Candidate #2 Reviewer B American Board of Rehabilitation Psychology Practice Sample Review Candidate: #2, Ph.D. Practice Sample Review #1: A 19-year-old male with traumatic brain injury (left frontal and temporal contusions) and complete paraplegia (T10 ASIA A). Reviewer: B A. Brief Description:.
This practice sample is focused on a 19-year-old male who sustained polytrauma, including severe traumatic brain injury and complete T10 spinal cord injury. The interventions provided span three different admissions over a one-year period. The first was for the initial brain and spinal cord injury, the second was to improve functional independence and self-cares, and the third was to improve functional independence and improve gaiting with bracing.
B. Statement of Acceptability With Rationale:
This practice sample is acceptable. This sample addresses a large number of competencies across the domains of assessment, intervention, and consultation. The richness of the material and the large number of interventions provided over a chronological time span were particularly helpful.
C. Description of Strengths:
The strengths of this work sample are numerous and include a complex history, longitudinal follow-up, multiple issues related to cognition, mood, substance abuse, and family integrity and home-going environment. This practice sample is clearly written with nicely and concisely referenced appropriate literature. The practice sample is easy to follow. Throughout this case, issues of sexuality and inappropriate sexual behavior are noted.
Description of Weaknesses: A primary weakness is that it is difficult for me to determine the precise number of times the patient was seen by Dr. #2 as well as to get a more precise understanding of the specific type of therapy that she was providing to the patient and family. Another weakness of this sample is although Dr. #2 claims to have covered personality and emotional assessment, there is no evidence that any standardized measure of personality or mood was administered. This is particularly striking given the complexity of this individual’s personality issues, substance abuse issues, and mood issues. D. Questions for the Oral Exam: 1. Given the complexity of this patient’s mother’s alcohol and substance abuse as well as the
brother’s history of the same, what factors did you consider in placement advocacy for this patient? How did you determine if this was an environment that would be safe for a cognitively compromised 19-year-old to return to? For example, from your notes that when he returned for a readmission that actually he had indeed been using substances and had developed a stage II right ischial decubitus ulcer. What role were substances potentially
playing in this case? Or did the fact that he reported using marijuana daily between admissions raise concern on your part about a dual TBI/substance abuse treatment program?
2. On Page 8, at the end of the second paragraph you note “and no formal or court-mandated
psychiatric involvement was noted.” I was uncertain what this was referring to and thought this would be helpful to be clarified.
3. On Page 13, you discuss the severity of his brain injury but then state “although substance
abuse issues were not able to be adequately addressed, I educated the patient and mother on the dangers of alcohol use and/or illicit drug use at this stage of his recovery.” How did you educate them? Doesn’t this contradict the statement earlier in the paragraph?
4. On Page 20, you indicate “I prefer proactive pharmacological treatment for levels of emotional
distress that are interfering with the patient’s ability to participate effectively in recovery.” Could you please elaborate on this philosophy? How do you go about implementing making these decisions and pursuing pharmacotherapy?
5. In terms of claimed competencies for this practice sample, you indicate personality/emotional
assessment. No evidence of the use of standardized personality or mood measures is evident in the practice sample. Please indicate the personality assessment and mood assessment instruments that are in your repertoire. Please describe the strengths and weaknesses of one of each of these and why you prefer this in use in the rehabilitation population. Are there particular personality and mood assessment instruments that you avoid given work with rehabilitation patients?
Candidate #2 Reviewer B American Board of Rehabilitation Psychology Practice Sample Review Candidate: #2, Ph.D. Practice Sample Review #2: Middle-aged woman (49) with secondary-progressive multiple sclerosis Reviewer: B E. Brief Description:.
This practice sample provides a longitudinal intervention over multiple years in a woman with multiple sclerosis. The practice sample addresses assessment, intervention, and consultation competencies.
F. Statement of Acceptability With Rationale:
This practice sample is acceptable. As noted above, this sample addresses a large number of competencies.
G. Description of Strengths:
As was true in the first practice sample, there are numerous strengths in this practice sample. These include a thorough description of the patient and her previous and current medical difficulties, a longitudinal picture of the progression of her multiple sclerosis and its being intertwined with cognitive, emotional, and relationship issues. Throughout this practice sample, in the margins I would write the word “good.” Some examples of strengths were Dr. #2 reviewed her role and purpose with the rehabilitation team and limits of confidentiality, her careful review of family members with a prior history of suicide, and her sophisticated observation of the patient minimizing concerns, diverting the discussion, and frequently laughing in a defensive manner. She also did a nice job of weaving problematic neuropsychological test results in helping the patient engage in realistic understanding of her cognitive weakness. The progression from a limited neuropsychological battery to a more complete neuropsychological battery is also a strength. I also appreciated Dr. #2’s philosophic statement as a rehabilitation psychologist stating “I am a optimistic realist, and I bring that to my clinical work with patients.”
Description of Weaknesses: The two primary weaknesses in this practice sample are the lack of standardized personality or mood assessment beyond the clinical interview and apparent pain rating scales. Given the interface between mood disorder, pain disorder, and perhaps personality factors, I would have anticipated a more thorough and objective approach to inform Dr. #2’s clinical impression. H. Questions for the Oral Exam:
1. This patient was initially admitted to the inpatient rehabilitation unit on Tegretol,
baclofen, amitriptoline, Zanaflex, Provigil, Celexa, and Avonex. This is a heavy
psychopharmacologic load. Please comment on the complexity of medications and their potential interaction. What is the role of psychologists in observing/noting these issues and perhaps working towards simplification of medications?
2. This individual’s depression was managed adequately, but it increased to a level of
chronic, passive, and intermittently active suicidal ideation after beginning Avonex for her MS. What is the potential relationship between Avonex and increase in her mood disorder? What standardized personality measures might you have used with this patient? What are their strikes and limitations? What standardized measures of mood (besides the Beck Depression Inventory-II) that you might use with this individual? What are the complicating factors that the BDI has in terms of items and their confounds with the sequela of multiple sclerosis?
3. You indicate that you are comfortable delving into issues of spirituality and their
potential impact on patient adjustment/coping. Are there times that focusing on spirituality issues have proved detrimental to your therapeutic interventions with a patient? Where do you draw the line in terms of discussing spiritual issues versus turning that role over to the patient’s personal faith figure (minister, priest, etc.)?
4. You mention the issue of sexuality frequently and clearly are comfortable talking about
this topic. Are there any standardized measures of sexuality and sexual function that you use in your practice? What are the potential implications of the polypharmacy that this patient was under and their sequela on sexual function?
5. You mentioned consulting with a liaison psychiatrist for medication management. Please
describe this relationship more fully. What, if any, professional issues have arisen in trying to collaborate with traditionally trained psychiatrists in the physical medicine and rehabilitation population?
6. As was true in practice sample No. 1, pain is of central concern in this individual. How
do you go about a standardized way of measuring pain? What pain scales are you familiar with? Are there any pain scales that you find particularly effective in working with the rehabilitation population, especially individuals with compromised cognition and chronic pain?
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