Training Program offers clinical science training in three ... › wp-content › uploads › ... · The topics covered in these seminars range widely from in-depth discussions about

WELCOME!

The University of Wisconsin School of Medicine and Public Health (UW SMPH) Psychology Internship Training Program offers clinical science training in three tracks - Adult, Child, and Pediatric. Our internship has been accredited by the American Psychological Association (APA) since 1963. We are also a member of the Academy of Psychological Clinical Science (APCS), an alliance of leading, scientifically oriented, doctoral and internship training programs in clinical and health psychology.

Our training program emphasizes outpatient and hospital-based services for adults and children including individual, group, and family-based assessment and intervention. Specifically, we offer instruction in CBT, IPT, ACT, DBT, UP, mindfulness, social skills training, parent management, psychodynamic, and family systems approaches.

Our internship features clinical science training in an evidence-based clinical care setting. The program is structured, yet flexible. We strongly encourage self-directed learning and the pursuit of elective experiences. Ours is a rich, stimulating, and vital training milieu characterized by invigorating discussion and collaborative clinical instruction. Trainees describe our program as warm and friendly.

Please explore the opportunities that “your” internship offers. And don’t hesitate to contact any of the faculty if you have questions. We wish you well and look forward to an exciting year.

Gregory G. Kolden, Ph.D. Director of Psychology Training Adult Track Program Director

Contents Program Description ............................................................................................................................................ 4

Profession-Wide Competencies (PWC) .............................................................................................................. 7

Policies .................................................................................................................................................................. 10

Intern Recruitment and Selection ..................................................................................................................... 11

Practica and Academic Preparation Requirements ........................................................................................... 12

Policy on Administrative and Financial Assistance ......................................................................................... 13

Requirements for Successful Internship Performance ...................................................................................... 14

Intern Performance Evaluation, Feedback, Retention, and Termination Decisions ......................................... 15

Identification and Remediation of Insufficient Competence and/or Problematic Behavior ............................. 16

Grievance Procedures for Interns including Due Process ................................................................................ 18

Academic Improvement and Corrective Action ........................................................................................... 19

Appeals of Resident Corrective Actions ....................................................................................................... 23

Supervision Requirements ............................................................................................................................. 26

Maintenance of Records ................................................................................................................................... 27

Nondiscrimination Policies ............................................................................................................................... 28

Statement of Nondiscrimination ................................................................................................................... 28

Affirmative Action and Equal Opportunity Policy ....................................................................................... 29

Policy on Integrating Testing in Evidence-Based Assessment ......................................................................... 30

2019-2020 Schedules & Supervision .................................................................................................................. 31

2019-2020 Psychology Trainee Weekly Schedules .......................................................................................... 31

2019-2020 Drop-In Supervision Schedule ....................................................................................................... 32

2019-2020 Supervision Assignments ............................................................................................................... 33

Seminars 2019-2020 ......................................................................................................................................... 34

Psychology Intern Seminar Grid 2019-2020 .................................................................................................... 34

Seminars Overview 2019-2020 ........................................................................................................................ 37

Clinical Science and Consultation .................................................................................................................... 40

Child Seminar Overview .................................................................................................................................. 42

Evaluations .......................................................................................................................................................... 44

Psychology Trainee Competency Assessment Form (PTCAF) ........................................................................ 44

Supervisor Assessment Form (SAF) ................................................................................................................. 54

Seminar Evaluation ........................................................................................................................................... 57

End of Year Evaluation ..................................................................................................................................... 59

Internship Training Committee (ITC) .............................................................................................................. 69

BY-LAWS ........................................................................................................................................................ 70

Important Department Information ................................................................................................................. 72

Pagers and Paging ............................................................................................................................................. 73

Vacation and Personal Days ............................................................................................................................. 73

Phones ............................................................................................................................................................... 73

Fax Machine ..................................................................................................................................................... 73

Paper Shredders ................................................................................................................................................ 73

Computer Set-up and Assistance ...................................................................................................................... 73

Parking Issues ................................................................................................................................................... 74

Business Cards .................................................................................................................................................. 74

Book Fund ......................................................................................................................................................... 74

Mail/Mailroom .................................................................................................................................................. 74

Office Supplies ................................................................................................................................................. 74

Staff Lounge ..................................................................................................................................................... 74

Personal Office ................................................................................................................................................. 74

Wellness Room ................................................................................................................................................. 74

Stipend and Tax Withholding ............................................................................................................................ 75

Expense Reports .................................................................................................................................................. 76

Employee Bus Passes / Transportation Services .............................................................................................. 79

Leave Procedures – Psychology Training Program ........................................................................................ 81

Leave Request Form ......................................................................................................................................... 82

UW Health Non-Employee ID Badge New or Replacement Form................................................................. 83

Photo ID Badge ................................................................................................................................................. 84

Monthly Training Log ........................................................................................................................................ 86

Department of Psychiatry - Office Contact List 2019-2020 ............................................................................ 88

Psychology Internship Training Faculty/Staff ................................................................................................. 89

External Contact Information: .......................................................................................................................... 91

Reference Materials ............................................................................................................................................ 92

Authorization for Verbal Communication and/or to Leave Voice Mail Messages .......................................... 92

Authorization for Disclosure of Protected Health Information ........................................................................ 94

Authorization for Release of Verbal Communication and Exchange of Written Information ......................... 97

Adult New Patient Form ................................................................................................................................. 100

2019-2020 Trainee Pictures ............................................................................................................................ 102

Program Description

• Diversity of experience, allowing for exposure to depth and breadth. We offer a number of trainingexperiences across three tracks: adult, child, and pediatric psychology. Importantly, we collaborateacross these various tracks to offer a full internship experience to all of our interns. Each track allowsfor deepening areas of interest as well as new opportunities to round out your training. And variety doesnot just happen throughout the year—trainees often comment on how they appreciate having theopportunity to engage in different types of clinical experiences each day.

• Flexibility. One of our program’s core hallmarks is allowing you to create and choose your owninternship experience. You are given the opportunity to shape your core experiences and select from anumber of electives.

• Exposure to an array of psychotherapeutic frameworks. Our faculty celebrate a variety ofapproaches to patient care and offer a respectful environment in which to practice and learn.Frameworks represented in our training program include cognitive-behavioral, dialectical behavioral,acceptance and commitment, psychodynamic, family systems, interpersonal, emotion-focused, cognitiveprocessing, exposure, motivational interviewing, and mindfulness-based. We do not dictate thetheoretical orientation from which interns should work, and we greatly value the intern who is willing toconsider new perspectives and integrate frameworks.

• Ample supervision. With 5 hours or more of supervision a week, we want to make sure you have thespace and time you need to reflect on your practice and professional growth. Supervision occurs boththrough formal individual and group supervision time, as well as through each supervisor’s open doorpolicy.

• Respect for your autonomy and independence. Although we provide ample supervision andfeedback, we also respect your individual competence and contributions.

• Number and quality of seminars. We dedicate a full morning each week to didactic learning, in whichinterns from all three tracks work and learn together. Interns from the William S. Middleton MemorialVeterans Hospital (the Madison VA Hospital) and UW Psychiatry residents also share in some of thediscussion and learning in seminars. The topics covered in these seminars range widely from in-depthdiscussions about specific psychotherapy frameworks to topics like supervision, professionaldevelopment, multicultural practice, and psychopharmacology basics for psychologists. A collection ofspecialized seminars is also provided within the adult, child, and pediatric psychology tracks. Seminarleaders are often our core faculty, as well as adjunct faculty, sharing their expertise and inviting theskills and thoughts of our interns.

