issue, and, if deemed suitable by the Committee, invited to attend the Training Review Committee meeting(s).

• In the case of prohibited conduct in the performance of patient care duties,

the TD may seek advisement from appropriate Health System resources in compliance with system policies, including Risk Management, Human Resources and/or Legal Counsel. If warranted, the trainee may be placed on administrative paid leave pending the results of an investigation and will receive written notification of this leave as soon as is practicable. Such leave is not considered an adverse action and is not subject to hearing or appeal.

• Following a careful review of the case, the Training Review Committee may

recommend no action, probation or dismissal of the trainee. Dismissal would reflect the determination by the Training Review Committee that the trainee’s conduct is not subject to remediation. If a probationary period is recommended it shall include the same procedures described above. A violation of the probationary agreement could necessitate the dismissal of the trainee's appointment at NSLIJHS. Dismissal (whether after unsuccessful remediation efforts or upon determination that the trainee’s conduct is not subject to remediation) may be appealed in accordance with the procedure given above.

Division of Psychological Services, Department of Psychiatry Long Island Jewish Medical Center

The Zucker Hillside Hospital

Extended Training Policy

1. Successful completion of the psychology externship, internship or fellowship

requires a year long, full-time training experience. It is recognized that on occasion a psychology trainee may not be able to complete this requirement during the 12 consecutive months because of medical problems or for extraordinary personal reasons. Given that trainees are accepted for one year only, extended leave1

therefore could jeopardize successful completion of training requirements.

2. At the discretion of the Psychology Education and Training Committee in conjunction with the Department of Psychiatry, a trainee who has not completed a year’s worth of training activity because of medical disability or extraordinary personal circumstances may be given the opportunity to complete training via an additional training period.

3. A request for extended training must be made in writing to the Director of

Psychology Training and can be submitted at any point in advance of the expected leave but no later than one week upon returning from leave. The Education and Training Committee and The Director of Psychological Services (or a designee) will review the request and made a determination as to whether extended training will be offered. The decision will take into consideration the reasons for the request for extended training and the availability of staff and other existing resources to support extended training.

4. If extended training is granted, it must be completed within one year following the

originally scheduled end of the training.

1 The Education and Training Committee will determine the exact amount of time that constitutes “extended leave” which would jeopardize successful completion of the training taking into account the trainee’s performance, pattern of attendance, training needs as well as regional licensure requirements if applicable.

Guides to Be Distributed Electronically

• APA Division 53 Child Residency Curriculum Summary

• APA Ethical Principles of Psychologists and Code of

Conduct including Amendments in 2010 and 2016

• Guidelines for Psychotherapy with Lesbian, Gay, and

Bisexual Clients

• Guidelines for Psychological Practice with Transgender and

Gender Nonconforming People

• Guidelines on Multicultural Education, Training, Research,

Practice, and Organizational Change for Psychologists

• Enhancing Your Interactions with People with Disabilities

• Guidelines for Psychological Practice With Older Adults

• Pike’s Peak Evaluation Tool

• Foundational Knowledge Competencies in Professional

Geropsychology

Clin

ical

Psy

chol

ogy

Post

doct

oral

Fel

low

ship

Pro

gram

with

Em

phas

is in

Ger

opsy

chol

ogy

Nam

e of

Tra

inee

:

Nam

e of

Sup

ervi

sor:

Tr

aini

ng Y

ear:

Date

of C

ompe

tenc

y Ev

alua

tion:

ASS

ESSM

ENT

MET

HO

D(S

) FO

R C

OM

PETE

NC

IES

__

___

Dire

ct O

bser

vatio

n

__

___

Rev

iew

of W

ritte

n W

ork

__

___

Vid

eota

pe

____

_ R

evie

w o

f Raw

Tes

t Dat

a __

___

Aud

iota

pe

____

_ D

iscu

ssio

n of

Clin

ical

Inte

ract

ion

____

_ C

ase

Pres

enta

tion

__

___

Com

men

ts fr

om O

ther

Sta

ff

For e

ach

com

pete

ncy

elem

ent,

plea

se u

se th

e sc

ale

belo

w to

indi

cate

how

char

acte

ristic

this

ele

men

t des

crip

tion

is o

f the

trai

nee’

s beh

avio

r.

Inte

rmed

iate

or

belo

w

High

Inte

rmed

iate

Co

mpe

tent

Ad

vanc

ed

Expe

rt

1 2

3 4

5

LEVE

L Co

mpe

tenc

y El

emen

ts

Out

com

e Ra

ting

LEVE

L 1:

Ad

vanc

ed

Com

pete

ncie

s (R

EQU

IRED

for

ALL

Post

doct

oral

Re

side

ncy

Prog

ram

s)

Ethi

cal a

nd L

egal

St

anda

rds

• (fr

om IR

C-9

P) B

e kn

owle

dgea

ble

of a

nd a

ct in

acc

orda

nce

with

eac

h of

the

follo

win

g:

o

the

curr

ent v

ersio

n of

the

APA

Ethi

cal P

rinci

ples

of P

sych

olog

ists a

nd

Code

of C

ondu

ct;

o

Rele

vant

law

s, re

gula

tions

, rul

es, a

nd p

olic

ies g

over

ning

hea

lth

serv

ice

psyc

holo

gy a

t the

org

aniza

tiona

l, lo

cal,

stat

e, re

gion

al, a

nd

fede

ral l

evel

s; a

nd

o

Rele

vant

pro

fess

iona

l sta

ndar

ds a

nd g

uide

lines

.

1 2

3 4

5

• (fr

om IR

C-9

P) R

ecog

nize

eth

ical

dile

mm

as a

s the

y ar

ise, a

nd a

pply

eth

ical

de

cisio

n-m

akin

g pr

oces

ses i

n or

der t

o re

solv

e th

e di

lem

mas

. 1

2 3

4 5

•

(from

IR C

-9 P

) Con

duct

self

in a

n et

hica

l man

ner i

n al

l pro

fess

iona

l act

iviti

es.

1 2

3 4

5

• Fe

llow

s will

spon

tane

ously

and

con

siste

ntly

iden

tify

ethi

cal a

nd le

gal i

ssue

s and

ad

dres

s the

m p

roac

tivel

y. D

emon

stra

te p

rofe

ssio

nal i

nter

actio

ns w

ith

trea

tmen

t tea

ms,

peer

s and

supe

rviso

rs, a

nd w

ill se

ek p

eer s

uppo

rt a

s nee

ded.

1 2

3 4

5

• De

mon

stra

te p

ositi

ve c

opin

g st

rate

gies

with

rega

rd to

per

sona

l and

pr

ofes

siona

l str

esso

rs a

nd c

halle

nges

. Fel

low

s will

mai

ntai

n pr

ofes

siona

l fu

nctio

ning

and

pro

vide

qua

lity

patie

nt c

are.

1 2

3 4

5

• Fe

llow

s will

be

resp

onsib

le fo

r key

pat

ient

car

e ta

sks a

nd w

ill c

ompl

ete

task

s pr

ompt

ly.

