Western Psychiatric - Value Behavioral Health of Pennsylvania

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Western Psychiatric Institute and Clinic
Office of Education and Regional
Programming
UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE
CENTER FOR CONTINUING EDUCATION IN THE HEALTH
SCIENCES
JanuaryMarch
2007
Videoconference Series
January
 Attention Deficit Hyperactivity Disorder in Adults
 Treatment of Children and Adolescents with Bipolar Disorder
February
 Identifying At Risk Older Adults
 Family Emergency Planning: Disaster Preparedness from an
Organizational Behavioral Perspective
March
 Psychopharmacology Update
 Working with Individuals with Autism Spectrum Disorders: A Family
Based Approach
To register:
Please complete the attached registration form
or download registration form at www.wpic.pitt.edu/oerp
Western Psychiatric Institute and Clinic is part of UPMC Presbyterian Shadyside
2007
January
VIDEOCONFERENCE
SERIES
W ESTERN PSYCHIATRIC INSTITUTE AND CLINIC
OFFICE OF EDUCATION AND REGIONAL PROGRAMMING
UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE
CENTER FOR CONTINUING EDUCATION IN THE HEALTH SCIENCES
ATTENTION DEFICIT HYPERACTIVITY DISORDER IN ADULTS
January 17, 2007
9:00 a.m. – 11:00 a.m.
Course Code: T209
Presenter:
Oscar Bukstein, MD, MPH
Associate Professor of Psychiatry
University of Pittsburgh School of Medicine
Director, Institute of Public Health and Psychiatry
Program Description:
This program is designed to present an overview of the diagnosis and treatment of Attention Deficit Hyperactivity
Disorder (ADHD) in the adult population. Special emphasis will be placed on practical and effective ways in working
with individuals with challenging behaviors.
Educational Objectives:
At the conclusion of this program, participants will be able to:
1. Diagnose the characteristics of ADHD in the adult population
2. Identify symptoms and behaviors of individuals with ADHD
3. List several treatments and interventions for aiding an individual’s recovery
4. Discuss practical and effective ways in the individual’s recovery to deal with the behavioral manifestations of ADHD
Target Audience:
Clinical and research professionals, students, and trainees as well as interested family members and individuals with
mental illness.
Continuing Education Credits:
ACT 48 – 2.0
CAC – 2.0
CME – 2.0
CPRP – 2.0
NBCC – 2.0
Psychologist – 2.0
SW – 2.0
CEU – 0.2
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing
Medical Education to provide continuing medical education for physicians. The University of Pittsburgh
School of Medicine designates this educational activity for a maximum of 2.0 AMA PRA Category 1 CreditsTM.
Each physician should only claim credit commensurate with the extent of their participation in the activity.
Other healthcare professionals are awarded 0.2 continuing education units (CEU's) which are equal to 2.0
contact hours.
Tuition:
This program is free of charge. Attendees requiring continuing education credits, however, will be asked to complete
an attendance form and submit it with payment ($5 for CEU’s, $25 for ACT 48, CAC, CME, CPRP, NBCC, Psychologist
and SW) after attending the program.
To register: Please complete the attached registration form or download the form at www.wpic.pitt.edu/oerp
Contacts:
Clinical Educator
Registrations
Joanne Slappo, PhD
Kyessa Brian
(412) 802-6918
(412) 802-6905
Telephone registrations CANNOT be accepted
Western Psychiatric Institute and Clinic is part of UPMC Presbyterian Shadyside
2007
January
VIDEOCONFERENCE
SERIES
W ESTERN PSYCHIATRIC INSTITUTE AND CLINIC
OFFICE OF EDUCATION AND REGIONAL PROGRAMMING
UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE
CENTER FOR CONTINUING EDUCATION IN THE HEALTH SCIENCES
TREATMENT OF CHILDREN AND ADOLESCENTS WITH
BIPOLAR DISORDER
January 31, 2007
9:00 a.m. – 11:00 a.m.
