application form for scrutiny of professional qualifications in clinical ...

APPLICATION FORM FOR SCRUTINY OFPROFESSIONAL QUALIFICATIONS IN CLINICALPSYCHOLOGYNon National QualificationsThe Psychological Society of Ireland has been requested by the Department ofHealth and Children to scrutinise applications for statements of equivalencefrom individuals who trained outside of Ireland. The Minister for Health andChildren is the designated authority with the responsibility for validatingnon-national qualifications under EU Directive 89/48. The Society, followingscrutiny of a non-national application, will advise the Department of Healthand Children who then make the final decision.Set out below are the criteria for the Advice of the Psychological Society ofIreland in relation to the Validation of Non National Qualifications for theOffice of Clinical Psychologist in accordance with the Ministerial Declaration ofOctober 2002.1. Applicants must hold a recognised university degree or diplomaobtained with first or second class honours in which psychology wastaken as a major subject and honours obtained in that subject.AND2. A recognised postgraduate qualification in Clinical Psychology.Clin Psych Validation Scrutiny Form Sept 2007 1

FOR ALL APPLICANTSBefore completing this form please consult the list of essential criteriabelow to ensure your qualifications and experience match those required.ESSENTIAL CRITERIASection 1.Recognised undergraduate qualification in Psychology withfirst or second class honours.1.1 Course transcript confirms appropriate content, proportion ofPsychology, duration of course and grades achieved.1.2 Achievements that lead to the acceptance for this award cannotbe recounted for further qualification.Section 2Recognised Postgraduate qualification in Clinical Psychology.2.1 Post graduate clinical course at least of 2 full calendar years, fulltime.2.2 Postgraduate thesis. Clinically relevant research of appropriatescope and length.2.3 At least 4 continuous training placements, covering thefollowing areas:• child and adolescent mental health services;• adult mental health services;• services for people with intellectual disability;• a specialist service.Each training placement should be supervised by Senior levelClinical psychologists.A minimum of 60 days in block should have been spent in eachof these areas.*NoteIt is recognised that training structures differ across countries.Work experience supervised by a Senior level ClinicalPsychologist, gained after formal postgraduate training may beconsidered in meeting the requirements of Section 2.3, in regardto clinical placements.2.4 Placements constitute 50-60% of course time.2.5 Across placements, applicant has gained experience ininterviewing, observation, psychometric assessments and use ofquestionnaires/checklists.Clin Psych Validation Scrutiny Form Sept 2007 2

2.6 Across placements, applicant has gained skills in developinghypotheses and formulations about presenting problem.2.7 Across placements, applicant has been supervised in theapplication of at least 2 therapeutic approaches.2.8 Across placements, applicant has developed skills in writtenand oral communication.2.9 Across placements, applicant has gained experience workingwith other health service professionals.2.10 Broad range of frequently occurring presenting problems seenby applicant across placements.2.11 For all applications, academic programme accounts for 20-30%of total course time.2.12 Academic programme covers a broad range of topics,assessment and intervention with children and adolescents,assessment and intervention with adults, assessment andintervention with people with learning disabilities and aspecialist population. Professional and ethical issues are alsocovered.Section 3Verification3.1 Evidence that the applicant’s qualification entitles him/her towork in the capacity of a Psychologist in the country in whichthe qualifications were obtained. If your registration or licensespecifies an area of practice, for example, Clinical Psychology,please include this.Clin Psych Validation Scrutiny Form Sept 2007 3