1

2 3

4 5

LEV E

L Co

mpe

tenc

y El

emen

ts

Out

com

e Ra

ting

Indi

vidu

al a

nd

cultu

ral d

iver

sity

• (fr

om IR

C-9

P) A

n un

ders

tand

ing

of h

ow th

eir o

wn

pers

onal

/cul

tura

l hist

ory,

at

titud

es, a

nd b

iase

s may

affe

ct h

ow th

ey u

nder

stan

d an

d in

tera

ct w

ith p

eopl

e di

ffere

nt fr

om th

emse

lves

. 1

2 3

4 5

• (fr

om IR

C-9

P) K

now

ledg

e of

the

curr

ent t

heor

etic

al a

nd e

mpi

rical

kno

wle

dge

base

as i

t rel

ates

to a

ddre

ssin

g di

vers

ity in

all

prof

essio

nal a

ctiv

ities

incl

udin

g re

sear

ch, t

rain

ing,

supe

rvisi

on/c

onsu

ltatio

n, a

nd se

rvic

e.

1 2

3 4

5

• (fr

om IR

C-9

P) T

he a

bilit

y to

inte

grat

e aw

aren

ess a

nd k

now

ledg

e of

indi

vidu

al

and

cultu

ral d

iffer

ence

s in

the

cond

uct o

f pro

fess

iona

l rol

es (e

.g.,

rese

arch

, se

rvic

es, a

nd o

ther

pro

fess

iona

l act

iviti

es).

This

incl

udes

the

abili

ty a

pply

a

fram

ewor

k fo

r wor

king

effe

ctiv

ely

with

are

as o

f ind

ivid

ual a

nd c

ultu

ral d

iver

sity

not p

revi

ously

enc

ount

ered

ove

r the

cou

rse

of th

eir c

aree

rs. A

lso in

clud

ed is

th

e ab

ility

to w

ork

effe

ctiv

ely

with

indi

vidu

als w

hose

gro

up m

embe

rshi

p,

dem

ogra

phic

cha

ract

erist

ics, o

r wor

ldvi

ews c

reat

e co

nflic

t with

thei

r ow

n.

1 2

3 4

5

• (fr

om IR

C-9

P) D

emon

stra

te th

e ab

ility

to in

depe

nden

tly a

pply

thei

r kno

wle

dge

and

dem

onst

rate

effe

ctiv

enes

s in

wor

king

with

the

rang

e of

div

erse

indi

vidu

als

and

grou

ps e

ncou

nter

ed d

urin

g re

siden

cy, t

ailo

red

to th

e le

arni

ng n

eeds

and

op

port

uniti

es c

onsis

tent

with

the

prog

ram

’s a

im(s

).

1 2

3 4

5

• In

add

ition

to th

e ab

ove

prog

ram

-wid

e el

emen

ts, f

ello

ws w

ill b

e co

mm

itted

to

prov

idin

g cu

ltura

lly se

nsiti

ve se

rvic

es e

spec

ially

with

rega

rd to

att

itude

s abo

ut

age.

1

2 3

4 5

Inte

grat

ion

of

scie

nce

and

prac

tice

• Pr

ofic

ienc

y in

the

rese

arch

bas

e fo

r int

erve

ntio

ns a

nd a

sses

smen

ts re

leva

nt to

Cl

inic

al P

sych

olog

y w

ith e

mph

asis

in G

erop

sych

olog

y.

1 2

3 4

5

• U

nder

stan

d ho

w p

ract

ice

info

rms a

nd sh

apes

scie

nce,

and

obt

ain

fam

iliar

ity

with

the

activ

ity o

f pro

fess

iona

l org

aniza

tions

rele

vant

to C

linic

al P

sych

olog

y w

ith e

mph

asis

in G

erop

sych

olog

y.

1 2

3 4

5

• In

depe

nden

tly se

ek o

ut in

form

atio

n to

enh

ance

clin

ical

pra

ctic

e ut

ilizin

g av

aila

ble

data

base

s, pr

ofes

siona

l lite

ratu

re, s

emin

ars a

nd tr

aini

ng se

ssio

ns, a

nd

othe

r res

ourc

es.

1 2

3 4

5

LEV E

L Co

mpe

tenc

y El

emen

ts

Out

com

e Ra

ting

Leve

l 2:

Prog

ram

-Sp

ecifi

c/Ar

ea o

f Fo

cus

Com

pete

ncie

s;

adva

nced

co

mpe

tenc

ies

rele

vant

to th

e pr

ogra

m’s

aim

s or

are

a of

focu

s.

Adva

nced

Co

mpe

tenc

y in

th

e Ro

le o

f a

Clin

ical

Ps

ycho

logi

st

with

Em

phas

is in

G

erop

sych

olog

y

• Fe

llow

s will

evi

denc

e kn

owle

dge

of p

rofe

ssio

nal i

ssue

s and

rele

vant

co

ntem

pora

ry re

sear

ch in

the

area

of C

linic

al P

sych

olog

y w

ith e

mph

asis

in

Gero

psyc

holo

gy.

1 2

3 4

5

• Fe

llow

s will

acq

uire

fam

iliar

ity w

ith th

e bi

olog

ical

, psy

chol

ogic

al, c

ultu

ral,

and

soci

al c

onte

nt a

nd c

onte

xts a

ssoc

iate

d w

ith n

orm

al a

ging

as p

art o

f the

ir kn

owle

dge

base

for w

orki

ng c

linic

ally

with

old

er a

dults

.

1 2

3 4

5

• Fe

llow

s will

be

info

rmed

abo

ut b

iolo

gica

l and

cog

nitiv

e ch

ange

s tha

t ac

com

pany

agi

ng a

nd a

bout

psy

chop

atho

logy

in th

e ag

ing

popu

latio

n.

1 2

3 4

5

Adva

nced

Co

mpe

tenc

y in

th

e As

sess

men

t an

d Tr

eatm

ent

of O

lder

Adu

lts

• Ab

ility

to in

depe

nden

tly se

lect

, ada

pt a

nd c

ondu

ct in

divi

dual

psy

chot

hera

py

and

cons

ulta

tion

with

old

er a

dults

in p

sych

iatr

ic tr

eatm

ent s

ettin

gs u

sing

at

leas

t tw

o m

ajor

em

piric

ally

-sup

port

ed a

ppro

ache

s.

1 2

3 4

5

• Fe

llow

s will

inde

pend

ently

und

erst

and

the

stre

ngth

s and

lim

itatio

ns o

f di

agno

stic

app

roac

hes a

nd in

terp

reta

tion

of re

sults

from

mul

tiple

mea

sure

s for

di

agno

sis a

nd tr

eatm

ent p

lann

ing.

1 2

3 4

5

• Fe

llow

s will

util

ize c

ase

form

ulat

ion

and

diag

nosis

for i

nter

vent

ion

plan

ning

in

the

cont

ext o

f sta

ges o

f hum

an d

evel

opm

ent a

nd d

iver

sity.

1

2 3

4 5

Com

pete

ncy

in

Supe

rvis

ion

and

Teac

hing

• Fe

llow

s will

dem

onst

rate

wor

king

kno

wle

dge

of th

eorie

s of s

uper

visio

n,

fam

iliar

ity w

ith th

e AP

A Su

perv

ision

Gui

delin

es a

s wel

l as s

kills

in m

anag

ing

boun

darie

s, p

rovi

ding

feed

back

and

disc

losu

re a

s evi

denc

ed b

y su

perv

isory

and

se

min

ar d

iscus

sions

.

