Home Base Training Institute
Prolonged Exposure Therapy Workshop and Consultation Registration Page
Thank you for your interest in attending the Home Base Training Institute Prolonged Exposure Therapy (PE) Workshop and Consultation Training Program. PE is one of the gold standard treatment options for individuals with posttraumatic stress disorder (PTSD) and consultation has been found to help therapists provide PE to their clients. The 2.5 day workshop training will take place January 8-10, 2020. Following the workshop, participants will join a weekly call for consultation support for six months. The accredited workshop training and six months of consultation is FREE to participants due to generous funding from the MA Department of Veteran Services. After completing the training program, participants will be supported in delivering PE competently in their practice and participating clinicians will join a community of trained providers in New England who are willing to take referrals and treat veterans and service members.
2.5 Day PE workshop information:
Dates:
January 8-10, 2020
January 8: 1PM - 4PM
January 9 and January 10: 9AM - 5PM both days
Participants must be able to commit to attend the entire 2.5 days of training.
Location:
Western Massachusetts Hospital
91 E. Mountain Road
Westfield, MA 01085
Tuition:
FREE
Breakfast and lunch will be provided on January 9 and January 10; however, participants must cover their own travel, lodging, parking, and any other associated expenses.
Credits:
Continuing education credits will be provided upon completion of the training program.
Please note:
To participate in this training you must be a licensed mental health provider in MA and agree to participate in six months of weekly group consultation calls to support your delivery of PE to your clients with PTSD. We are able to offer training to 20 clinicians, so please be thorough in your completion of the application to help with our selection process.
Thank you!
First Name
* must provide value
Last Name
* must provide value
Degree
* must provide value
Licensure (if different from degree)
License Number
* must provide value
Work/Organization Name (if private practice, write "solo")
* must provide value
Second Work/Organization Name (If private practice write "solo")
Address Street
* must provide value
State
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CT MA ME NH NY RI VT Other
Please Specify State
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Zip code
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Work Email Address
* must provide value
Telephone Number (please indicate if the number provided is a work or personal number)
* must provide value
I am able to attend the 2.5 day workshop and participate in the 6 month phone consultation program (involving 1 hr per week for 6 months with an expert PE consultant and other trainees).
* must provide value
Yes
No
I am willing and able to take at least 2 referrals of veterans with a diagnosis of PTSD for a 2-year period following completion of workshop.
* must provide value
Yes
No
Maybe
My current caseload includes clients with a PTSD diagnosis.
* must provide value
Yes
No
PTSD is their primary concern.
* must provide value
Yes
No
Are they reporting re-experiencing the traumatic event?
* must provide value
Yes
No
I will be able to initiate PE with two clients with PTSD within 4 months of completing the 2.5 day workshop training. (We encourage treating military members).
* must provide value
Yes
No
I am willing to obtain informed consent from my clients to audio record PE sessions for consultation purposes. Consultants will review three audio recordings for each client and provide constructive feedback during consultation calls. (Audio recorders will be provided by Home Base and audio files will be managed in a HIPAA compliant manner).
* must provide value
Yes
No
I will be able to schedule 90 minute sessions for clients in PE sessions.
* must provide value
Yes
No
Are you trained and licensed as a professional provider of mental health in MA?
* must provide value
Yes
No
Do you work directly with the following types of clients/clients as part of your regular professional activities:
* must provide value
Adults only
Children only
Both adults and children
None of the above - Do not provide direct care
In which city is your practice located?
* must provide value
Which of the following best describes your provider type:
* must provide value
Masters-Level, licensed professional counselor (e.g., LPC, LMHC, LMFT)
Licensed Clinical Social Worker (MSW, LCSW or LICSW)
Clinical Psychologist (PhD or PsyD)
Psychiatrist (MD)
Other
Which of the following best describes your practice setting? Please check all that apply.
* must provide value
Please provide the name of your organization
* must provide value
How many years have you been practicing clinically?
* must provide value
Less than 1 year
1 to 4 years
5 to 9 years
10 to 20 years
More than 20 years
What types of health insurance does your practice currently accept? Please check all that apply.
* must provide value
In a typical work week, how many clients do you provide direct care for?
* must provide value
0-5 6-10 11-15 16-20 21-25 26-30 31-35 36-40
What percentage of clients are veterans or service members?
* must provide value
0% 1-10% 11-20% 21-30% 31-40% 41-50% 51-60% 61-70% 71-80% 81-90% 91-100%
Have you ever worked in either a military setting (such as a military treatment facility or clinic) or in the Veterans Health Administration? Please include any time spent in a training fellowship, internship, or residency in a VA hospital, clinic, or vet center.
* must provide value
Yes
No
Do you have any prior training or experience with Cognitive Behavioral Therapy?
* must provide value
Yes
No
Don't know
Have you ever received training in evidence-based psychotherapy for PTSD (e.g., PE, CPT, EMDR)?
* must provide value
Yes
No
Don't know
What have you received training in?
* must provide value
In the past six months, have you used an evidence-based psychotherapy for PTSD (e.g., PE, CPT, EMDR)?
* must provide value
Yes
No
Don't know
In the past six months, have you treated patients/clients with PTSD?
* must provide value
Yes
No
Don't know
What percentage of your clients have a diagnosis of PTSD?
* must provide value
0% 1-25% 26-50% 51-75% 76-100%
How interested are you in treating veterans?
* must provide value
Very interested
Somewhat interested
Not interested
Don't know
Would you be willing and able to receive referrals from Home Base and/or community sources to provide
psychotherapy for PTSD to military service members and their families?
* must provide value
Yes
No
Don't know
How many referrals might you be able to accept in a year?
* must provide value
0-1 2-5 5-10 11+
Do you have any additional information you would like to provide about receiving referrals?
Please provide a brief (3 to 4 sentences) de-identified, overview of a client with PTSD on your current caseload that you may consider providing PE to following the training. We have found that having a specific client in mind can help increase engagement and learning during the 2.5 day workshop. (Brief description can include age, trauma type, co-morbid diagnoses, and symptoms that will be targeted in treatment).
* must provide value
Gender
* must provide value
Male
Female
Transgender
Other
Prefer not to answer
Race (please select all that apply)
* must provide value
Ethnicity (choose the one you most closely identify with)
* must provide value
Not Hispanic or Latino
Hispanic or Latino
Prefer not to answer
Please indicate your age range
* must provide value
18 to 24
25 to 34
35 to 44
45 to 54
55 to 64
65 and older
Prefer not to answer
Have you ever served in the US Armed Forces?
* must provide value
Yes
No
Prefer not to answer
Did you serve in a war zone?
* must provide value
Yes
No
Prefer not to answer
Do you have any close family members who have served in the US Armed Forces anytime from 1960 to the present?
* must provide value
Yes
No
Prefer not to answer
Did he/she serve in a war zone?
* must provide value
Yes
No
Prefer not to answer
How did you hear about this training opportunity?
* must provide value
Note: Once your application is received you will receive an email confirming we received it. Please allow at least a week for us to reach back out to you once we receive your application.
If you have any questions, please email/call : Emma Morrison, Assistant Director of Education, at emorrison4@partners.org.
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