The following documentation in full must accompany your application1. A copy of your undergraduate degree or diploma,2. An original transcript of all examination results showing subjectsstudied and grades obtained, duration of course, if part-time gives fulltime equivalent.3. A copy of the abstract of your undergraduate thesis/research project.4. A copy of your postgraduate degrees/diplomas,5. An original transcript of all examination results showing subjectsstudied and grades obtained, duration of course, if part-time gives fulltime equivalent6. A certified statement from the relevant educational institute detailingthe syllabus of the postgraduate education and training which youundertook, including details of:• Academic courses taken• Details of research expertise• Type of practice placements (nature of the work, duration ofeach placement, client groups, ages, numbers, supervisionarrangements)7. A copy of your Postgraduate Thesis abstract and the structuredsummary (see guidelines to structured summary on page 15).8. Evidence (in the form of a license or registration statement) that thequalification you hold entitles you to practice as an equivalentpsychologist in the country where your qualification was obtained.All documentation must be authenticated as true copies of the originalsApplicants should ensure that all required documentation is attached, asincomplete applications cannot be processedSCRUTINY FEE: A cheque, postal order or bank draft for €183.00 madepayable to The Psychological Society of Ireland and drawn on an IrishBank should be enclosed.Clin Psych Validation Scrutiny Form Sept 2007 4

A. PERSONAL DETAILSPLEASE PRINT IN BLOCK CAPITALSSurname: ___________________________________ Title: ___________________Previous surname, if any: ______________________________________________First Name(s): ________________________________________________________Date of Birth: Day__ __ Month__ __ Year__ __ __ __Address for correspondence:_______________________________________________________________________________________________________________________________________________________________________________________________________________Email Address: _______________________________________________________Contact Telephone Number: ___________________________________________If you are a member of any Psychological Societies, please give details in thetable below:Name of Society Contact address MembershipnumberMembershipstatusClin Psych Validation Scrutiny Form Sept 2007 5

B. QUALIFICATIONS IN PSYCHOLOGYPlease list all your degrees and qualifications in psychology in chronological order, starting with the first.Degree andType of study andName of Accrediting Bodygrade obtainedassessment methodFull title of the course asnamed by the degreeawarding authorityUndergraduateStart dateCompletion dateDate awarded(month & year)Name of university,Institute, college or otherdegree awardingauthorityUndergraduatePost-graduatePost-graduateNotes about the row headings.Title of the course: Please give the full title of yourdegree exactly as shown on the degree certificate,including such descriptions as Joint Honours orCombined Studies.Degree and Grade obtained: Please give theabbreviated title of your degree with your honoursclassification, for example, BA 2(1) Hons, MPsychSc,PhDTypes of study and assessment methods: Fulltime/part time/distance learning, Show whether yourdegree involved course work, empirical research, or somecombination, and how it was assessed for example:Course work and examination60% course and exam, 40% thesisResearch and thesisCourse work and continuous assessmentClin Psych Validation Scrutiny Form Sept 2007 6

C. UNDERGRADUATE QUALIFICATION IN PSYCHOLOGYIndicate below how you see your education/training in psychology as meetingthe requirements in relation to some or all of the following components. Thecomponents are in accord with the PSI Guidelines on the Accreditation of CoursesLeading to a First Qualification in Psychology.a. include only courses in psychology (generally courses presented inPsychology Departments or by suitably qualified psychologists);b. indicate clearly which courses were taken at an advanced level; andc. include cross-references to the supporting documentation you havesubmitted, e.g. the course code from your official transcriptsComponent Information from Applicant Transcript CourseReference NumberBiological Bases of BehaviourRequired componentInclude areas such as:Neuropsychology, PhysiologicalPsychology, Behaviour Analysis, andAnimal BehaviourDevelopmental PsychologyRequired componentInclude areas such as: ChildPsychology, Adolescence, Adulthood& Ageing, and LifespanDevelopment.Cognitive PsychologyRequired ComponentInclude areas such as:Perception, Memory, Thinking andArtificial IntelligenceSocial PsychologyRequired ComponentInclude areas such as:Group Behaviour, andOrganisational PsychologyClin Psych Validation Scrutiny Form Sept 2007 7