1 2

3 4

5

SUPE

RVIS

OR

COM

MEN

TS:

SU

MM

ARY

OF

STRE

NGT

HS:

AR

EAS

OF

ADDI

TIO

NAL

DEV

ELO

PMEN

T O

R RE

MED

IATI

ON

, INCL

UDIN

G RE

COM

MEN

DATI

ON

S: RE

MED

IAL

WO

RK IN

STRU

CTIO

NS

In th

e ra

re si

tuat

ion

whe

n it

is re

cogn

ized

that

a tr

aine

e ne

eds r

emed

ial w

ork,

a c

ompe

tenc

y as

sess

men

t for

m sh

ould

be

fille

d ou

t im

med

iate

ly, p

rior t

o an

y de

adlin

e da

te fo

r ev

alua

tion,

and

shar

ed w

ith th

e tr

aine

e an

d th

e di

rect

or o

f tra

inin

g.

In o

rder

to a

llow

the

trai

nee

to g

ain

com

pete

ncy

and

mee

t pas

sing

crite

ria fo

r the

rota

tion,

thes

e ar

eas m

ust

be a

ddre

ssed

pro

activ

ely

and

a re

med

ial p

lan

need

s to

be d

evise

d an

d im

plem

ente

d pr

ompt

ly.

C ON

CLU

SIO

NS

GO

AL F

OR

FELL

OW

EVA

LUAT

ION

S DO

NE

AT 6

MO

NTH

S G

OAL

FO

R FE

LLO

W E

VALU

ATIO

NS

DON

E AT

12

MO

NTH

S Al

l com

pete

ncy

area

s will

be

rate

d at

a le

vel 3

or h

ighe

r. Al

l com

pete

ncy

area

s will

be

rate

d at

leve

l of 4

or h

ighe

r. �

The

trai

nee

HAS

succ

essf

ully

com

plet

ed th

e ab

ove

goal

. W

e ha

ve re

view

ed th

is ev

alua

tion

toge

ther

. �

The

trai

nee

HAS

NO

T su

cces

sful

ly c

ompl

eted

the

abov

e go

al.

We

have

mad

e a

join

t writ

ten

rem

edia

l pla

n as

att

ache

d, w

ith sp

ecifi

c da

tes i

ndic

ated

for

com

plet

ion.

Onc

e co

mpl

eted

, the

rota

tion

will

be

re-e

valu

ated

usin

g an

othe

r eva

luat

ion

form

, or o

n th

is fo

rm, c

lear

ly m

arke

d w

ith a

diff

eren

t col

or in

k. W

e ha

ve re

view

ed th

is ev

alua

tion

toge

ther

. Su

perv

isor _

____

____

____

____

____

____

____

___

Date

___

____

____

TRAI

NEE

CO

MM

ENTS

REG

ARDI

NG

COM

PETE

NCY

EVA

LUAT

ION

(IF

ANY)

: I h

ave

rece

ived

a fu

ll ex

plan

atio

n of

this

eval

uatio

n. I

und

erst

and

that

my

signa

ture

doe

s not

nec

essa

rily

indi

cate

my

agre

emen

t. Tr

aine

e __

____

____

____

____

____

____

____

____

__

Date

___

____

____

Clin

ical

Chi

ld P

sych

olog

y Po

stdo

ctor

al F

ello

wsh

ip P

rogr

am

N

ame

of T

rain

ee:

N

ame

of S

uper

viso

r:

Trai

ning

Yea

r:

A

SSES

SMEN

T M

ETH

OD

(S) F

OR

CO

MPE

TEN

CIE

S

____

_ D

irect

Obs

erva

tion

____

_ R

evie

w o

f Writ

ten

Wor

k

____

_ V

ideo

tape

__

___

Rev

iew

of R

aw T

est D

ata

____

_ A

udio

tape

__

___

Dis

cuss

ion

of C

linic

al In

tera

ctio

n __

___

Cas

e Pr

esen

tatio

n

____

_ C

omm

ents

from

Oth

er S

taff

Fo

r eac

h co

mpe

tenc

y el

emen

t, pl

ease

use

the

scal

e be

low

to in

dica

te th

e tr

aine

e’s l

evel

of c

ompe

tenc

y.

In

term

edia

te o

r Bel

ow

High

Inte

rmed

iate

Co

mpe

tent

A

Expe

rt

1 2

3 4

5

LEVE

L Co

mpe

tenc

y El

emen

ts

Out

com

e Ra

ting

LEVE

L 1:

Ad

vanc

ed

Com

pete

ncie

s (R

EQU

IRED

for

ALL

Post

doct

oral

Re

side

ncy

Prog

ram

s)

Ethi

cal a

nd L

egal

St

anda

rds

• (fr

om IR

C-9

P) B

e kn

owle

dgea

ble

of a

nd a

ct in

acc

orda

nce

with

eac

h of

the

follo

win

g:

o

the

curr

ent v

ersio

n of

the

APA

Ethi

cal P

rinci

ples

of P

sych

olog

ists a

nd

Code

of C

ondu

ct;

o

Rele

vant

law

s, re

gula

tions

, rul

es, a

nd p

olic

ies g

over

ning

hea

lth

serv

ice

psyc

holo

gy a

t the

org

aniza

tiona

l, lo

cal,

stat

e, re

gion

al, a

nd

fede

ral l

evel

s; a

nd

o

Rele

vant

pro

fess

iona

l sta

ndar

ds a

nd g

uide

lines

.

1 2

3 4

5

• (fr

om IR

C-9

P) R

ecog

nize

eth

ical

dile

mm

as a

s the

y ar

ise, a

nd a

pply

eth

ical

de

cisio

n-m

akin

g pr

oces

ses i

n or

der t

o re

solv

e th

e di

lem

mas

. 1

2 3

4 5

•

(from

IR C

-9 P

) Con

duct

self

in a

n et

hica

l man

ner i

n al

l pro

fess

iona

l act

iviti

es.

1 2

3 4

5

• Fe

llow

s will

spon

tane

ously

and

con

siste

ntly

iden

tify

ethi

cal a

nd le

gal i

ssue

s and

ad

dres

s the

m p

roac

tivel

y. D

emon

stra

te p

rofe

ssio

nal i

nter

actio

ns w

ith

trea

tmen

t tea

ms,

peer

s and

supe

rviso

rs, a

nd w

ill se

ek p

eer s

uppo

rt a

s nee

ded.

1 2

3 4

5

• De

mon

stra

te p

ositi

ve c

opin

g st

rate

gies

with

rega

rd to

per

sona

l and

pr

ofes

siona

l str

esso

rs a

nd c

halle

nges

. Fel

low

s will

mai

ntai

n pr

ofes

siona

l fu

nctio

ning

and

pro

vide

qua

lity

patie

nt c

are.

1 2

3 4

5

• Fe

llow

s will

be

resp

onsib

le fo

r key

pat

ient

car

e ta

sks a

nd w

ill c

ompl

ete

task

s pr

ompt

ly.

1

2 3

4 5

LEV E

L Co

mpe

tenc

y El

emen

ts

Out

com

e Ra

ting

Indi

vidu

al a

nd

cultu

ral d

iver

sity

• (fr

om IR

C-9

P) A

n un

ders

tand

ing

of h

ow th

eir o

wn

pers

onal

/cul

tura

l hist

ory,

at

titud

es, a

nd b

iase

s may

affe

ct h

ow th

ey u

nder

stan

d an

d in

tera

ct w

ith p

eopl

e di

ffere

nt fr

om th

emse

lves

. 1

2 3

4 5

• (fr

om IR

C-9

P) K

now

ledg

e of

the

curr

ent t

heor

etic

al a

nd e

mpi

rical

kno

wle

dge

base

as i

t rel

ates

to a

ddre

ssin

g di

vers

ity in

all

prof

essio

nal a

ctiv

ities

incl

udin

g re

sear

ch, t

rain

ing,

supe

rvisi

on/c

onsu

ltatio

n, a

nd se

rvic

e.