• Multidisciplinary collaboration. There is no shortage of opportunity to work with multidisciplinaryteams. Whether you are part of a psychiatric treatment team (e.g., working as a therapist on a complexcase alongside a psychiatrist, nurse, and social worker), working with a large team in a hospital unit(e.g., working as a psychological consultant alongside physicians, nurses, medical assistants, physicaltherapists, occupational therapists, speech therapists, social workers, and pastoral care), or in othersettings offered in our training experiences, you will find many opportunities to collaborate, contribute,and learn from other disciplines.

• Access to research and program development. UW-Madison is a large research institution with arobust number of exciting and cutting-edge research programs. Our internship offers the opportunity toconnect with some of our core faculty in their research projects, as well as the opportunity to connectwith other faculty across UW engaging in research of interest. For those who may be interested inclinical program development, we are also glad to support interns who wish to pursue such endeavors.

• Promotion of a positive work environment and self-care. Overall, trainees describe our program aswarm and friendly. We find this essential as internship year can be challenging! You are embarking on

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full-time clinical work for the first time, often in a new city, while balancing the completion of your graduate work and considering the next steps of your career. Our faculty understand these challenges and work to make your experience fun and supportive through supervision, seminars, and dedication of a full day to a self-care workshop designed by the interns for themselves. We also love to have fun outside of work with our interns and have a number of events set up throughout the year to help in promoting self-care and fellowship, including nights at the UW Terrace, our annual departmental holiday party, and a graduation dinner with a bonfire afterwards.

• Opportunities for training after internship. For those interested in a more clinically focused post-doctoral fellowship, we have several opportunities consistently offered through UW Health in healthpsychology and child and adolescent psychotherapy. There is also another clinical post-doctoralfellowship in the area of primary care behavioral health (this is also one of our off-site electiveopportunities). For those interested in a more research focused post-doctoral fellowship, those researchprograms available during your internship experience may also offer the opportunity to stay on forfellowship, and UW offers many training grants and fellowship awards that can be pursued during yourinternship year. Additionally, the Madison VA offers research-focused fellowships in addictions andwomen’s health. Regardless of whether you want to stay in Madison or search for your next opportunitymore broadly, you will find we want to support you in the process of selecting the next step of yourcareer.

• Training tailored to your career goals is prioritized. This is our main guiding principle, and wesupport interns in a variety of career paths. This allows all of our interns to explore the best path forthem moving forward. We are delighted you are considering us for your internship training.

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APA Accreditation Our internship program has been accredited by American Psychological Association (APA) since 1963. The last APA site visit occurred in 2013 at which time the program was fully reaccredited for seven years. The program’s next accreditation site visit will occur in 2020.

Office of Program Consultation and Accreditation American Psychological Association

750 First Street, N.E. Washington, D.C. 20002

Phone: 202-336-5979 Email: [email protected]

Website: www.apa.org/ed/accreditation

APCS Membership Our internship program is a member of the Academy of Psychological Clinical Science (APCS), an alliance of leading, scientifically oriented, doctoral and internship training programs in clinical and health psychology. Our training is integrative and patient-focused; we strive to prepare clinicians to provide quality clinical care informed by psychological clinical science.

Training Model and Philosophy Our internship program follows a clinical science model of training and is intended for those individuals whose training and interests emphasize the application of scientific principles within clinical psychology. Our educational mission emphasizes evidence-informed approaches to clinical care. Our goal is to provide our interns with a comprehensive training experience that will enable them to become highly effective clinicians. The primary training method is experiential with conscientious attention to didactic exposure, mentoring, modeling and supervisory/consultative guidance. Clinical experiences are structured in order to achieve a balance between ongoing activities throughout the internship year and activities that change according to predictable time frames. All clinical activities are carefully supervised according to the required needs and desires of the individual intern. Special attention is given to training in and provision of evidence-based practice in all training activities. Professional and ethical conduct, as well as the highest standards for quality of care with multicultural awareness, are also highly emphasized.

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mailto:[email protected]

http://www.apa.org/ed/accreditation

http://acadpsychclinicalscience.org/

Profession-Wide Competencies (PWC)

Our program provides clinical and educational activities for all interns to achieve and demonstrate competency in the core elements of the professional practice of health service psychology “profession-wide competencies” (PWC). To “be competent” is to possess the knowledge, skills, and abilities to carry out clinical activities well enough to meet a standard of performance. The standard of performance for completion of psychology internship training is “readiness for entry-level practice”. Performance expectations for interns for minimum levels of achievement (MLA) always take into consideration level of training, prior clinical experience, and stage of professional development. In general, interns are expected to demonstrate each PWC with increasing levels of independence and complexity as they progress through the training year so that at completion each intern demonstrates readiness for entry-level practice. The Psychology Trainee Competency Assessment Form (PTCAF) specifies the content of each PWC and associated elements. Supervisors complete the PTCAF quarterly for each intern they oversee and provide performance feedback in a face-to-face conversation. Interns will have met performance expectations for MLA for required profession-wide competencies and successful program progression (i.e., “readiness for entry-level practice”) when they have achieved average ratings of “intermediate- routine supervision required”. In addition, interns will have no specific competency element rated by any supervisor as "Entry Level - Remedial/intensive supervision required".

1. Research: Understanding of research. Respect for scientifically derived knowledge.

Element 1.1 Scientific mindedness

Element 1.2 Scientific foundation

Element 1.3 Evidence-based practice

Element 1.4 Scientific evaluation

2. Ethical and Legal Standards: Application of ethical concepts and awareness of legal issues regardingprofessional activities. Seeks consultation as needed.

Element 2.1 Knowledge and understanding of ethical, legal, and professional standards and guidelines

Element 2.2 Awareness and application of ethical decision making.

Element 2.3 Ethical conduct

Element 2.4 Risk management

3. Individual and Cultural Diversity: Awareness, sensitivity and skills in clinical work with diverse individualsand communities.

Element 3.1 Cultural self-awareness

Element 3.2 Cultural awareness of others

Element 3.3 Cultural awareness in interactions

4. Professional Values, Attitudes, and Behaviors: Comportment that reflects the values of integrity andresponsibility.

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Element 4.1 Integrity

Element 4.2 Deportment

Element 4.3 Accountability

Element 4.4 Seeks consultation/supervision

Element 4.5 Engages in self-care

Element 4.6 Administrative efficiency

5. Communication and Interpersonal Skills: Relates effectively and meaningfully. Demonstrates personal andprofessional self-awareness.

Element 5.1 Demonstrates productive and respectful relationships

Element 5.2 Affective skills

Element 5.3 Expressive skills

Element 5.4 Self-Awareness

Element 5.5 Effective use of emotional reactions in clinical interactions.

6. Assessment: Evaluation and diagnosis of problems, issues and strengths of individuals andgroups/communities.

Element 6.1 Diagnosis and Formulation

Element 6.2 Evaluation methods

Element 6.3 Conceptualization and recommendations

Element 6.4 Communication of findings

7. Intervention: Designs and implements treatment plans to alleviate suffering as well as promote health andwell-being.

Element 7.1 Nonspecific skills

Element 7.2 Intervention planning

Element 7.3 Knowledge of interventions

Element 7.4 Intervention implementation

Element 7.5 Individual therapy skills and preparation.

Element 7.6 Group therapy skills and preparation.