C. UNDERGRADUATE QUALIFICATION IN PSYCHOLOGY continuedComponentPersonality and IndividualDifferencesRequired componentInclude areas such as:Personality Theory, andPsychoanalysis.Information fromApplicantTranscript CourseReference NumberResearch MethodsEssential componentInclude areas such as: ResearchDesign, Psychological Statistics,Qualitative Methods, and SurveyMethods.Research ProjectSpecify any independent researchand name of supervisorApplied PsychologyInclude areas such as: Psychologyof Disability and Rehabilitation,Educational, Clinical, Health,Industrial, and ForensicPsychologyOther Areas of PsychologyInclude areas such as: History ofPsychology, Environmental, CrossculturalPsychology, Theories ofPsychology, and ProfessionalEthicsCommunication andInterpersonal SkillsInclude areas such as: InterviewingTechniques, Social Skills Training,Small Group Processes.Clin Psych Validation Scrutiny Form Sept 2007 8

D. POSTGRADUATE QUALIFICATIONFull title of Postgraduate training course:__________________________ From: _____________ to:______________ (insert month andyear)Year 1 _____weeks Year 2_____weeks Year 3_____weeks Year 4______weeks Year 5_____weeks.Proportion of total course time allocated to clinical placement experience_______%; to academic teaching_______%Please give details of supervised placements during your professional training course1PlacementSettingClient Group & AgeRangesDatesfrom/toNumber ofPlacementDaysFrequency ofSupervisionName & Position ofSupervisorMethod ofAssessment23456Clin Psych Validation Scrutiny Form Sept 2007 9

1. PLACEMENTS DURING TRAININGPlease provide details, for each placement outlined on page 9, of supervisedtraining experience and skill development in the areas of a) assessment, b)formulation, c) written & oral communication, d) therapeutic models used, e)indirect work, f) multi-disciplinary contact, g) intervention and h) evaluation.Placement 1Placement 2Placement 3Clin Psych Validation Scrutiny Form Sept 2007 10

Placement 4Placement 5Placement 6Clin Psych Validation Scrutiny Form Sept 2007 11

2. RANGE OF PRESENTING PROBLEMSPlease describe the range of presenting problems encountered in eachplacement:Placement typePresenting Problems/Age ranges1.2.3.4.5.6.3.THERAPEUTIC MODELSWhat were the dominant therapeutic models taught and practiced on yourcourse?______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Clin Psych Validation Scrutiny Form Sept 2007 12

4. ACADEMIC PROGRAMMEPlease describe the main topic areas covered including client groups;presenting problems, assessment, formulation, intervention, researchmethods & statistics, service based issues, professional/ethical issues andsocial/cultural issues.Cross reference by giving the course number or code from your officialtranscripts.Year 1Year 2Year 3Clin Psych Validation Scrutiny Form Sept 2007 13

5. ACADEMIC ASSESSMENTPlease give details of the academic work you submitted during training(indicate whether each piece was a case study, essay, research project,presentation or written/oral exam, thesis).Title of WorkDescription and approx word countClin Psych Validation Scrutiny Form Sept 2007 14

6. THESISApplicant should supply the official abstract and also a structured summaryof the thesis using the guidelines below. The structured summary should be250 to 400 words in length.Please give:• The thesis title, number of words, and date examined• Names of examiners and degree for which the thesis was presented• Objectives: State the objective of the research and the mainhypotheses or questions addressed• Design: Describe the design specifying the number of groups studied, and the number ofoccasions on which data were collected from these groups• Methods: State if quantitative or qualitative methods were used. Specify the number andcharacteristics of participants; the assessment instruments, psychological tests or specialapparatus used; and the procedures followed during data collection• Results: Give the main results. Numerical data may be given briefly• Data analysis: State the way qualitative data were processed or the statistics used to analysequantitative data• Conclusions: State the conclusions from the research and the implications of these forclinical practice, policy development and further research.Clin Psych Validation Scrutiny Form Sept 2007 15

7. EXPERIENCE OF TEACHING/TRAINING/GIVING PRESENTATIONSDURING TRAININGTopic Audience DateClin Psych Validation Scrutiny Form Sept 2007 16