Course Code: T210
Presenter:
David Axelson, MD
Assistant Professor of Psychiatry
University of Pittsburgh School of Medicine
Western Psychiatric Institute and Clinic
Program Description:
This program will address the clinical presentation and epidemiology of bipolar disorder in children and adolescents. It
will also discuss new information on the longitudinal course of child and adolescent bipolar disorder as well as recent
advances in treatment.
Educational Objectives:
At the conclusion of the program, participants should be able to:
1. Describe the clinical features of bipolar disorder in children and adolescents
2. Examine the features of the longitudinal course of child and adolescent bipolar disorder
3. Discuss new treatment approaches for bipolar disorder in children and adolescents
Target Audience:
Clinical and research professionals, students, and trainees as well as interested family members and individuals with
mental illness.
Continuing Education Credits:
ACT 48 – 2.0
CAC – 2.0
CME – 2.0
NBCC – 2.0
Psychologist – 2.0
SW – 2.0
CEU – 0.2
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing
Medical Education to provide continuing medical education for physicians. The University of Pittsburgh
School of Medicine designates this educational activity for a maximum of 2.0 AMA PRA Category 1 CreditsTM.
Each physician should only claim credit commensurate with the extent of their participation in the activity.
Other healthcare professionals are awarded 0.2 continuing education units (CEU's) which are equal to 2.0
contact hours.
Tuition:
This program is free of charge. Attendees requiring continuing education credits, however, will be asked to complete
an attendance form and submit it with payment ($5 for CEU’s, $25 for ACT 48, CAC, CME, CPRP, NBCC, Psychologist
and SW) after attending the program.
To register: Please complete the attached registration form or download the form at www.wpic.pitt.edu/oerp
Contacts:
Clinical Educator
Registrations
Joanne Slappo, PhD
Kyessa Brian
(412) 802-6918
(412) 802-6905
Telephone registrations CANNOT be accepted
Western Psychiatric Institute and Clinic is part of UPMC Presbyterian Shadyside
2007
February
VIDEOCONFERENCE
SERIES
W ESTERN PSYCHIATRIC INSTITUTE AND CLINIC
OFFICE OF EDUCATION AND REGIONAL PROGRAMMING
UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE
CENTER FOR CONTINUING EDUCATION IN THE HEALTH SCIENCES
CO-SPONSORED BY SOUTHWESTERN PA BEHAVIORAL HEALTH AND AGING COALITION
IDENTIFYING AT RISK OLDER ADULTS WHO MAY NEED BEHAVIORAL
HEALTH SERVICES AND SUPPORT
February 14, 2007
9:00 a.m. – 11:00 a.m.
Course Code: T211
Presenters:
Charles F. Reynolds, III, MD
Richard Morycz, PhD
UPMC Professor of Geriatric Psychiatry
Director, Advanced Center for Interventions and Services
Research for Late-Life Mood Disorders and
John A. Hartford Center of Excellence in Geriatric
Psychiatry
University of Pittsburgh School of Medicine
Program Director
Benedum Geriatric Center
Chief, Geriatric Clinical Service
Western Psychiatric Institute and Clinic
Associate Professor of Social Work
Program Description:
This program will examine the risk factors associated with depression and other mental health disorders in later life, as
well as preventive interventions. Risk factors for not maintaining mental health, such as issues of adjustment and poor
coping, will be examined. Preventive interventions such as community outreach will be discussed.
Educational Objectives:
At the conclusion of this program, participants should be able to:
1. Identify risk factors for depression and other mental health disorders in older adults
2. Review research on successful aging, what works and what doesn’t work
3. Describe preventative interventions which have proven to be successful
Target Audience:
Clinical and research professionals, students, and trainees as well as interested family members and individuals with
mental illness.
Continuing Education Credits:
ACT 48 – 2.0
CAC – 2.0
CME – 2.0
CPRP – 2.0
NBCC – 2.0
Psychologist – 2.0
SW – 2.0
CEU – 0.2
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing
Medical Education to provide continuing medical education for physicians. The University of Pittsburgh
School of Medicine designates this educational activity for a maximum of 2.0 AMA PRA Category 1 CreditsTM.