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Element 7.7 Couple/marital therapy skills and preparation.

Element 7.8 Family therapy skills and preparation.

Element 7.9 Progress Evaluation

8. Supervision: Understanding of supervision. Respect for supervisory process and functions.

Element 8.1 Expectations and roles

Element 8.2 Processes and procedures

Element 8.3 Supervisory relationships

Element 8.4 Participation in peer consultation process

Element 8.5 Ethical and legal issues

9. Consultation and interprofessional/interdisciplinary skills: Awareness of concepts and issues in relateddisciplines. Cultivation of interactions with professionals in related disciplines. Provision of professionalassistance and guidance.

Element 9.1 Knowledge of the shared and distinctive contributions of other professions

Element 9.2 Participation in interprofessional/interdisciplinary contexts

Element 9.3 Respectful and productive relationships

Element 9.4 Role of consultant

Element 9.5 Consultation assessment

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Policies

1. Intern Recruitment and Selection

2. Any required prior doctoral program preparation and experiences

a. Practica and Academic Preparation Requirements

3. Administrative and Financial Assistance

4. Requirements for Successful Internship Performance

5. Intern Performance Evaluation, Feedback, Retention and Termination Decisions

6. Identification and Remediation of Insufficient Competence and/or Problematic Behavior

7. Grievance Procedures for Interns including Due Process

a. Academic Improvement and Corrective Action

b. Appeals of Resident Corrective Actions

8. Supervision Requirements

9. Maintenance of Records

10. Nondiscrimination Policies

a. Statement of Nondiscrimination

b. Affirmative Action

11. Integrating Testing in Evidence-Based Psychological Assessment

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UW SMPH Psychology Internship Training Program Updated 5/11/15, 4/5/17, 4/30/19

Intern Recruitment and Selection

Applicants may be invited for an interview after a review of application materials. Notification of interview decision will be no later than December 15. The UW SMPH Psychology Internship Training Program interview days typically take place in December and January. Interviews using computer technology (e.g., Skype) are an option in exceptional circumstances. We invite all applicants to identify special needs that might require an accommodation during the interview process. The UW SMPH Psychology Internship Training Program is committed to providing access for all people with disabilities and will provide accommodations for interviewees if notified within two weeks of interview day. The training program adheres to APPIC policies regarding applicants with special needs. For more information about assistance to individuals with special needs please refer to the APPIC web site (www.appic.org - “Interviewing Applicants with Disabilities for Doctoral and Postdoctoral Internship Positions”).

The UW SMPH Psychology Internship Training Program participates in the APPIC Internship Matching Program (www.appic.org). Our program agrees to abide by the APPIC policy that no person at this training facility will solicit, accept, or use any ranking-related information from any intern applicant.

UWCHS training faculty and current interns participate in the selection process by involvement in reviewing applicant materials and face-to-face interviews. After all applicant interviews have been completed, a meeting is convened in which applicants are discussed and ranked for submission to the APPIC match process.

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http://www.appic.org/


Practica and Academic Preparation Requirements

The program determines the appropriateness of an intern’s overall clinical and academic qualificiations relative to the program’s goals and objectives via a process for considering applicants that can be referred to as a “wholistic review” whereby an application (AAPI, letters of recommendation, CV, interviews) is evaluated with an eye toward “goodness-of-fit” with regard to program goals and objectives based on academic preparation, clinical practicum experiences, motivation, achievements and life experiences, personal qualities and any unique or outstanding characteristics (i.e., diversity broadly defined).

Applicants must be enrolled in an accredited doctoral program in clinical, counseling, or school psychology (APA or APCS). Applications from members of diverse populations (e.g., gender, race, ethnicity, age, sexual orientation, religious affiliation, socioeconomic class, and health status) are especially welcomed. Applicants from graduate programs adhering to a clinical science model of training are preferred as the UW SMPH Psychology Internship Training Program is a member of the Academy of Psychological Clinical Science. Clinician-scientist trained Psy.D. applicants may be considered on a case by case basis. Applicants from school psychology programs may also be considered on a case by case basis for the child and pediatric tracks. All applicants must have completed the third year of their graduate program by the beginning of the internship year. Completion of all academic work, including the dissertation, is preferred. Practicum experiences will be evaluated for type of setting and clinical experiences commensurate with the respective training tracks of Adult, Child, and Pediatric. The Adult and Child Tracks look for broad-based outpatient assessment, consultation, and intervention experiences, especially those outside departmental training clinics. The Pediatric Track emphasizes hospital-based assessment, consultation, and intervention experiences with medically ill children and adolescents. As a guideline we consider the minimum number of AAPI intervention hours to be 500 and the minimum number of AAPI assessment hours to be 100. Overall, we prefer 1000 hours of clinical experience (intervention, assessment and supervision) with a minimum of 800. In addition, we also consider types of clinical experiences (e.g., DBT, mindfulness, diverse populations, special interests), achievements (e.g., leadership positions in program, community service, research record), personal qualities (e.g., foreign language, character, interpersonal skills, resilience/adversity, self-care), and unique/outstanding characteristics (e.g., diversity/multicultural background, awards).

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Policy on Administrative and Financial Assistance

Administrative Assistance

Interns have offices with computers, telephones, photocopy privileges, and clerical support. Pagers are also issued to interns. Educational resources available to interns include the University of Wisconsin library and computer systems, a departmental library, and audiovisual equipment for viewing and recording clinical work. The UW SMPH Psychology Internship Training Programis also supported by a 50% time internship coordinator (funded by the Department of Psychiatry).

Financial Assistance

A $25,350 stipend is provided along with fringe benefits that include health insurance and a professional expense allowance ($400). Interns also receive 16 days of vacation as well as recognized holidays and a limited number of paid sick days. Attendance at local, regional, and national professional meetings is encouraged. Additional leave days may be negotiated for professional activities (e.g., dissertation-related work, presentations at meetings, postdoctoral fellowship and/or job interviews).

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UW SMPH Psychology Internship Training Program Updated 6/14/17, 5/10/19

Requirements for Successful Internship Performance

The UW SMPH Psychology Internship Training Program requires that interns complete 2000 hours of training activities within a 12-month time frame for successful fulfillment of program goals and objectives. In addition, expectations for successful internship performance are defined according to minimal levels of achievement (MLA) for required profession wide competencies (PWC) as specified on our Psychology Trainee Competency Assessment Form (PTCAF). The PTCAF is designed to guide psychology trainees in the development of PWCs as well as provide constructive, written feedback regarding professional development. Supervisors provide quarterly ratings of competency elements reflecting knowledge, skills, and values observed during training activities including at least one instance of direct observation (either live or electronic) per quarter of the trainee engaged in clinical activities overseen by the supervisor. In addition to these ratings, supervisors are encouraged to provide narrative comments highlighting individualized training feedback. Trainees receive copies of the PTCAF at the time of orientation to internship training. Expectations for MLA and feedback are also reviewed at that time.

MLA defined: Performance expectations for interns for MLA using the PTCAF should always take into consideration level of training, prior clinical experience, and stage of professional development. In general, interns are expected to demonstrate each PWC with increasing levels of independence and complexity as they progress over the course of the training year. Trainees will have met expectations for MLA for required PWCs and successful program completion when they have achieved average ratings of 4 or higher for each competency domain across supervisors and clinical training activities. In addition, trainees will have no specific competency element rated by any supervisor less than 4. That is, the trainee will not have received a rating on any element as "Entry Level - Remedial/intensive supervision required". In the situation where it is recognized that a trainee is not meeting expectations for MLA, procedures for remediation are to be initiated immediately (see policy entitled “Identification and Remediation of Insufficient Competence and/or Problematic Behavior”). The appeals process is outlined in the policy “Grievance Procedures for Interns including Due Process”.