E. SUPERVISED CLINICAL EXPERIENCEIt is recognised that training structures differ across countries. Work experience supervised by a Clinical Psychologist, gained afterformal postgraduate training may be considered in meeting the requirements in regard to Clinical placements.Please give details of the supervised work experience you have obtained under the supervision of a Clinical psychologistWork Experience1.Client group& Age rangesDatesfrom/toNumber ofdaysFrequency ofsupervisionName & position ofsupervisorMethod ofassessment2.3.4.Clin Psych Validation Scrutiny Form Sept 2007 17

1.PRESENTING PROBLEMSPlease describe the range of presenting problems encountered in each area ofsupervised work experienceSupervised Work ExperiencePresenting Problems/Age ranges1.2.3.4.2.THERAPEUTIC MODELSWhat were the dominant therapeutic models taught and practiced duringyour supervised Clinical experience?_______________________________________________________________________________________________________________________________________________________________________________________________________________3. EXPERIENCE OF TEACHING/TRAINING/GIVING PRESENTATIONSDURING SUPERVISED CLINICAL EXPERIENCETopic Audience DateClin Psych Validation Scrutiny Form Sept 2007 18

F. EMPLOYMENT AS A PSYCHOLOGISTJob TitleService name/clientgroupAddressDates fromDate toHours perweekMain DutiesNote: Job or occupation: Indicate with a bracket or in some other way any appointments you have held (or hold) concurrently.Date: Give month and year. It will be assumed that you are not working as a psychologist during any period not accounted for in youremployment record.If the spaces provided are insufficient please photocopy this page to accommodate additional information and attach thephotocopied page to your applicationClin Psych Validation Scrutiny Form Sept 2007 19

G. ADDITIONAL INFORMATIONState here any other information you feel is needed to support your application:Clin Psych Validation Scrutiny Form Sept 2007 20

H. TO BE COMPLETED BY REFEREESThe applicant has set out in his/her application form details of clinical or otherspecialist training along with information on relevant work experience. The applicantis applying for a statement of equivalence for a non-national qualification in ClinicalPsychology in order to work as a Clinical Psychologist in the Health Service in theRepublic of Ireland. Each referee should read the completed application form andcomplete and sign one of the referee sections below.Please complete your details in block capitals.Appropriate referees would include the course co-ordinator or supervisor(s) duringyour professional training or senior psychologist(s) from your current or most recentemployment.THE PSI RESERVES THE RIGHT TO CONTACT REFEREES DIRECTLY, ASDEEMED NECESSARYREFEREE 21. Name: ____________________________________________________________________2. Official job title/position: ___________________________________________________3. Work address: _____________________________________________________________________________________________________________________________________________________________________________________________________________________4. Telephone no. & e-mail address: _____________________________________________5. Nature of contact during training/work experience/employment:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________6. Referees should indicate their status within the psychological society of their owncountry:Name of Psychological Society: _______________________________________________Status: _____________________________________________________________________To the best of my knowledge, the details of training and experience contained inthis form are correctSigned: _________________________________ Date: ____________________________Clin Psych Validation Scrutiny Form Sept 2007 22

I. EVIDENCE OF QUALIFICATIONPlease list below the evidence you have enclosed which shows that your qualificationsentitle you to practice as a Psychologist in the country where you qualified.If your registration or license specifies an area of practice, for example, ClinicalPsychology, please include this.1.2.3.Please label each accompanying document clearlyJ. DECLARATIONI DECLARE THAT, TO THE BEST OF MY KNOWLEDGE AND BELIEF, THEFORGOING STATEMENTS ARE TRUE.Signed: _____________________________Date: ________________________________________________BLOCK CAPITALSIMPORTANT NOTESBefore forwarding your application, ensure that all relevant sections have beencompleted and that all documentation required is attached and clearly labelled.Retain a copy of your application form and copies of all the documentation yousubmit, for your own records.Clin Psych Validation Scrutiny Form Sept 2007 23