Each physician should only claim credit commensurate with the extent of their participation in the activity.
Other healthcare professionals are awarded 0.2 continuing education units (CEU's) which are equal to 2.0
contact hours.
Tuition:
This program is free of charge. Attendees requiring continuing education credits, however, will be asked to complete
an attendance form and submit it with payment ($5 for CEU’s, $25 for ACT 48, CAC, CME, CPRP, NBCC, Psychologist
and SW) after attending the program.
To register: Please complete the attached registration form or download the form at www.wpic.pitt.edu/oerp
Contacts:
Clinical Educator
Joanne Slappo, PhD
(412) 802-6918
Registrations
Kyessa Brian
(412) 802-6905
Telephone registrations CANNOT be accepted
Western Psychiatric Institute and Clinic is part of UPMC Presbyterian Shadyside
2007
February
W ESTERN PSYCHIATRIC INSTITUTE AND CLINIC
OFFICE OF EDUCATION AND REGIONAL PROGRAMMING
VIDEOCONFERENCE
SERIES
UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE
CENTER FOR CONTINUING EDUCATION IN THE HEALTH SCIENCES
SERIES
FAMILY EMERGENCY PLANNING: DISASTER PREPAREDNESS
FROM AN ORGANIZATIONAL AND BEHAVIORAL PERSPECTIVE
SERIES
February 28, 2007
9:00 a.m. – 11:00 a.m.
Course Code: T212
Presenter:
Robert S. Fonte, RN, MEd
Program Director, Crisis Training Institute
Office of Education and Regional Programming
Western Psychiatric Institute and Clinic
Program Description:
Emergency Preparedness Training is an introductory course designed to provide individuals with the fundamental
skills needed to prepare for and/or cope with disaster situations. The educational activities of this course are
designed to walk participants step by step through the disaster process, Emergency Family Planning, Building a
Home Disaster Supply Kit, and identification of local resources.
Educational Objectives:
At the conclusion of the program, participants should be able to:
1. Identify types and nature of disasters
2. Examine the impact of disasters and the disaster declaration process
3. Develop an understanding of individual behavioral responses in a disaster
4. Identify individual and community physical and psychological needs and interventions
5. Develop pre- and post-disaster strategies
Target Audience:
All clinical and research professionals, students, and trainees as well as interested family members and individuals
with mental illness.
Continuing Education Credits:
ACT 48 – 2.0
CAC – 2.0
CME – 2.0
CPRP – 2.0
NBCC – 2.0
Psychologist – 2.0
SW – 2.0
CEU – 0.2
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing
Medical Education to provide continuing medical education for physicians. The University of Pittsburgh
School of Medicine designates this educational activity for a maximum of 2.0 AMA PRA Category 1
CreditsTM. Each physician should only claim credit commensurate with the extent of their participation in
the activity. Other healthcare professionals are awarded 0.2 continuing education units (CEU's) which are
equal to 2.0 contact hours.
Tuition:
This program is free of charge. Attendees requiring continuing education credits, however, will be asked to
complete an attendance form and submit it with payment ($5 for CEU’s, $25 for ACT 48, CAC, CME, CPRP,
NBCC, Psychologist and SW) after attending the program.
To register: Please complete the attached registration form or download the form at
www.wpic.pitt.edu/oerp
Contacts:
Clinical Educator
Joanne Slappo, PhD
(412) 802-6918
Registrations
Kyessa Brian
(412) 802-6905
Telephone registrations CANNOT be accepted
Western Psychiatric Institute and Clinic is part of UPMC Presbyterian Shadyside
March
2007
W ESTERN PSYCHIATRIC INSTITUTE AND CLINIC
OFFICE OF EDUCATION AND REGIONAL PROGRAMMING
VIDEOCONFERENCE
SERIES
UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE
CENTER FOR CONTINUING EDUCATION IN THE HEALTH SCIENCES
PSYCHOPHARMACOLOGY UPDATE
March 14, 2007
9:00 a.m. – 11:00 a.m.