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Intern Performance Evaluation, Feedback, Retention, and Termination Decisions

Performance Evaluation. Our Psychology Trainee Competency Assessment Form (PTCAF) is completed quarterly by supervisors and is designed to guide psychology trainees in the development of profession wide competencies (PWC) as well as provide constructive, written feedback regarding professional development. Supervisors provide ratings of knowledge, skills, and values observed during training activities including at least one instance of direct observation (either live or electronic) per quarter of the trainee engaged in clinical activities overseen by the supervisor. In addition to these ratings, supervisors are encouraged to provide narrative comments highlighting individualized training goals and objectives. Trainees receive copies of the PTCAF at the time of orientation to internship training. Expectations for performance, feedback, retention and termination decisions are also reviewed at that time and each intern is provided with written copies of the relevant policy statements including the document outlining “Grievance Procedures for Interns including Due Process”.

Feedback. Supervisors are expected to develop an individualized training plan with each intern for which they provide clinical supervision. Expectations and standards for clinical knowledge, skills, and values associated with PWC are discussed during weekly meetings. Supervisees may complete the PTCAF in a self-report fashion at the beginning of training experiences to elucidate areas in which they believe they demonstrate relative strength as well as areas where continued growth is required. Trainee specific goals and objectives should emerge from this process. The PTCAF is completed quarterly by supervisors and discussed with interns.

Retention. The manner in which PTCAF ratings are used to lead to recommendations for administrative actions due to unsatisfactory performance (i.e., insufficient competence and/or problematic behavior or misconduct) is determined by each supervisor. Supervisors may consider PWC element ratings, critical incidents, and the constellation of ratings in arriving at their recommendations. Expectations for minimum levels of achievement (MLA) are outlined in the policy document “Requirements for Successful Internship Performance” and reflected in the rating anchors for the PTCAF. The PTCAF is organized by the PWCs (specified in the Standards of Accreditation; SoA) and constituent elements.

Each individual PWC element is operationalized by observable behaviors, skills, and attitudes that are rated by supervisors on a 10-point scale - 10 (Advanced Skills- independent practice), 7-9 (High Intermediate – occasional supervision), 4-6 (Intermediate– routine supervision), 1-3 (Entry-level– Remedial-Intensive supervision). Intermediate to High-Intermediate indications on the PTCAF correspond to ratings from 4 to 9 on any specific PWC element. Interns are expected to demonstrate each PWC with increasing levels of independence and complexity as they progress over the course of the training year. Trainees will have met expectations for MLA for PWCs and successful program completion when they have achieved average ratings of 4 or higher for each PWC domain across supervisors and clinical training activities. In addition, trainees will have no specific PWC element rated by any supervisor less than 4. That is, the trainee will not have received a rating on any element as "Entry Level - Remedial/intensive supervision required". This MLA criterion demonstrates appreciation for growth and remediation as necessary during the the training program while at the same time clearly articulating expectations for intermediate to high-intermediate levels of skill for each PWC element as the training year progresses.

Termination Decisions. Steps for addressing substandard intern performance requiring administrative action (up to and including dismissal from the program) and development of a remediation plan are specified in the program document entitled “Identification and Remediation of Insufficient Competence and/or Problematic Behavior”. Intern appeal processes are specified in the program document “Grievance Procedures for Interns including Due Process”.

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UW SMPH Psychology Internship Training Program Reviewed 6/14/17 Updated 5/1/19

Identification and Remediation of Insufficient Competence and/or Problematic Behavior

Identification of Insufficient Competence and/or Problematic Behavior or Misconduct Psychology interns are formally evaluated by supervising training faculty using the Psychology Trainee Competency Assessment Form (PTCAF). Expectations for intern performance are specified in two policy documents - “Requirements for Successful Internship Performance” and “Intern performance evaluation, feedback, retention, and termination decisions”. The manner in which PTCAF ratings are used to lead to recommendations for administrative actions due to the identification of insufficient competence and/or problematic behavior or misconduct is determined by training faculty. Training faculty may consider profession wide competency (PWC) ratings, critical incidents, and the constellation of ratings in arriving at recommendations for academic improvement and/or corrective action. Expectations for minimum levels of achievement (MLA) are outlined in the policy document “Requirements for Successful Internship Performance”. Any concerns or difficulties that are identified during the course of these evaluations may be addressed by the appropriate steps outlined below - “Psychology Intern Remediation Procedures” and “Psychology Intern Dismissal Procedures”. In addition, intern performance expectations are subject to an institutional level Graduate Medical Education policy titled “Academic Improvement and Corrective Action” (see attached document). Psychology Intern Remediation Procedures Once it is recognized that a trainee is falling short of expectations for MLA due to either insufficient competence and/or problematic behavior or misconduct, a competency assessment form is to be completed immediately by the supervising training faculty and shared with the trainee, Track Director, and Director of Psychology Training. Initiation of this procedure constitutes “notice”. In order to allow the trainee an opportunity to meet expectations for MLA, performance expectations must be promptly developed and clearly specified in a remediation plan agreed upon by all parties. Completion of this procedural step constitutes “hearing”. At the end of the specified remediation period, expectations for MLA included in the remediation plan will be reviewed by the trainee, supervisor, Track Director and Director of Psychology Training. If the trainee requires additional remediation, the procedural steps outlined above are to be repeated until the trainee has met expectations for MLA. Interns are required to meet performance expectations for MLA in order to successfully complete the training program. A psychology intern may initiate appeal procedures in response to the decision to initiate remediation procedures and/or the outcome of a remediation plan. Appeal procedures are outlined below and guided by the institutional level Graduate Medical Education policy titled “Appeals of Resident Corrective Actions” (see attached). Psychology Intern Dismissal Procedures As noted above, interns are required to meet performance expectations for MLA in order to successfully complete the training program. An intern may be dismissed from the program if they fail to meet expectations for MLA due to either insufficient competence and/or problematic behavior or misconduct, after repeated attempts at remediation. Whenever possible, performance review and remediation procedures will be conducted within the framework of the psychology training program. However, this may not always be viable. Trainee behavior could automatically trigger intervention by institutional representatives or external persons and/or agencies.

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Appeal Procedures A psychology intern may initiate appeal procedures in response to the decision to initiate remediation procedures and/or the outcome of a remediation plan. The appeal will be taken up by the University of Wisconsin Department of Psychiatry Vice Chair of Education and the Department Chair. These individuals will conduct an independent appraisal of the remediation process and procedures followed, review the remediation plan documentation, and conduct interviews with the parties involved (i.e., intern and training faculty). The psychology intern may designate a training faculty member of their choosing as an advocate in this process. The process will also be guided by the institutional level Graduate Medical Education policy titled “Appeals of Resident Corrective Actions”. Following the completion of this process, a formal written decision will be rendered regarding the substantive content of the appeal.

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Grievance Procedures for Interns including Due Process

Psychology interns are entitled to pursue grievances according to procedures of due process without fear of retribution. Due process procedures involve steps of notice, hearing and appeal. The guidelines specified below are intended to provide psychology interns with a formal process to resolve disagreements that cannot be resolved by informal means.

A psychology intern may initiate grievance procedures at any time as outlined.