1 2

3 4

5

• (fr

om IR

C-9

P) T

he a

bilit

y to

inte

grat

e aw

aren

ess a

nd k

now

ledg

e of

indi

vidu

al

and

cultu

ral d

iffer

ence

s in

the

cond

uct o

f pro

fess

iona

l rol

es (e

.g.,

rese

arch

, se

rvic

es, a

nd o

ther

pro

fess

iona

l act

iviti

es).

This

incl

udes

the

abili

ty a

pply

a

fram

ewor

k fo

r wor

king

effe

ctiv

ely

with

are

as o

f ind

ivid

ual a

nd c

ultu

ral d

iver

sity

not p

revi

ously

enc

ount

ered

ove

r the

cou

rse

of th

eir c

aree

rs. A

lso in

clud

ed is

th

e ab

ility

to w

ork

effe

ctiv

ely

with

indi

vidu

als w

hose

gro

up m

embe

rshi

p,

dem

ogra

phic

cha

ract

erist

ics, o

r wor

ldvi

ews c

reat

e co

nflic

t with

thei

r ow

n.

1 2

3 4

5

• (fr

om IR

C-9

P) D

emon

stra

te th

e ab

ility

to in

depe

nden

tly a

pply

thei

r kno

wle

dge

and

dem

onst

rate

effe

ctiv

enes

s in

wor

king

with

the

rang

e of

div

erse

indi

vidu

als

and

grou

ps e

ncou

nter

ed d

urin

g re

siden

cy, t

ailo

red

to th

e le

arni

ng n

eeds

and

op

port

uniti

es c

onsis

tent

with

the

prog

ram

’s a

im(s

).

1 2

3 4

5

• In

add

ition

to th

e ab

ove

prog

ram

-wid

e el

emen

ts, f

ello

ws w

ill b

e co

mm

itted

to

prov

idin

g cu

ltura

lly se

nsiti

ve se

rvic

es e

spec

ially

with

rega

rd to

dev

elop

men

tal

issue

s.

1 2

3 4

5

Inte

grat

ion

of

scie

nce

and

prac

tice

• Pr

ofic

ienc

y in

the

rese

arch

bas

e fo

r int

erve

ntio

ns a

nd a

sses

smen

ts re

leva

nt to

Cl

inic

al C

hild

Psy

chol

ogy.

1

2 3

4 5

• U

nder

stan

d ho

w p

ract

ice

info

rms a

nd sh

apes

scie

nce,

and

obt

ain

fam

iliar

ity

with

the

activ

ity o

f pro

fess

iona

l org

aniza

tions

rele

vant

to C

linic

al C

hild

Ps

ycho

logy

.

1 2

3 4

5

• In

depe

nden

tly se

ek o

ut in

form

atio

n to

enh

ance

clin

ical

pra

ctic

e ut

ilizin

g av

aila

ble

data

base

s, pr

ofes

siona

l lite

ratu

re, s

emin

ars a

nd tr

aini

ng se

ssio

ns, a

nd

othe

r res

ourc

es.

1 2

3 4

5

Leve

l 2:

Prog

ram

-Sp

ecifi

c/Ar

ea o

f

Com

pete

ncy

in

Supe

rvis

ion

and

Teac

hing

• Fe

llow

s will

dem

onst

rate

wor

king

kno

wle

dge

of th

eorie

s of s

uper

visio

n,

fam

iliar

ity w

ith th

e AP

A Su

perv

ision

Gui

delin

es a

s wel

l as s

kills

in m

anag

ing

1 2

3 4

5

1 2

3 4

5

LEV E

L Co

mpe

tenc

y El

emen

ts

Out

com

e Ra

ting

Focu

s Co

mpe

tenc

ies;

ad

vanc

ed

com

pete

ncie

s re

leva

nt to

the

prog

ram

’s ai

ms

or a

rea

of fo

cus.

boun

darie

s, p

rovi

ding

feed

back

and

disc

losu

re a

s evi

denc

ed b

y su

perv

isory

and

se

min

ar d

iscus

sions

.

Leve

l 3:

Spec

ialty

Co

mpe

tenc

ies

Adva

nced

Co

mpe

tenc

y in

th

e Ro

le o

f Cl

inic

al C

hild

Ps

ycho

logi

st

• Kn

owle

dge

of c

hild

dev

elop

men

t, fa

mily

pro

cess

es, c

hild

and

ado

lesc

ent

psyc

hopa

thol

ogy,

dev

elop

men

tal p

sych

opat

holo

gy, a

cade

mic

& in

telle

ctua

l fu

nctio

ning

/lear

ning

disa

bilit

ies,

and

bio

-psy

chos

ocia

l asp

ects

of d

evel

opm

ent.

1 2

3 4

5

• Kn

owle

dge

of sy

stem

s ser

ving

chi

ldre

n an

d fa

mili

es.

1

2 3

4 5

Adva

nced

Co

mpe

tenc

y in

th

e Ev

alua

tion,

Co

nsul

tatio

n,

and

Prac

tice

of

Clin

ical

Chi

ld

Psyc

holo

gy

• Kn

owle

dge

of e

mpi

rical

ly su

ppor

ted

asse

ssm

ent,

trea

tmen

ts, a

nd a

ppro

pria

te

trea

tmen

t mat

chin

g fo

r chi

ldre

n an

d ad

oles

cent

s.

1 2

3 4

5

• Ad

vanc

ed sk

ills i

n th

e as

sess

men

t of c

hild

ren

and

adol

esce

nts.

1

2 3

4 5

• Ad

vanc

ed sk

ills i

n th

e tr

eatm

ent o

f chi

ldre

n an

d ad

oles

cent

s 1

2 3

4 5

• Ad

vanc

ed sk

ills i

n co

nsul

tatio

n to

a w

ide

varie

ty o

f men

tal h

ealth

and

non

-m

enta

l hea

lth p

rofe

ssio

nal s

taff.

1

2 3

4 5

SUPE

RVIS

OR

COM

MEN

TS:

SU

MM

ARY

OF

STRE

NGT

HS:

AREA

S O

F AD

DITI

ON

AL D

EVEL

OPM

ENT

OR

REM

EDIA

TIO

N, IN

CLUD

ING

RECO

MM

ENDA

TIO

NS:

REM

EDIA

L W

ORK

INST

RUCT

ION

S In

the

rare

situ

atio

n w

hen

it is

reco

gnize

d th

at a

trai

nee

need

s rem

edia

l wor

k, a

com

pete

ncy

asse

ssm

ent f

orm

shou

ld b

e fil

led

out i

mm

edia

tely

, prio

r to

any

dead

line

date

for

eval

uatio

n, a

nd sh

ared

with

the

trai

nee

and

the

dire

ctor

of t

rain

ing.

In

ord

er to

allo

w th

e tr

aine

e to

gai

n co

mpe

tenc

y an

d m

eet p

assin

g cr

iteria

for t

he ro

tatio

n, th

ese

area

s mus

t be

add

ress

ed p

roac

tivel

y an

d a

rem

edia

l pla

n ne

eds t

o be

dev

ised

and

impl

emen

ted

prom

ptly

.

CON

CLU

SIO

NS

GO

AL F

OR

FELL

OW

EVA

LUAT

ION

S DO

NE

AT 6

MO

NTH

S G

OAL

FO

R FE

LLO

W E

VALU

ATIO

NS

DON

E AT

12

MO

NTH

S Al

l com

pete

ncy

area

s will

be

rate

d at

a le

vel o

f 3 o

r hig

her.