Course Code: T213
Presenters:
Tanya Fabian, PharmD, PhD
Directory of Pharmacy
Research and Pharmacy Services
Western Psychiatric Institute and Clinic
Program Description:
This program will provide an update on commonly prescribed psychotropic medications for adults and children with
mental illness. The program will review the indications, adverse drug reactions, important drug interactions, dosing and
administration of these agents. In addition, counseling for individuals with mental illness and their families regarding
medications will be discussed.
Educational Objectives:
At the conclusion of this program, participants will be able to:
1. Identify the various classes of psychopharmacologic agents presently being used
2. Monitor individuals with mental illness for the desired therapeutic outcome and for the potential occurrence of
adverse effects from the drugs
3. Provide individuals with mental illness and their families with the appropriate information and counseling
regarding these new medications
4. Develop an understanding of the economic implications associated with the use of these new drugs
Target Audience:
Clinical and research professionals, students, and trainees as well as interested family members and individuals with
mental illness.
Continuing Education Credits:
ACT 48 – 2.0
CAC – 2.0
CME – 2.0
CPRP – 2.0
NBCC – 2.0
Psychologist – 2.0
SW – 2.0
CEU – 0.2
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing
Medical Education to provide continuing medical education for physicians. The University of Pittsburgh
School of Medicine designates this educational activity for a maximum of 2.0 AMA PRA Category 1 CreditsTM.
Each physician should only claim credit commensurate with the extent of their participation in the activity.
Other healthcare professionals are awarded 0.2 continuing education units (CEU's) which are equal to 2.0
contact hours.
Tuition:
This program is free of charge. Attendees requiring continuing education credits, however, will be asked to complete
an attendance form and submit it with payment ($5 for CEU’s, $25 for ACT 48, CAC, CME, CPRP, NBCC, Psychologist
and SW) after attending the program.
To register: Please complete the attached registration form or download the form at www.wpic.pitt.edu/oerp
Contacts:
Clinical Educator
Registrations
Joanne Slappo, PhD
Kyessa Brian
(412) 802-6918
(412) 802-6905
Telephone registrations CANNOT be accepted
Western Psychiatric Institute and Clinic is part of UPMC Presbyterian Shadyside
2007
March
VIDEOCONFERENCE
SERIES
W ESTERN PSYCHIATRIC INSTITUTE AND CLINIC
OFFICE OF EDUCATION AND REGIONAL PROGRAMMING
UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE
CENTER FOR CONTINUING EDUCATION IN THE HEALTH SCIENCES
WORKING WITH INDIVIDUALS WITH AUTISM SPECTRUM
DISORDERS: THE FAMILY BASED APPROACH
March 28, 2007
9:00 a.m. – 11:00 a.m.
Course Code: T214
Presenters:
Jeannie Starzynski, LSW
Rebecca Burkley, MS
Clinical Program Director, Family Based Services
Clinical Supervisor, Family Based Autism Teams
Western Psychiatric Institute and Clinic
Western Psychiatric Institute and Clinic
Martin Lubetsky, MD
Child and Adolescent Psychiatry Services
Center for Autism and Development Disorders, Merck Program
Western Psychiatric Institute and Clinic
Associate Professor of Child and Adolescent Psychology
University of Pittsburgh School of Medicine
Program Description:
This program will review the Family Based (FB) model and the development of specialty teams to work with individuals with
autism spectrum disorder and their families. The FB model stresses the critical necessity to work and communicate with the
family to establish effective collaboration. The outcome of this commitment to collaboration is the enhancement and support of
the family’s capacity to remain intact in a way that promotes the best interest of the child or adolescent. The addition of the
Applied Behavior Analyst for individuals with autism spectrum disorder provides an important component to the traditional FB
team that enhances the skills of the family and the child, aids in continuity of care, crisis intervention, case management and
advocacy for the client and the family.