Step 1: Raise the issue with a supervising training faculty in an effort to resolve the grievance-related issue. The intern is encouraged to keep personal documentation of these efforts. Initiation of this procedural step constitutes “notice”.

Step 2: If the matter cannot be resolved with the training faculty supervisor, the next level of recourse is to present the issue to the Track Training Director and to notify the Director Psychology Training in writing that this step has been initiated. Written documentation of this process should be maintained by both the intern and the Training Track Director. In addition, the psychology intern may designate a training faculty member of their choosing as an advocate in this process.

Step 3: If the matter cannot be resolved at the level of the Track Training Director, the next level of recourse is to present the issue to the Director of Psychology Training. Written documentation of this process should be maintained by both the intern and the Director of Psychology Training.

Step 4: If the intern and the Director of Psychology Training cannot resolve the matter, the Director will choose a member of the training faculty, acceptable to the psychology intern, who will attempt to mediate the grievance-related disagreement. Again, written documentation of this process should be maintained by the intern and The Director of Psychology Training.

Step 5: If mediation fails, the Internship Training Committee will review the grievance-related issue based on materials supplied by the psychology intern, the supervising training faculty, the Track Director, the Director of Psychology Training and the chosen faculty mediator. The psychology intern, supervisor, Track Director, Director of Psychology Training, and chosen training faculty mediator must be present for this discussion. The Internship Training Committee will offer a formal written decision regarding the grievance.

Appeal Procedures A psychology intern may initiate appeal procedures in response to the grievance-related decision of the Internship Training Committee. The appeal will be taken up by the University of Wisconsin Department of Psychiatry Vice Chair of Education and the Department Chair. These individuals will conduct an independent appraisal of the grievance process and the procedures followed, review the written documentation, and conduct interviews with the parties involved as deemed necessary. The psychology intern may designate a training faculty member of their choosing as an advocate in this appeal process. The process will also be guided by the principles inherent in the institutional level Graduate Medical Education policy titled “Appeals of Resident Corrective Actions”. Following the completion of this process, a formal written decision will be rendered regarding the substantive content of the grievance-related appeal.

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Graduate Medical Education Departmental Policy Policy Title: Academic Improvement and Corrective Action Policy Number: 43.2

Effective Date: December 16, 2015 Version: New

I. PURPOSETo establish procedures for all UW Health Graduate Medical Education (GME) training programs to followif a resident fails to meet academic expectations and/or engages in misconduct.

II. PERSONS AFFECTEDThis policy applies to all residents and fellows in Graduate Medical Education (GME) programssponsored by the University of Wisconsin Hospitals and Clinics Authority (UW Health).

III. DEFINITIONSA. The term “resident” refers to residents and fellows in ACGME accredited programs.B. Program(s) will refer to ACGME-accredited program(s) sponsored by the University of Wisconsin Hospitals

and Clinics Authority (UW Health).C. UW Health: For the purpose of this policy, the term “UW Health” shall mean University of Wisconsin

Hospitals and Clinics Authority, which is the sponsoring institution of the ACGME- accredited training programs. “UW Health” is the trade name of University of Wisconsin Hospitals and Clinics Authority and its affiliates.

D. Defined Training Period: The length of the training program as defined by the ACGME.

IV. POLICYE. Academic Deficiency - the resident is not meeting an objective assessment of competence in one or more of

the ACGME Core Competencies (patient care and procedural skills, medical knowledge, practice-basedlearning and improvement, interpersonal and communication skills, professionalism, and systems-basedpractice) or is not meeting expected milestone levels. Examples of academic deficiencies include but are notlimited to:1) Issues involving knowledge or skills;2) Job performance or scholarship; and3) Minor professionalism concerns.

F. Misconduct - the resident’s conduct or behavior violates workplace rules or policies, applicable law, or widelyaccepted societal norms. Examples of misconduct include but are not limited to:1) Unethical conduct, such as dishonesty or falsification of records;2) Significant professionalism concerns;3) Illegal conduct (regardless of criminal charges or criminal conviction);4) Sexual misconduct or sexual harassment;5) Workplace violence;6) Tardiness, absenteeism, or job abandonment;

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7) Boundary violations with patients;8) Failure to meet conditions of employment; and9) Violation of UW Health or other applicable policies or procedures.

G. Structured Feedback – giving a resident documented assessment of his/her competence in one or more of theACGME Core Competencies for the purpose of helping the trainee understand aspects of his/her performancein order to reflect on, and where necessary, improve learning and practice.

H. Academic Improvement Plan (AIP) - a plan of academic remediation designed to improve aresident’s proficiency in one or more ACGME Core Competencies. An AIP is not Corrective Action or formaldisciplinary action, but rather an educational tool to correct areas of unsatisfactory academic performance by aresident. Therefore, a resident may not appeal an AIP pursuant to the Appeals of Resident Corrective ActionsPolicy. The issuance of an AIP does not trigger a report to any outside agencies, but may be reported shouldan outside agency specifically inquire whether a resident ever received remediation. An AIP may include oneor more of the following measures:1) Additional academic study and/or assessment;2) Repetition of Rotation - due to identified areas of unsatisfactory performance, the resident must repeat a

rotation and perform at an acceptable level in order to advance to the next level of training.3) Extension of the Defined Training Period – due to identified areas of unsatisfactory performance, the

resident will not complete the program on time and the defined training period will be extended to allowthe resident an opportunity to perform at the level required.

I. Corrective Action - formal disciplinary action issued to a resident as the result of unsatisfactory academicperformance and/or misconduct. The program is not required to issue a resident an AIP as a prerequisite toCorrective Action. Serious academic deficiencies and/or misconduct may warrant Corrective Action up toand including dismissal, regardless of whether a resident ever received an AIP. A Corrective Action mayinclude one or more of the following measures:1) Probation - formal notification to the resident that there are identified areas of unsatisfactory

performance that will require remediation and/or improvement or the resident will not be permitted tocontinue in program.

2) Suspension – the resident is temporarily not permitted to perform any job duties due tounsatisfactory performance.

3) Non-promotion to the next PGY level or successful program completion - due to identified areas ofunsatisfactory performance, the resident will not be promoted to the next level of training or graduatedfrom the program unless or until the resident’s performance improves to the level required.

4) Non-renewal – the resident completes current contract and is then terminated from the program.5) Dismissal – the resident is permanently separated from the program prior to the end of their contract.A Corrective Action may trigger a report to outside agencies (e.g., licensing or certification boards) and isappealable pursuant to the General Grievances and Due Process for Corrective Actions Policy.

J. Appeals – Actions which result in probation, suspension, non-renewal, non-promotion or dismissal mustreceive due process in accordance with the ACGME program and institutional level appeals policies (IRIV.C.1.b).

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V. PROCEDURESK. Providing Structured Feedback

1) When a program determines a resident has an academic deficiency, the program may elect to first providestructured feedback to the resident concerning the deficiency. Depending on the level of deficiency, thefeedback may be in the form of a letter of advisement or warning.

2) Structured feedback should include discussion with the resident of the specific (or global)deficiencies and strategies for improvement.

3) Structured feedback, including documentation of verbal feedback, must be documented in the resident’sfile.

4) If the program determines that structured feedback has not produced the necessary improvement within aspecified amount of time, or the deficiency is significant enough to warrant more formal action, the programmay elect to issue an AIP or Corrective Action.