All c

ompe

tenc

y ar

eas w

ill b

e ra

ted

at le

vel o

f 4 o

r hig

her.

� T

he tr

aine

e HA

S su

cces

sful

ly c

ompl

eted

the

abov

e go

al.

We

have

revi

ewed

this

eval

uatio

n to

geth

er.

� T

he tr

aine

e HA

S N

OT

succ

essf

ully

com

plet

ed th

e ab

ove

goal

. W

e ha

ve m

ade

a jo

int w

ritte

n re

med

ial p

lan

as a

ttac

hed,

with

spec

ific

date

s ind

icat

ed fo

r co

mpl

etio

n. O

nce

com

plet

ed, t

he ro

tatio

n w

ill b

e re

-eva

luat

ed u

sing

anot

her e

valu

atio

n fo

rm, o

r on

this

form

, cle

arly

mar

ked

with

a d

iffer

ent c

olor

ink.

We

have

revi

ewed

this

eval

uatio

n to

geth

er.

Supe

rviso

r ___

____

____

____

____

____

____

____

_

Da

te _

____

____

__

T RAI

NEE

CO

MM

ENTS

REG

ARDI

NG

COM

PETE

NCY

EVA

LUAT

ION

(IF

ANY)

: I h

ave

rece

ived

a fu

ll ex

plan

atio

n of

this

eval

uatio

n. I

und

erst

and

that

my

signa

ture

doe

s not

nec

essa

rily

indi

cate

my

agre

emen

t. Tr

aine

e __

____

____

____

____

____

____

____

____

__

Date

___

____

____

REQUEST FOR PAID TIME-OFF

PURPOSE: The “Request for Paid Time-Off” Form is used to schedule paid time-off, or time away from work with pay. WHO COMPLETES THIS FORM: Employees who are entitled to days-off with pay who are not using the myTIME Request for Time-Off feature in mySelfService. HOW TO COMPLETE AND SUBMIT THIS FORM: Employees may access this form on the Intranet. An employee who needs to schedule paid time-off needs to complete the form in advance, discuss the request with his/her supervisor and obtain supervisory approval. The signed form is then maintained in the employee’s departmental file. INSTRUCTIONS:

The employee must complete the form with the following information:

a. Name

b. Date

c. Department

d. Based on the number of hours accrued:

Number of days off requested

Equivalent number of hours

Date(s)

The employee must then discuss the request with his/her supervisor

Once the dates are agreed upon, the employee and his/her supervisor sign and date the form

A copy is maintained in the employee’s department file

REQUEST FOR PAID TIME-OFF

Employee Name: Emp ID: Department: Date:

Paid Time-Off Number of Days Equivalent # Hours Date(s)

Personal Day(s)

Vacation Day(s)

2018 S M T W T F S S M T W T F S S M T W T F S S M T W T F S

JANUARY FEBRUARY MARCH APRIL

1 2 3 4 5 6 1 2 3 1 2 3 1 2 3 4 5 6 7

7 8 9 10 11 12 13 4 5 6 7 8 9 10 4 5 6 7 8 9 10 8 9 10 11 12 13 14

14 15 16 17 18 19 20 11 12 13 14 15 16 17 11 12 13 14 15 16 17 15 16 17 18 19 20 21

21 22 23 24 25 26 27 18 19 20 21 22 23 24 18 19 20 21 22 23 24 22 23 24 25 26 27 28

28 29 30 31 25 26 27 28 25 26 27 28 29 30 31 29 30

MAY JUNE JULY AUGUST

1 2 3 4 5 1 2 1 2 3 4 5 6 7 1 2 3 4

6 7 8 9 10 11 12 3 4 5 6 7 8 9 8 9 10 11 12 13 14 5 6 7 8 9 10 11

13 14 15 16 17 18 19 10 11 12 13 14 15 16 15 16 17 18 19 20 21 12 13 14 15 16 17 18

20 21 22 23 24 25 26 17 18 19 20 21 22 23 22 23 24 25 26 27 28 19 20 21 22 23 24 25

27 28 29 30 31 24 25 26 27 28 29 30 29 30 31 26 27 28 29 30 31

SEPTEMBER OCTOBER NOVEMBER DECEMBER

1 1 2 3 4 5 6 1 2 3 1

2 3 4 5 6 7 8 7 8 9 10 11 12 13 4 5 6 7 8 9 10 2 3 4 5 6 7 8

9 10 11 12 13 14 15 14 15 16 17 18 19 20 11 12 13 14 15 16 17 9 10 11 12 13 14 15

16 17 18 19 20 21 22 21 22 23 24 25 26 27 18 19 20 21 22 23 24 16 17 18 19 20 21 22

23 24 25 26 27 28 29 28 29 30 31 25 26 27 28 29 30 23 24 25 26 27 28 29

30 30 31

(2018 legal holidays are highlighted)

Signature and Approval: All of the above information must be completed in full to ensure the timely processing of your request.

Employee Signature/Date Supervisor Approval/Date Covering:

Fir

e S

afe

ty

Eve

ry e

mplo

yee

in t

he

hosp

ital

must

kn

ow

:◦The

exac

t lo

cation o

f fire

ala

rm b

oxes

, ex

its

and e

xtin

guis

her

s.◦H

ow

to o

per

ate

the

fire

ala

rm s

yste

m a

nd fire

extinguis

her

s.◦H

ow

to inte

rpre

t fire

ala

rm s

ignal

s.◦The

phra

se “

Code

Red

” sh

ould

be

use

d inst

ead

of

“fire”

during a

fire

rela

ted e

vent.

◦Em

ergen

cy p

hone

num

ber

X22.

RA

CE

R

–Res

cue

any

one

in im

med

iate

dan

ger

(w

ithout

putt

ing y

our

self in d

anger

)

A–

Sound t

he

alar

m b

y ac

tiva

ting t

he

nea

rest

pull

stat

ion a

nd c

allin

g X

22

C

–Conta

in f

ire

& s

moke

by

closi

ng d

oors

an

d w

indow

s

E–

Ext

inguis

h w

hen

eve

ryone

is s

afe

and

alar

m h

as b

een a

ctiv

ated

CO

MM

ON

FIR

E C

LASS

IFIC

ATI

ON

S“O

rdin

ary”

com

bust

ibles

P ape

r, wo

od, r

ubbe

r, pla

stics

an

d te

xtiles

“Flam

mab

le liq

uids

”Oi

l, gas

oline

, solv

ents

“Ene

rgize

d cir

cuits

”El

ectri

cal e

quipm

ent

and

com

pute

rs

Fir

e E

xti

ng

uis

hers

Cla

ss A

Woo

d, L

inen

, Car

dboa

rd

Cla

ss B

Flam

mab

le L

iqui

ds

Cla

ss C

Elec

trica

l Equ

ipm

ent

ABC

fire

ext

inguis

her

can

be

use

d in a

ll fire

s

*U

se L

ow

Mast

er

key t

o o

pen

C

ab

inets

*

PA

SS

PULL

AIM SQ

UEEZE

SW

EEP

1)Ke

ep yo

ur ba

ck to

a cle

ar es

cape

route

.2)

Pull

the P

IN.

3) S

tand b

ack 6

to 8

feet

from

the fir

e.4)

The

n swe

ep si

de to

sid

e, aim

ing at

the

base

of th

e fire

.

P.A

.S.S

.