Educational Objectives:
Upon completion of this program, participants should be able to:
1. Describe structural family therapy as utilized by family based services
2. Identify tools used in family therapy
3. Utilize genograms, structural maps and ecomaps in assessing families
4. Develop treatment goals to plan for positive outcomes for the school-aged, autism spectrum children and their
families
Target Audience:
All clinical and research professionals, students, and trainees as well as interested family members and individuals with
mental illness.
Continuing Education Credits:
ACT 48 – 2.0
NBCC – 2.0
CEU – 0.2
CAC – 2.0
Psychologist – 2.0
CME – 2.0
SW – 2.0
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical
Education to provide continuing medical education for physicians. The University of Pittsburgh School of Medicine
designates this educational activity for a maximum of 2.0 AMA PRA Category 1 CreditsTM. Each physician should only claim
credit commensurate with the extent of their participation in the activity. Other healthcare professionals are awarded 0.2
continuing education units (CEU's) which are equal to 2.0 contact hours.
Tuition:
This program is free of charge. Attendees requiring continuing education credits, however, will be asked to complete
an attendance form and submit it with payment ($5 for CEU’s, $25 for ACT 48, CAC, CME, CPRP, NBCC, Psychologist
and SW) after attending the program.
To register: Please complete the attached registration form or download the form at www.wpic.pitt.edu/oerp
Contacts:
Clinical Educator
Joanne Slappo, PhD
(412) 802-6918
Registrations
Kyessa Brian
(412) 802-6905
Telephone registrations CANNOT be accepted
Western Psychiatric Institute and Clinic is part of UPMC Presbyterian Shadyside
Continuing Education Credit
Each program is offered for the designated number of continuing education credits
PHYSICIANS: CME
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing
Medical Education to provide continuing medical education for physicians. The University of Pittsburgh
School of Medicine designates these educational activities for a maximum number of AMA PRA Category 1
CreditsTM. Each physician should only claim credit commensurate with the extent of their participation in the
activity.
EDUCATORS: ACT 48
Western Psychiatric Institute and Clinic is recognized by the Pennsylvania Department of Education to offer
continuing education credits under Act 48 guidelines. Western Psychiatric Institute and Clinic adheres to
the Act 48 Continuing Education Guidelines.
CERTIFIED ADDICTION COUNSELORS: CAC
Western Psychiatric Institute and Clinic, Office of Education and Regional Programming is certified by the
Pennsylvania Chemical Abuse Certification Board (PCACB) to provide Certified Addiction Counselor (CAC)
continuing education credits for those participants attending the entire program.
CERTIFIED PSYCHIATRIC REHABILITATION PRACTITIONERS: CPRP
The announced credit hours for each program can be applied to your training hours for the Certified
Psychiatric Rehabilitation Practitioners (CPRP).
COUNSELORS: NBCC
Western Psychiatric Institute and Clinic is recognized by the National Board for Certified Counselors to offer
continuing education for National Certified Counselors. Western Psychiatric Institute and Clinic adheres to
the NBCC Continuing Education Guidelines.
PSYCHOLOGISTS
Western Psychiatric Institute and Clinic is approved by the American Psychological Association to offer
continuing education for psychologists. Western Psychiatric Institute and Clinic maintains responsibility for
this program and its contents. These programs are being offered for 2.0 continuing education credits.
SOCIAL WORKERS: SW
The indicated number of credit hours of continuing education is provided through co-sponsorship of the
University of Pittsburgh School of Social Work, a PA-approved provider of social work continuing education.
These credit hours satisfy requirements for LCSW renewal. For information of social work continuing
education, call (412) 624-3711.
MENTAL HEALTH PROFESSIONALS: CEU
Nurses and other health care professionals are awarded the designated number of Continuing Education
Units (CEU). One CEU is equal to 10 contact hours.