L. Issuing an Academic Improvement Plan (AIP)1) An AIP must be in the form of a letter from the program director to the resident and should follow the

AIP Template available from the UW Health GME Office. An AIP must include:a. formal notice to the resident of the specific academic deficiencies;b. the remedial action or improvement that is required;c. a plan of remediation to correct the deficiencies;d. a defined period of time the resident has to correct cited deficiencies (e.g., 60 days) with a start and end

date; ande. information regarding the Employee Assistance Program.

2) The AIP must be reviewed and approved by the Director of Graduate Medical Education before it isdelivered to the resident.

3) The AIP must be signed by the program director, delivered to the resident in person, and co- signed by theresident. If the resident refuses to sign, the program director should note this on the document.

4) A copy of the signed AIP must be placed in the resident’s file and forwarded to the UW Health GMEOffice.

5) At the end of the AIP period, the program director must provide the resident with written notice as towhether the resident has or has not satisfactorily corrected the deficiency. A copy of this written notice mustbe placed in the resident’s file and forwarded to the UW Health GME Office.

6) If the program director determines that the resident has failed to satisfactorily correct thedeficiency or produce the necessary improvement(s) outlined in the resident’s AIP by the end of the AIPperiod, the resident may be issued an updated or new AIP or Corrective Action.

7) If the program director determines that there is insufficient evidence of progressive improvement after areasonable time to evaluate during the AIP period, the program director may move to corrective actionwhich may include termination.

8) An AIP is academic in nature and is not appealable pursuant to the Appeals of Resident CorrectiveActions Policy.

M. Issuing Corrective Action1) When a program director has determined that Corrective Action is warranted, the program director should

first consult the UW Health GME Office. A Corrective Action cannot be issued to a resident until it hasbeen reviewed and approved by the Director of Graduate Medical Education.

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2) A Corrective Action must be in the form of a letter from the program director to the residentand must include:

a. the specific Corrective Action measure(s) to be taken;b. a description of the academic deficiencies and/or incidents of misconduct that

are the basis for the Corrective Action;c. the specific remedial action or improvement that is required (unless the

Corrective Action is dismissal);d. a defined period of time the resident has to correct cited deficiencies (e.g., 60 days)

with a start and end date (if applicable);e. information regarding the Employee Assistance Program; andf. notice of the right to appeal, the deadline to initiate an appeal, and that failure to

timely appeal constitutes the resident’s waiver of all appeal rights.3) The Corrective Action should be signed by the program director, delivered to the resident in

person, and co-signed by the resident. If the resident refuses to sign, the program directorshould note this on the document.

4) A copy of the signed Corrective Action must be placed in the resident’s file and forwardedto the UW Health GME Office.

5) If the Corrective Action was suspension, probation, or dismissal and the resident timelysubmits an appeal, the program director may remove the resident from participation in theprogram (administrative leave) pending final resolution of the appeal.

VI. RESPONSIBILITIESN. Clinical Competency Committee or Clinical Education Committee - advise the program director

about resident performance and progress and make recommendations to the program directorregarding promotion, remediation, and dismissal decisions.

O. Director of Graduate Medical Education – review and approve all AIPs and Corrective Actionsbefore they are issued to the resident; provide guidance to the program director regarding thisprocedure and the proper handling of academic improvement and corrective action issues involvingresidents.

P. Program Director - make decisions regarding resident performance; ensure structured feedback, AIPsand Corrective Actions are given in accordance with this procedure and in consultation with theDirector of Graduate Medical Education.

VII. COORDINATIONSr. Management Sponsor: Susan L. Goelzer, MD, M.S., Designated Institutional OfficialAuthor: Director, Graduate Medical Education and Medical Staff Administration Approval Committee: Graduate Medical Education Committee

SIGNED BY Susan L. Goelzer, MD, M.S. Professor of Anesthesiology, Internal Medicine and Population Health Sciences Senior Medical Director for GME/Designated Institutional Official Associate Dean for Graduate Medical Education

Revision Details: Previous Revision Date: New Next Revision Due: 12/16/2018 (3 years after effective date)

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Graduate Medical Education Department Policy Policy Title: Appeals of Resident Corrective Actions Policy Number 43.4 Effective Date: December 16, 2015 Version: Revision (previous titled Appeals of Resident Evaluation, Discipline, Non-Renewal or Dismissal Decisions)

I. PURPOSE

All GME programs at UW Health will promote fair, reasonable, efficient and equitable resolutions for generalgrievances that may arise in the course of residency training. Residents who receive Corrective Action pursuant tothe Academic Improvement and Corrective Action Policy will be permitted to appeal in accordance with the dueprocess procedure outlined herein. Actions which result in probation, suspension, non-renewal, non-promotion ordismissal must receive due process in accordance with the ACGME program and institutional level requirements(IR IV.C.1.b).

II. PERSONS/PROGRAMS AFFECTED

This policy applies to all residents and fellows in Graduate Medical Education (GME) programs sponsored bythe University of Wisconsin Hospitals and Clinics Authority (UW Health).

III. DEFINITIONS

A. The term “resident” refers to residents and fellows in ACGME accredited programs.B. “Program(s)” refers to ACGME-accredited program(s) sponsored by the University of Wisconsin

Hospitals and Clinics Authority (UW Health).C. UW Health: For the purpose of this policy, the term “UW Health” shall mean University of Wisconsin

Hospitals and Clinics Authority, which is the sponsoring institution of the ACGME- accreditedtraining programs. “UW Health” is the trade name of University of Wisconsin Hospitals and ClinicsAuthority and its affiliates.

D. “Days” is defined as calendar days exclusive of Saturdays, Sundays and legal holidays.

IV. POLICY

A. Each GME training program must maintain a program policy and procedure for providing residentswith fair, reasonable, and accessible procedures for appeals and due process at the program and/ordepartment level. The policy is to minimize conflict of interest by adjudicating parties in addressingacademic or other disciplinary actions taken against residents that could result in probation,suspension, non-renewal, non-promotion or dismissal. At a minimum, these appeal policies andprocedures must include:

• timelines,• a written request of appeal by the resident,• review or reviews that include(s) at least 2 faculty members, and• written notification of the decision and information about the next level of appeal.

B. Intradepartmental review and appeal mechanisms must be completed before the resident mayrequest an institutional review of issues delineated above.

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C. The written notice of the final department decision must include the intended action and shall offerthe resident an opportunity for appeal to the GME Appeals Committee (Committee).

D. No resident shall be penalized or retaliated against in any way for filing grievances or appeals.E. If no review or appeal is requested within the noted timelines at any stage of the procedure, the last

decision made will take effect as specified in the written notification. Further appeal of the decisionshall be deemed waived.

V. PROCEDURES

A resident may appeal a Corrective Action received pursuant to the Academic Improvement and Correction ActionPolicy as follows:

A. To initiate the appeal process, the resident must submit a written appeal to the GME Office([email protected] or 600 Highland Ave, Madison, WI 53792) within five (5) days of receipt ofnotice of the Corrective Action being appealed. The resident’s appeal should state the facts on which theappeal is based, the reason(s) the resident believes the Corrective Action was in error, and the remedyrequested.

B. The Committee shall schedule a review meeting within twenty (20) days of the receipt of thewritten request of appeal. Timelines may be extended by mutual agreement of the parties involved.

C. The GME Office will send a Hearing Notice to the resident and program director. The Hearing Noticewill contain the names of the Committee members, the date, time and location of the appeal hearing,and the deadline to submit evidence. The resident should receive at least ten (10) days’ notice of thehearing date.