Evacu

ati

on

Pro

ced

ure

s

If t

he

alar

m indic

ates

that

ther

e is

an inci

den

t in

your

build

ing,

you m

ust

eva

cuat

e th

at b

uild

ing.

Lo

w 3

,4 5

& 6

eva

cuat

e if t

he

fire

is

on t

hei

r unit.

All

inpat

ient

units

will

eva

cuat

e to

thei

r ap

pro

priat

e co

urt

yard

s.

If a

cces

s to

those

are

as a

re

blo

cked

, th

en t

hey

will

eva

cuat

e th

rough a

sec

ondar

y m

eans

of

egre

ss.

Pa

tien

ts in

res

trai

nts

will

be

man

aged

by

the

nurs

e m

anag

er

in a

man

or

that

will

ensu

re t

he

safe

ty o

f th

e pat

ient.

General Statement of Purpose:

When an ambulatory service physician makes a decision to admit a patient to the inpatient

service or via the Easy Access Program (hereafter, EZAP), established safety procedures

consistent with other routes of admission to the hospital should be established. The physician

will also make a determination regarding transport resources needed for a safe transport.

Procedure for Ambulatory Services:

Voluntary Admission

When a patient presently in an ambulatory setting requires inpatient hospitalization and is

agreeable to hospitalization, the physician will call Central Intake to obtain a room assignment.

After 5pm a page is made to the A.D.N and Central Intake /A.D.N will then inform the receiving

unit of the pending admission. The referring physician will complete the legal papers with the

patient and sign Part B. The physician or staff member will escort the patient to the unit. The

Physician or designated staff member will provide a handoff communication to a clinician on the

receiving inpatient treatment team. The admission search will be conducted by the inpatient staff

when the patient arrives on the unit.

When the outpatient physician determines additional assistance is needed to safely escort the

patient to the unit, the physician or designee will call a “22” stating “ambulatory transport”. The

caller must provide the operator with the standard nomenclature to identify the location. A

Patient Engagement Specialist will respond to provide support during the transport and arrival to

the unit. Clerical staff should be notified to send an email to the ambulatory psychiatric

emergency distribution list notifying front desks of the location of the “ambulatory transport.”

Involuntary Admission

Following the physician’s decision to admit an involuntary patient to the inpatient service the

clinician involved in the situation calls or directs that a “22” is called stating “ambulatory

psychiatric emergency.” The caller must provide the operator with the standard nomenclature to

identify the location. A call is also made to the Northwell Health EMS (718-747-4911) to

provide transport to the LIJ ED. The clinician or delegate will communicate to the Northwell

Northwell Health The Zucker Hillside Hospital

PATIENT CARE SERVICES

POLICY TITLE: Inpatient Admission from ZHH Ambulatory Services and EZAP

Prepared by: ZHH Policy and Procedure Committee

Approval Date: 1/13/17 Effective Date: 1/13/17

Last 11/14/12 Revised/Reviewed: 1/15/14

Pg 1 of 2

Health EMS any identified patient safety risk that would prompt a decision by EMS to also call

911 to request an N.Y.P.D. response. It is the role of the clinician or their designee who called

the “ambulatory psychiatric emergency” to meet the patient engagement specialist, nursing

director or A.D.N and security upon arrival, provide the team with a brief assessment of the

situation, as well as any concerns, e.g., potential for aggression, impulsivity or flight. The

responsibility for the direction of the ambulatory psychiatric emergency response is assigned the

Director of Patient Care Services or A.D.N. until the arrival of the program director. Once the

program director arrives, the Director of Patient Care Services or A.D.N. will brief the director

prior to leaving the area. The clinician on site must remain as a consultant until the situation is

resolved.

The standard nomenclature to identify the location is as follows:

ACP- Ambulatory Care Pavilion

ACP, basement, child clinic

ACP, first floor, centers

ACP, second floor, PACE program

ACP, second floor, adult partial hospital

ACP, second floor, gero clinic

ACP, second floor, gero partial

Sloman- Adult Clinic, Medical Clinic

Sloman, basement, adult clinic

Sloman, first floor, medical clinic

Sloman, first floor, adult clinic

Sloman, first floor, Clozapine clinic

Sloman, second floor, adult clinic

Littauer- ARS (includes MMTP and DAEHRS), Social Work

Littauer, first floor, ARS

Littauer, second floor, Social Work

Research - Psychiatry Research

Research, BHP, basement, room #

Research, ACP, first floor, room#

It is the ambulatory staff’s responsibility to secure the immediate area from other patients, staff

or visitors, alert security to notify them that EMS has been called, to call the LIJ Psych ED to

give a verbal handoff and to subsequently notify family contacts as appropriate. For the purpose

of informing all outpatient areas and aiding in directing the responding team, the ambulatory

support staff will also send an email to an Ambulatory Reception distribution specifying the

location of the ambulatory psychiatric emergency.

Procedure for EZAP:

When Central Intake books an appointment for a Patient Admission via EZAP, Central Intake

will inform the ADN and the receiving unit of the pending admission. The MD will assess the

patient in the EZAP office. Following the assessment and presuming the patient will be

admitted, the physician will call the receiving unit to request escort to the unit from the EZAP

office, the physician will provide handoff communication to the receiving RN. Staff designated

by the unit nurse will pick up the patient from the EZAP office and search the patient’s

belongings prior to entry to the unit.

GUIDE TO HOSPITAL CODES

STANDARDIZATION for North Shore-LIJ

Employees

New Emergency, Clinical and Security Codes Description of Actions for Each Code

Frequently Asked Questions

Table of Contents

ABOUT NEW HOSPITAL CODES ..…………….. 3 FREQUENTLY ASKED QUESTIONS …………… 3 I. EMERGENCY CODES

Code Amber …………………………………… 4 Code Flight …………………………………… 5 Code Decon …………………………………… 6

Code Red …………………………………….... 6 II. SECURITY CODES

Code Gray ……………………………………... 9

Code Green ……………………………………. 9

Code HEICS …………………………………... 9 “All Clear” ………………………………….... 9

III. CLINICAL CODES

Code Blue ……………………………………... 9 Code Fusion …………………………………… 9 Code Stroke …………………………………… 9 Code Trauma …………………………………. 9 Code White …………………………………..... 9 Rapid Response ….............................................. 9 STAT Response …………………………………….... 9

2

3

About the Hospital Codes Standardization North Shore-LIJ continuously strives to create a safe environment for patients, their families and employees. In order for the health system to continue to provide the highest quality patient care, it is standardizing all hospital emergency, security, and clinical codes starting April 1, 2010. It is every employee’s responsibility to learn each code and be in compliance with its requirements.

Frequently Asked Questions

Why is North Shore-LIJ standardizing its hospital codes? In order to ensure the organization delivers quality care across all hospitals and medical facilities, the hospital codes must be unified. Today, some of our hospitals use different codes for the same incident, causing confusion among employees and community-based physicians who work at multiple locations. By standardizing each code across the organization, all employees and community-based physicians will be knowledgeable about each code, and comfortable responding. When do the “new” hospital codes take effect? The codes described in this guide will take effect on April 1, 2010. Who is affected by the “new” hospital codes? All North Shore-LIJ employees working at a hospital, regardless of his/her role at the hospital must learn each code and the actions associated with it. I know other hospital codes (such as Dr. Red) that are not outlined in this guide. What happened to those codes? Some hospitals were using alternative codes for the same incidents as described in this guide. Only the hospital codes outlined in this guide are to be used starting April 1, 2010. All other codes are no longer being used. What if my co-workers and I have our own department codes that we prefer? All hospitals will use the same codes as outlined in this guide. Department codes or abbreviated codes will not be permitted after April 1, 2010. How will I remember each code? North Shore-LIJ has produced a wallet-size “codes card” containing each code and the proper actions for every hospital employee. This card may be carried as part of the uniform until the employee becomes comfortable. Where can I get a “codes card”? If you did not already receive a codes card, please contact your safety office or your Human Resources department to obtain a card. Where may I obtain more information about my hospital’s codes? Please contact your site’s Safety Office for specific information related to your hospital.