The University of Pittsburgh, as an educational institution and as an employer, values equality of opportunity, human dignity, and
racial/ethnic and cultural diversity. Accordingly, the University prohibits and will not engage in discrimination or harassment on
the basis of race, color, religion, national origin, ancestry, sex, age, marital status, familial status, sexual orientation, disability,
or status as a disabled veteran or a veteran of the Vietnam era. Further, the University will continue to take affirmative steps to
support and advance these values consistent with the University's mission. This policy applies to admissions, employment, access
to and treatment in University programs and activities. This is a commitment made by the University and is in accordance with
federal, state, and/or local laws and regulations. For information on University equal opportunity and affirmative action
programs and complaint/grievance procedures, please contact: William A. Savage, Assistant to the Chancellor and Director of
Affirmative Action (and Title IX and 504 Coordinator), Office of Affirmative Action, 901 William Pitt Union, University of
Pittsburgh, Pittsburgh, PA 15260, (412) 648-7860.
Participating Sites/Locations
Beaver County MH/MR/D&A
Beaver County CYS
8th Avenue
Conference Room B
Beaver Falls, PA 15010
Contact: Terri Cordes
724-847-6225
Community Care Behavioral
Health Organization
One Chatham Center, Suite 700
Room 750
Pittsburgh, PA 15219
Contact: Paul Wittman
412-454-8625
Dubois Regional Medical Center
Central Resource Center
Classroom A
100 Hospital Avenue
Dubois, PA 15801
Contact: Cindy Carnahan
814-375-3428
Greene Co. Human Services
(2/28 PROGRAM ONLY)
3rd Floor Fort Jackson Building
Small Conference Room
19 South Washington St.
Waynesburg, PA 15370
Contact: Tammy Henderson
724-852-5276
Torrance State Hospital
Torrance State Hospital
Greizman Building
Torrance, PA 15779
Contact: David Frantz
724-459-4410
Bradford Regional Medical
Center
Department of Education
116 Interstate Parkway
Bradford, PA 16701
Contact: Beth Price
814-362-8328
Community Education Council
4 Erie Ave, Suite 200
St. Mary’s, PA 15857
Contacts: Judy Smith
814-774-8016x136
UPMC Biomedical Science Tower
(Lobby of Eye and Ear Institute)
Room S104
Pittsburgh, PA 15213
Contact: Kyessa Brian
412-802-6905
Value Behavioral Health of PA
520 Pleasant Valley Road
Trafford, PA 15085
Contact: Brian Phelps
724-744-6308
VA Pittsburgh Healthcare
System
Highland Drive Division
Building 1, First Floor
Director’s Conference Room
7180 Highland Drive
Pittsburgh, PA 15206
Contact: Sara Salmon-Cox
412-365-4550
Venango County Exchange Bldg.
1283 Liberty Street
Room 309
Franklin, PA 16323
Contact: Nancy Rodgers
814-432-9753
Warren State Hospital
Medical Library
33 Main Street
N. Warren, PA 16365
Contact: Barb Frazier
814-726-4318
Erie County MH/MR
Site TBA
Contact: Patricia Popovich
814-451-6848
Mayview State Hospital
Regional Conference Center,
Dietary Building
1601 Mayview Road
Bridgeville, PA 15017
Contact: Jim Patrick
412-257-6738
Clarion County MH/MR
Site TBA
Contact: Kerry Keifer
814/226-6252 ext 563
Crawford County Courthouse
Crawford County Courthouse
903 Diamond Square
Room #3
Meadville, PA 16335
Contact: Stephanie Ace
814-373-2674
Fayette County MH/MR Program
Fayette County MH/MR Program
215 Jacob Murphy Lane
Conference Room 1
Uniontown, PA 15401
Contact: Bob Calisti
724-430-1370
Southwest Behavioral Health
Management Inc.
2520 New Butler Road
New Castle, PA 16101
Contact: Brian Bartley
724-657-3470
REGISTRATION FORM FOR THE VIDEOCONFERENCE SERIES JANUARY-MARCH 2007
Please MAIL or FAX this registration form to:
Please duplicate this registration form as needed
Kyessa L. Brian
PLEASE NOTE: Pre-registration is REQUIRED
OERP/WPIC
Telephone registrations CANNOT be accepted.