D. Any evidence the resident or the program director wishes the Committee to consider must be submittedto the GME Office at least five (5) days prior to the appeal hearing. Submissions should contain anyevidence (including witness statements and written, recorded, or electronic material) believed to berelevant to the appeal. Failure to submit evidence in the time and manner required by the GME Officemay result in the material not being considered by the Committee. The GME Office will facilitate theexchange of evidence between the resident and the program director and will provide copies of allevidence to the Committee.

E. The Committee chairperson has wide discretion with respect to conducting the appeal hearing. Ingeneral, appeal hearings will proceed according to the following format:

1. The program director may make a presentation to the Committee up to twenty (20) minutes.2. The resident may make a presentation to the Committee up to twenty (20) minutes.3. The program director will have up to ten (10) minutes to respond to the statements made by

the resident.4. The resident will have up to ten (10) minutes to respond to the statements made by the

program director.5. Panel members may ask questions of the resident and/or the program director.

6. Peers or witnesses other than the program director and the resident will not be permitted toparticipate in the appeal hearing unless called by the Committee. In the event the Committee

elects to hear from additional witnesses, the program director and the resident may question those witnesses.

7. Following the appeal hearing, the Committee shall deliberate privately.F. The Committee will make a determination of the facts involved and whether the

program decision shall stand. This committee will provide a writtenrecommendation to the CEO within fifteen (15) days of the review meeting.

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G. The CEO shall review the matter and make the final decision. The CEO will notify theGME Office, resident, program director and department chair of the final decision inwriting.

H. If no review or appeal is requested within the noted timelines at any stage of the procedure,the last decision made will take effect as specified in the written notification. Further appeal ofthe decision shall be deemed waived.

I. MODIFICATIONS

This policy creates no rights, contractual or otherwise. Statements of policy obtained herein are notmade for the purpose of inducing any person to become or remain an employee of UW HEALTH,and should not be considered "promises" or as granting "property" rights. UW HEALTH may add to,subtract from and/or modify this policy at any time. Nothing contained in this policy impairs the rightof an employee of UW HEALTH to terminate the employment relationship at-will.

II. COORDINATION

Sr. Management Sponsor: Susan L. Goelzer, MD, M.S., Designated Institutional OfficialAuthor: Director, Graduate Medical Education and Medical Staff Administration ApprovalCommittee: Graduate Medical Education Committee

SIGNED BY

Susan L. Goelzer, MD, M.S. Professor of Anesthesiology, Internal Medicine and Population Health Sciences Senior Medical Director for GME/Designated Institutional Official Associate Dean for Graduate Medical Education

Revision Details: Previous Revision Date: August 21, 2013 Next Revision Due: December 16, 2018

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Supervision Requirements Supervisors

All supervisors of interns are faculty members who have doctoral degrees in psychology, medicine, or a master’s level graduate degree in a related mental health field (e.g., Licensed Marital and Family Therapy, Counseling Psychology, Social Work). Supervisors, regardless of degree type, are licensed to practice in the state of Wisconsin and credentialed by UW Health. Supervisors are required to be in good standing with the appropriate Wisconsin State Licensing Board. Supervisors are assigned by Track Training Directors (all of whom have doctoral degrees in psychology and are responsible for the interns overall training plan) based on the sites at which interns are involved in training activities. Supervisors provide written feedback to interns quarterly for required profession wide competencies (PWC) as specified on our Psychology Trainee Competency Assessment Form (PTCAF). Quarterly feedback is based in part on at least one instance of direct observation (either live or electronic) of the trainee engaged in clinical activities overseen by the supervisor. Furthermore, supervisors are available on-site whenever an intern is engaging in a clinical activity.

Interns

Interns receive at a minimum at least 4 hours of supervision each week at least 2 of which are individual and face-to-face provided by a licensed psychologist. The purpose of supervision is to discuss patient issues and the intern's professional performance and development. Topics discussed in supervision may include the conduct of supervision itself, multiple aspects of patient care, intern education, professional expectations, and administrative duties. If problems of any sort arise in supervision, grievance and due process procedures are implemented according to formal policies.

Issues may also include, but are not limited to, the following: • Assessment, differential diagnosis and case formulation• Disposition and treatment planning• Risk assessment and management• Crisis procedures and need for higher level of care• Consultation and referral• Documentation• Countertransference/transference issues• Caseload management• Termination issues• Confidentiality/privacy issues• Missed/late sessions• Boundary issues• Ethical issues• Legal issues• Financial issues

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Maintenance of Records

Records are securely maintained and retained indefinitely. Access to these records is limited to the Program Coordinator, the Director of Psychology Training, and the Track Directors.

Contents of the records minimally include the following documents: 1. Intern AAPI and CV2. Correspondence with graduate program (notification after the match, mid-year letter, final letter)3. All evaluation forms*4. Written complaints and/or grievances from the intern5. Written documentation regarding any intern competency achievement/performance issues6. A copy of the intern’s final certificate of completion

*It should be noted that as of 7/1/2016 the following records have been retained in electronic format on theMedHub system and in folder on a secure program server with limited access as noted above: intern quarterlycompetency assessments by supervisors, supervisor assessments by interns, seminar assessments by interns, andend of year program evaluations by interns.

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Nondiscrimination Policies UW SMPH Psychology Internship Training Program Updated 5/8/2019

Statement of Nondiscrimination

The University of Wisconsin is an equal opportunity employer (see the Affirmative Action and Equal Opportunity Policy at the following url - http://www.wisc.edu/policies/aaeo/ ). As such, the UW SMPH Psychology Internship Training Program does not discriminate on the basis of sex, age, race, color, national origin, religion, sexual orientation or disability or any other applicable legally protected status in appointments to, or conduct of, our psychology training program. We encourage applicants from diverse backgrounds to apply and we endeavor to foster an atmosphere that supports diversity of experiences as well as opinions. All eligible candidates are invited to apply for position vacancies as appropriate. Furthermore, our program strives to avoid any actions that would restrict access or completion on grounds that are irrelevant to success in graduate training or the profession.

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http://www.wisc.edu/policies/aaeo/

Affirmative Action and Equal Opportunity Policy

True learning requires free and open debate, civil discourse and tolerance of many different individuals and ideas. We are preparing students to live and work in a world that speaks with many voices and from many cultures. Tolerance is not only essential to learning, it is an essential to be learned. The University of Wisconsin–Madison is built upon these values and will act vigorously to defend them. We will maintain an environment conducive to teaching and learning that is free from intimidation for all.

In its resolve to create this positive environment, the UW–Madison will ensure compliance with federal and state laws protecting against discrimination. In addition, the UW–Madison has adopted policies that both emphasize these existing protections and supplement them with protections against discrimination that are not available under either federal or state law.

Federal and state laws provide separate prohibitions against discrimination that is based on race, color, creed, religion, sex, national origin or ancestry, age, or disability. State law additionally prohibits discrimination that is based on sexual orientation, arrest or conviction record, marital status, pregnancy, parental status, military status, or veteran status. The application of specific state prohibitions on discrimination may be influenced by an individual's status as an employee or student.

Department of Defense personnel policies governing enlistment and commissioning of armed forces personnel and awarding of Reserve Officer Training Corps scholarships to UW–Madison students do discriminate on the basis of sexual orientation. The University of Wisconsin Board of Regents and UW–Madison faculty, staff and student governance groups have registered their strong opposition to this discrimination and urge the Department of Defense to change its policy.