I. EMERGENCY CODES

Code Amber Pediatric or Infant has been abducted or is missing Procedure: In response to a “Code Amber”, which is an unauthorized removal of an infant/pediatric patient from the unit, the hospital will initiate its lockdown procedures as outlined in the Security Management Plan. Upon verification, the involved nursing unit should notify Security, utilizing the appropriate STAT Extension, and provide the physical description of the infant/pediatric patient (i.e., race, gender, age, unit of origin), and the physical description of the abductor (i.e., race, gender, age, height, build and clothing worn) if known. Example: 3 Monti, infant female, 24 hours old. Abductor: White female, 25-30 years old, 5’3” – 5’5” tall, medium build wearing a long black coat and carrying a shopping bag. The Nursing team will keep detailed notes of time and notification, and will seal off the unit, allowing no-one in or out until the “All Clear” is sounded. Nursing and Security teams will carry out the established “Code Amber” policies and procedures. Communications will be asked to announce a “Code Amber” over the public address system, and provide the identifying information. Voice Communications will announce the “Code Amber” via the overhead P/A system as per site policy. After hearing a “Code Amber” announcement, all employees should be looking for an abductor as described in the overhead announcement, and should immediately report any suspicious observations associated with the description of the abductor to Security at the appropriate extension. If possible, the suspected abductor should be followed to determine a vehicle description and the license plate number. The Hospital Incident Command System (HICS) will be implemented as indicated by the hospital’s Comprehensive Emergency Management Plan (CEMP). All “Code Amber” events will be documented and reviewed, as per protocol, through either the Site Safety Committee or the Site PICG. 4

Code Flight Adult patient has eloped or is missing Procedure: To establish a plan to assist the clinical staff in locating a missing patient, and assist in the safe return of the patient to the appropriate patient care unit.

1) When it is discovered that a patient is missing, the team member will dial the Stat extension, and notify Communications of a “Code Flight,” stating the nursing unit location of the missing patient.

2) Communications will immediately make notifications as per their protocol, including an overhead announcement.

3) After the overhead announcement is made, all employees are to follow the hospital’s “Code Flight” procedures, which include communication of the patient’s description, and the monitoring of hallways, entrances and exits, and the overall hospital campus. In every incident, the Nurse Manager will be notified.

4) After notification, Security will respond to the area where the patient was reported missing. Security will verify if the patient is: a danger to themselves or others; not capable of consent to discharge (i.e. a pediatric patient, or a patient with an altered mental state). Security will obtain an accurate physical description of the patient. The description will include the patient’s sex, race, complexion, age, height, weight, build, hair, eyes, clothing, mental state and direction of travel.

5) If, in the judgment of the responsible clinician on site, (i.e. MD, RN), the notification procedure (see number 8) can be implemented immediately.

6) The verifying security guard will broadcast, via radio, the physical description on the security frequency.

7) When a missing patient is located on the hospital property, the appropriate patient care unit will be notified, and the unit representative will be asked to escort the patient back to the unit. If a representative is unable to respond in a timely manner, the search team will attempt to persuade the patient to return to the unit voluntarily.

8) If the patient is unwilling to return to the unit of origin and meets the criteria of a pediatric patient, or a patient with an altered mental state, the security desk officer will be notified. The desk officer will contact the patient unit for origin, and request an MD or RN to respond, or be transported to the scene for clinical intervention. Members of the search team are to monitor the patient until clinical assistance arrives. If the patient is not located on the hospital property, additional notifications will be made, as per site policy, that includes the following; ! The Director of Security ! The local Police department or Precinct ! The Nurse Manager/Designee will be informed of the action taken, and

the progress being made 5

! For Inpatient Psychiatric Patients (only), notify the Director of Inpatient Services (Psychiatry).

! The Nurse Manager/Designee will notify the Administrator-on-Duty and ensure the patient’s family and physician have been notified (determine if missing/eloped patient arrived home safely).

! North Shore-LIJ Network Emergency Management (NEM) – 516-719-5000 They will be provided with the physical description of the missing patient, and informed of who was notified.

9) A Security Incident Report will be completed in a timely manner by the Security Department designee. The report will include all appropriate actions taken, all notifications, the name and shield number of the notified police officers, and the case number from Police Department having jurisdiction.

Code DECON Activation of Decon response team due to an external event Procedure: Upon notification of an incident involving chemical, biological or nuclear contamination, or a contaminated patient(s), a Code Decon announcement will be made over the public address system. The decontamination team will respond as per the DECON Annex of the hospital’s Comprehensive Emergency Management Plan (CEMP) and implement DECON procedures as appropriate. The Hospital’s Incident Command System (HICS) will be implemented.

Code Red Fire Procedure: The phrase “Code Red” will be used to designate a fire situation, and will provide supplemental support to the hospital’s fire alarm system. The code phrase will be announced three times over the public address system, in conjunction with all fire alarms, with the exception of weekly alarm tests. When announced overhead, the code phrase will be accompanied by a location (i.e. “Code Red, Tower Building, 6th Floor, South Stair”). The fire alarm “all-clear” (series of single bells), which designates resolution of the alarm condition, must also be backed-up by an overhead announcement.

6

7

The hospital team is required to dial the hospital’s stat extension, and give their name and location immediately after activating a fire alarm. Once this information is relayed to the hospital switchboard operator, the P.A. announcement will be made. If the operator receives no call, an announcement will be made based on the fire alarm bell code. If the fire alarm systems malfunctions, or has been deactivated for servicing, it is especially important that the location of a fire be given to the Switchboard Operator for announcement purposes. Under such circumstances, the Switchboard Operator will notify the Boiler Room, and the Boiler Room Watch Engineer will notify the Fire Department. The code phrase should also be used by employees in the immediate area of a fire, to avoid yelling “fire” and possibly causing panic with the patients. Employees should call aloud the established code phrase and the fire location, i.e. “Code Red, Room 258.” Employees should respond to a “Code Red” announcement in the same manner as the mechanical fire alarm. Note: Upon activation of a “Code Red” staff must ensure that all corridor and patient room doors are closed, in addition to all other doors. Staff Fire Response Fire in your area:

! Locate fire; call aloud “Code Red” and the involved location to alert employees in the area; remove anyone in immediate danger

! Rescue or evacuate anyone in the immediate area of the fire ! Activate fire alarm; pull the fire pullbox station nearest to the fire site ! Call the hospital “stat” line switchboard at the hospital’s stat extension;

state name, location and type of fire; verify alarm ! If you hear a fellow team member call out “Code Red” and have not heard

the fire bells, respond by activating the nearest pullbox and make the notification to the Communications department

! Turn off oxygen and electrical equipment in the area of fire (away from the area of fire; provide oxygen support for patients on oxygen; call Respiratory Therapy for backup as warranted) - Confine fire by closing windows, doors (but do not lock) - Clear corridors and close corridor doors; control traffic in the area - Use appropriate fire extinguishers

! Wait for instructions from Fire Response Team or Fire Department – do not evacuate patients except in case of immediate danger.