3811 O’Hara Street, Ross Building, 1st Floor
Please register TWO WEEKS BEFORE THE COURSE(S)
Pittsburgh, PA 15213
YOU WISH TO ATTEND as space may be limited.
Fax: 412-802-6910
Unless otherwise indicated, programs are FREE OF CHARGE
PLEASE BE AWARE THAT ONLY THE CONTINUING EDUCATION CREDITS LISTED ON THE INDIVIDUAL PROGRAM DESCRIPTION
ARE AVAILABLE FOR THAT PROGRAM.
Registration forms and information on our upcoming programs are available on the OERP website at: http://www.wpic.pitt.edu/oerp
Social Security# (last five digits only):
Name (Last, First):
Agency:
Address:
City:
State:
Zip code:
County:
Day Telephone: (
)
DEGREE
01 Psychology
02 Psychiatry
03 Professional/Technical
04 Medicine
05 Social Work
06 Nursing, RN
07 Nursing, LPN
08 Education
09 Related Therapies
10 Social Sciences
11 Administrative /Business
12 Other
01 High School
02 Associate Degree
03 Nursing Degree
04 Bachelor's Degree
05 Master's Degree
06 Doctoral Degree
07 M.D.
08 Other
JOB TITLE
Email:
Please note: You must apply for continuing education
credits on site by completing an attendance form and
submitting it with payment ($5 for general CEUs, $25 for
licensure credits) to OERP/WPIC after attending the
program.
Are You A WPIC Employee?
DISCIPLINE
Yes
No
01 Executive Director
02 County MH/MR Admin
03 Unit/Program Director
04 Unit Program Coordinator
05 Clinical Supervisor
06 Team Leader
07 Psychologist-Supervisor
08 Psychiatrist-Supervisor
09 Physician-Supervisor
10 Accountant
11 Medical Records
12 Clerical
13 Psychotherapist
14 Therapist
15 Caseworker
16 Case Manager
17 Counselor
18 Consultant
19 Intake/Assessment
20 Residential Program
21 Aide
22 Psychologist
23 Psychiatrist
24 Other Physician
25 Clergy/Chaplain
26 Staff Nurse
27 Other
PLEASE INDICATE WITH AN “X” WHICH PROGRAM(S) YOU WISH TO ATTEND
January
February
March
Attention Deficit Hyperactivity Disorder
in Adults 1/17/07 (T209)
Identifying At Risk Older Adults 2/14/07
(T211)
Psychopharmacology Update 3/14/07
(T213)
Children and Adolescents with Bipolar
Disorder 1/31/07 (T210)
Emergency Preparedness 2/28/07 (T212)
 Working with Individuals with Autism
Spectrum Disorders 3/28/07 (T214)
Please choose Videoconference location:
Greene Co Human Services (2/28 program only)
Beaver County MH/MR/D&A
Bradford Regional Medical Center
Mayview State Hospital
Clarion County MH/MR (Site TBA)
Southwest Behavioral Health Management Inc.
Community Care Behavioral Health Organization
Torrance State Hospital
Community Education Council (St. Mary’s)
UPMC Biomedical Science Tower
Crawford County Courthouse
Value Behavioral Health of Pennsylvania
Dubois Regional Medical Center
VA Medical Center
Erie County MH/MR
Venango County Exchange Building
Fayette County MH/MR Program
Warren State Hospital
This program is free of charge. Attendees requiring continuing education credits, however, will be asked to
complete an attendance form and submit it with payment ($5 for CEU’s, $25 for ACT 48, CAC, CME, CPRP, NBCC,
Psychologist and SW) after attending the program.
In accordance with Accreditation Council for Continuing Medical Education requirements on disclosure, information about relationships of presenters
with commercial interests (if any) will be included in materials distributed at the time of the conference.
Participation by all individuals is encouraged. Advance notification of any special needs will help us provide better service. Please notify us of your
needs at least two weeks in advance of the program by calling 412-802-6905.
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