Solo Providers Registration



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  • Solo Practitioner Commitments
    As the responsible professional in licensed independent clinical practice delivering the SMC intervention, I confirm that the following statements are true:

    Initial implementation
    1. I will fulfill the responsibilities of implementation of the SMC and conduct on-going liaison to the SMC staff. These responsibilities include:
    • Participating in pre-learnings and attendance at the multiple-day tutor training workshop as well as attendance at the supervisor orientation meeting
    • Document a complete first (training) case on the form provided and submit this, along with mirror image fidelity checklists (client and tutor) for each session in this case to the SMC staff (via postal mail or email).
    • Conducting an agency-wide in-service training about traumatic stress and the SMC intervention
    • Providing license-related forms to the SMC staff (initially and at the annual renewal)
    2. I will arrange for clinical supervision, including case consultation, working through challenges, addressing vicarious trauma, or other needs, consistent with norms in behavioral health service settings.
    3. I will facilitate an in-service training (or review the training content with them 1:1 or in a small group informally) with colleagues who also work with my clients. This information sharing serves to advance clinical collaborations toward being fully trauma-informed AND aware of the SMC. This is an in-service Trauma Informed Care (TIC) education program in the form of a slide deck, developed by SMC.
    4. I will compile and maintain a list of referral resources appropriate to trauma-informed care in the perinatal period, including:
    • Intimate partner violence services
    • Substance abuse services
    • Specialist mental health services (i.e., psychiatrist, psychotherapist)
    • Child welfare services
    • Emergency care where psychiatric concerns can be addressed
    Tutoring with fidelity
    5. I understand that tutor fidelity to the manual is the best predictor of effectiveness for manualized programs like the SMC (Bellg AJ et al., 2004, Moore GF et al., 2015) *, so I will:
    • Use the “Each and Every Time” fidelity guide and fidelity checklist
    • Use the SMC tools for assessment, monitoring, and referral tracking
    • Make use of clinical supervision for challenging or unique cases
    • Strive for a high-quality tutor-client relationship because helping clients feel supported while they are learning skills is an essential intervention component
    • Accept remediation via consultation with the SMC staff or via refresher training
    6. I will audit my own fidelity to the design of the SMC by periodically completing the tutor fidelity checklist and requesting fidelity checklists from my client for the same session (i.e., “mirror image reports”). I also will periodically review a case file to verify that I monitored distress scores (e.g., safety) and made referrals when appropriate. I will document my performance as:
    • True to the curriculum (>=80% on the SMC fidelity guide/checklist)
    • Of high quality in terms of the tutor-client relationship (respect and rapport, attaining active participation from the mom)
    • Safe, with appropriate referral

    Renewal
    7. I understand that, at the time of license renewal at the end of each year , I will also complete a case study (on the form provided), documenting knowledge of SMC’s use. A mirror image (client and tutor) pair of fidelity checklists must be included from at least one session within this case. I will send this documentation, as well as other information requested on the annual renewal form to the SMC staff. They will review and discuss with me and impediments to renewal.

    I will stop delivering the SMC and close my license if I am not able to provide documentation demonstrating fidelity, a high-quality tutor-client relationship, safety, and availability of referral resources. OR I will stop delivering the SMC if I have not been able to deliver tutoring to at least 2 clients. OR I will attend tutor training again, using the refresher opportunity.
    8. I will complete and store SMC (electronic and/or paper) documentation as outlined in the Renewal Checklists License-related documents, including forms pertaining to:
    • agency-level in-service training
    • training attendance and training case with fidelity monitoring
    • on-going self-monitoring of fidelity to achieve >=80% adherence
    • remediation efforts to achieve fidelity or plan to use refresher training
    • and re-certification paperwork for renewal, including case study with fidelity forms
    • as well as documentation of availability (supervisor) and utilization of clinical supervision (supervisor, facilitated by tutor or clinical supervisor).
    9. I acknowledge that conveying the license-related reports to SMC staff is required to maintain my SMC end-user license.
    10. I understand that, at the time of license renewal, SMC staff will review the license-related documentation and discuss any impediments with the supervisor.

    Licensing
    1. I have read the list of commitments agree to this scope of work.
    2. I am aware that I can contact the SMC staff to get information, technical assistance, or consultation as part of the agency’s end-user license agreement.
    3. I am aware that SMC tutoring and supervision occurs only in the setting of an agency or organization (or, in my case, an independent licensed practice) holding an end-user license agreement and that the SMC curriculum and materials may not be used outside this context or at variance from the license agreement except by express written permission.
    4. I have read and e-signed the Terms of Use, Privacy Policy, and End User License Agreements on the SMC website.
    (If some aspect of these Commitments is impossible in your setting, please do not proceed, but contact us to discuss how we might accommodate your needs.)
    Email: julia.seng@survivormoms.org
    Phone: (734) 773-1480

    *References regarding fidelity:
    Bellg AJ, Borrelli B, Resnick B, Hecht J, Minicucci DS, Ory M, et al. Enhancing treatment fidelity in health behavior change studies: Best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol. 2004;23(5):443–51. doi: 10.1037/0278-6133.23.5.443

    Moore GF, Audrey S, Barker M, et al. Process evaluation of complex interventions: Medical Research Council guidance. The BMJ. 2015;350:h1258. doi:10.1136/bmj.h1258.




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