If feasible, mark the closed door to the room containing the fire, preferably with red tape.

8

An easy method to remember basic fire procedures is: R.A.C.E. Remove anyone in immediate area of danger (while calling aloud “Code Red” and the location of the fire to employees in the area). Activate alarm: Pull the fire alarm pullbox nearest to the fire site. Dial the hospital’s stat extension to report fire situation and exact location. Confine the fire (e.g. close windows and doors, but do not lock). Extinguish fire (attempt to extinguish small fire with proper extinguisher and without endangering yourself). If necessary, evacuate horizontally to adjacent safe smoke compartment, and then if necessary, vertically. Fire in another area of hospital:

! Identify location of fire ! Close doors and windows to avoid draft ! Clear corridors ! Man telephones, extinguishers and oxygen shut-off valves ! Remain in your area ! Control traffic in your area ! Remain calm and reassure patients ! Wait for further instructions

Additional procedures:

! In the event of a fire, if the fire/smoke doors on magnetic hold open do not automatically close, employees should manually close the doors. Employees should also ensure that these fire/smoke doors are not breached until the “all clear” is announced.

! Visitors should remain with patients in the room. ! Employees must terminate non-essential activities, telephone conversations. ! Narcotics, records, valuables should be secured. ! In units/areas with special exit door locking arrangements (e.g. Psychiatry

Unit, Infant Protection Systems), employees should be posted at unit entrance doors to facilitate the entry of emergency responders, or a way out in the event of fire/medical/safety emergency.

! Do not use elevators. ! Evacuation decisions will be made by ranking fire responder,

Administration, Hospital Incident Command, or the Fire Department.

II. SECURITY CODES

Code Gray Security Stat – plus announce location

Code Green Security Stat – plus announce location because of violence with weapon

Code HICS Activation of EOP – plus activation level (I, II, III, IV)

“All Clear” Announced twice following resolution of incident

Note: Please ensure you are familiar with your site’s security and safety manual. III. CLINICAL CODES

Code Blue Adult Cardiac/Respiratory Arrest – plus announce location

Code Fusion Transfusion Emergency – plus announce service and location

Code Stroke Activation of Stroke Team – plus announce location

Code Trauma

Activation of Trauma Team – plus announce level and location

Code White Pediatric Cardiac/Respiratory Arrest – plus announce location

Rapid Response Activation of Rapid Response Team – plus announce medical/surgical/pediatric

and location

STAT Response

Announce Service STAT to location – (service e.g. Respiratory, OB, Cath Lab)

9

TH

E Z

UC

KE

R H

ILL

SID

E H

OS

PIT

AL

App

eara

nce

Pla

n

Dep

art

men

tal

Gu

idel

ines

, E

ff. 7

-5-1

0*

(Ap

pli

es t

o a

ll e

mp

loyee

s, s

tuden

ts, v

olu

nte

ers,

and a

gen

cy s

taff

whil

e on d

uty

on a

nd o

ff H

osp

ital

pre

mis

es)

(Acc

om

mo

dat

ion

s fo

r re

ligio

us

or

oth

er l

egit

imat

e re

ason

s w

ill

be

mad

e b

y H

um

an R

esourc

es o

n a

cas

e b

y c

ase

bas

is,

if n

eces

sary

)

Clo

thin

g;

Foot

wea

r; a

nd

Acc

esso

ries

Dep

artm

ents

/Offi

ces

(Oth

er th

an In

patie

nt/N

ursi

ng/C

ampu

s Su

ppor

t Ser

vice

s)

Ban

dana

s or

”D

u” R

ag

s

NO

Bod

y Pi

erci

ngs:

Vis

ible

N

O

Blo

uses

: Rev

ealin

g, S

heer

N

O

Dre

sses

(No

shor

ter t

han

2 in

ches

abo

ve th

e kn

ee)

YES

Hat

/Hea

ddre

ss (A

ccep

tabl

e on

ly fo

r rel

igio

us o

r oth

er a

utho

rized

reas

ons)

N

O

ID B

adge

(Wea

r abo

ve th

e w

aist

; pho

to m

ust f

ace

forw

ard;

mus

t use

a re

com

men

ded

lany

ard,

cl

ip o

r non

-mag

netic

hol

der)

YE

S

Jew

elry

: Ear

rings

(Max

imum

2 e

arrin

gs p

er e

ar; n

ot m

ore

than

1 1

/2" i

n le

ngth

and

/or

diam

eter

) YE

S

Jew

elry

: Fac

ial (

Eye

brow

, nos

e, c

heek

, lip

jew

elry

) N

O

Jew

elry

: Gen

eral

(Not

func

tiona

lly re

stric

tive

or d

ange

rous

to jo

b pe

rform

ance

; not

hing

ex

cess

ive

or n

oisy

) YE

S

Pant

s: C

apri

NO

Pant

s: C

lose

Fitt

ing

Stre

tch

Pant

s (L

eggi

ngs,

Stir

rup)

N

O

Pant

s: D

enim

/Jea

ns (A

ll co

lors

) N

O

Pant

s: G

ener

al (A

nkle

leng

th/c

rop

or lo

nger

) YE

S

Clo

thin

g;

Foot

wea

r; a

nd

Acc

esso

ries

Dep

artm

ents

/Offi

ces

(Oth

er th

an In

patie

nt/N

ursi

ng/C

ampu

s Su

ppor

t Ser

vice

s)

Pant

s: K

haki

YE

S

Unl

ess

othe

rwis

e di

rect

ed; M

ust b

e w

orn

with

shi

rt &

tie

Pant

s-Sw

eat

NO

Perf

ume/

Col

ogne

/Afte

r Sha

ve/H

and

Lotio

n

(In m

oder

atio

n or

avo

ided

alto

geth

er)

YES

Polo

Shi

rt

NO

Scru

bs

NO

Shirt

s: M

idrif

f/Tan

k/H

alte

r N

O

Shoe

s: B

ackl

ess

(Mus

t pro

vide

saf

e, s

ecur

e fo

otin

g &

offe

r pro

tect

ion

agai

nst h

azar

ds)

YES

Shoe

s: S

anda

ls; F

lip F

lops

/Tho

ng

NO

Shor

ts

NO

Skirt

s-G

ener

al (M

ust b

e no

sho

rter t

han

2 in

ches

abo

ve th

e kn

ee)

YES

Snea

kers

/Ath

letic

Sho

es

NO

Snea

kers

-Hig

h To

p

NO

Sung

lass

es

NO

Swea

t sui

ts

NO

Tatto

os: V

isib

le

NO

U

nles

s m

odes

t/dis

cree

t

Clo

thin

g;

Foot

wea

r; a

nd

Acc

esso

ries

Dep

artm

ents

/Offi

ces

(Oth

er th

an In

patie

nt/N

ursi

ng/C

ampu

s Su

ppor

t Ser

vice

s)

Ties

(Nea

t, pr

oper

ly ti

ed, a

nd w

orn

to th

e to

p sh

irt b

utto

n)

YES

T-Sh

irts

N

O

Wal

kman

s/R

adio

s/iP

ods/

Blu

e To

oth

devi

ces/

Hea

dset

s

NO

Ref

er t

o N

SL

IJH

S P

erso

nal

Ap

pea

ran

ce p

oli

cy.

*S

ub

ject

to

rev

isio

n.