University policies create additional protections that prohibit harassment on the basis of cultural background and ethnicity. Inquiries concerning this policy may be directed to the appropriate campus admitting or employing unit or to the Office for Equity and Diversity <http://www.oed.wisc.edu/> , 179A Bascom Hall, 500 Lincoln Drive, Madison, WI 53706, 608/263-2378 or (TDD) 608/263-2473.

Feedback, questions or accessibility issues: [email protected] <mailto:[email protected]>

©2019 Board of Regents of the University of Wisconsin System

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http://www.oed.wisc.edu/

http://www.oed.wisc.edu/




UW SMPH Psychology Internship Training Program Created 12/17/01 Updated 9/11/2013, 5/8/2019

Policy on Integrating Testing in Evidence-Based Assessment

Comprehensive training in clinical psychology requires attention to the development of competence in evidence-based assessment. This includes evaluation and diagnosis of problems, issues, and strengths of individuals and groups/communities. Specific competency elements include diagnosis and formulation, evaluation methods, conceptualization and recommendations, and communication of findings (see Psychology Trainee Competency Assessment Form, Competency 5).

Evidence-based assessments of psychological functioning include data from testing instruments (broadly defined) as is warranted by the nature of presenting and/or suspected problems, referral questions, and domains relevant for progress/outcome monitoring. The guidelines articulated below are offered to ensure that each psychology trainee has the opportunity to achieve competence in assessment.

Each psychology intern is expected to work collaboratively with their supervisor(s) to develop an assessment “portfolio” that is consistent with their interests, learning objectives, and clinical activities. The portfolio is comprised of copies of written documentation (e.g., formal reports, progress notes, clinical information notes, treatment summaries) demonstrating the completion of at least six (6) work products integrating data from testing instruments. Trainees are encouraged to consult with supervisors throughout the internship year on the compilation of their assessment portfolio.

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2019-2020 Schedules & Supervision 2019-2020 Psychology Trainee Weekly Schedules

Adult Track Emily Sargent – DBT Monday; Dana Bruck-Segal – DBT Thursday Amber Craig – DBT Friday

MON TUES WED THUR FRI AM OPC Elective OPC

Intakes Seminars

DBT Consult Group

OPC

PM OPC Couples Clinic

Elective OPC

Child Clinic

OPC Elective

Child Track Jordan Horwath, Jennifer Stewart

MON TUES WED THUR FRI AM

OPC-JS PCPBH- JH

Elective OPC Intakes

Seminars

DBT Consult Grp

OPC

Family Clinic

PM OPC-JS PCPBH- JH

Elective OPC

Child Clinic

OPC

DBT Group

Elective

Pediatric Track (Wed PM)

Kristine Pickwith, Joelle Zegas

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2019-2020 Drop-In Supervision Schedule

Mondays

AM Greg Kolden (Adult) Liz Bartholomew (Child)

PM Meredith Rumble (Adult) Jason Horowitz (Child)

Tuesdays No Coverage

Wednesdays

AM Daniel Dickson (Adult) Stephanie Steinman (Child)

PM Jason Horowitz (Child) Mike Thalasinos (Child)

Thursdays

AM No Coverage

PM Greg Kolden (Adult) Jason Horowitz (Child)

Fridays

AM Greg Kolden (Adult) Michael Thalasinos (Child)

PM No coverage unless arranged

Faculty Pager Numbers: Liz Bartholomew 1693 Daniel Dickson 1478 Jane Gogan: 6158 If the supervisor does not appear within the scheduled Jason Horowitz: 5863 appointment time you should page them. Greg Kolden: 7420 Meredith Rumble 6159 Stephanie Steinman: 0660 Michael Thalasinos: 3360

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2019-2020 Supervision Assignments Psychology Interns

7/1/19 to 12/31/19

Adult Track Interns Supervisor Supervisor

1. Dana Bruck-Segal Gogan Sweetnam 2. Amber Craig Kolden Serlin 3. Emily Sargent Rumble Treece

Child Track Interns

1. Jordan Horwath Wells Bartholomew 2. Jennifer Stewart Rosh

Peds Track Interns (WISPIC)

1. Kristine Pickwith Horowitz – Child Faculty 2. Joelle Zegas Horowitz – Child Faculty

Peds Track Interns (UWHC)

1. Kristine Pickwith Farrell-Peds Faculty 2. Joelle Zegas Farrell-Peds Faculty

Electives

Adult Track Interns Supervisor Elective

1. Dana Bruck-Segal Lori DuBenske Cancer Psychology 2. Amber Craig Meghan Fondow Access 3. Emily Sargent Meghan Fondow Access

Peds Track Interns

4. Kristine Pickwith Justin Moore East Outpatient and Pain Psychology 5. Joelle Zegas Justin Moore East Outpatient and Pain Psychology

Child Track Interns

6. Jordan Horwath Meredith Rumble Behavioral Sleep Medicine 7. Jennifer Stewart Stephanie Farrell Inpatient Pediatric Consultation

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Seminars 2019-2020 Psychology Intern Seminar Grid 2019-2020

Dates 8-9 9-10 10-11 11-127/4/19 Holiday 7/11/19 Crisis and Hospital Intake Demo-SS Intake Demo Child Seminar 7/18/19 Crisis and Hospital Intake Demo-DD Intake Demo Child Seminar

7/25/19 Practical Epic I Diversity: Cultural Humility-EH DBT-6 Child Seminar

8/1/19 Psychosocial Oncology I Behavioral Activation I DBT Child Seminar 8/8/19 Psychosocial Oncology II Behavioral Activation II DBT Child Seminar 8/15/19 Research: Eating Disorders Sleep DBT Child Seminar 8/22/19 Practical Epic II Sleep DBT Child Seminar 8/29/19 Research: Women’s MH Sleep DBT Child Seminar 9/5/19 Diversity: Family Care Sleep MBCT-8 Child Seminar 9/12/19 Child Seminar- pharm MI MBCT Adult-pharm 9/19/19 Ethics MI MBCT Child Seminar 9/26/19 Postdoc/PD IPT MBCT Child Seminar 10/3/19 Psychotherapy Demo-JG IPT MBCT Child Seminar 10/10/19 Child Seminar- pharm IPT MBCT Adult-pharm 10/17/19 Child Seminar-sleep Postdoc/PD MBCT Diversity- Using Interpreter Services 10/24/19 Postdoc/PD IPT MBCT Child Seminar 10/31/19 Postdoc/PD IPT OPEN Child Seminar 11/7/19 Psychotherapy Demo-DD IPT AODA-6 Child Seminar 11/14/19 Child Seminar- pharm IPT AODA Adult-pharm 11/21/19 Ethics-LD ACT-10 AODA Child Seminar 11/28/19 Holiday 12/5/19 Psychotherapy Demo- SS ACT AODA Child Seminar 12/12/19 Child Seminar- pharm ACT AODA Adult-pharm 12/19/19 Research: Novel Treatments ACT AODA Child Seminar 12/26/19 Holiday

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Dates 8-9 9-10 10-11 11-12 1/2/2020 Holiday 1/9/2020 Research: BMT ACT Unified Protocol-6 Child Seminar 1/16/2020 Research: BMT ACT Unified Protocol Child Seminar 1/23/2020 Technology as Tx ACT Unified Protocol Child Seminar 1/30/2020 Patient Decision Making ACT Unified Protocol Child Seminar 2/6/2020 Psychotherapy Demo-MR ACT Unified Protocol SELF-CARE DAY 2/13/2020 Research: Goldberg MBCT ACT Unified Protocol Child Seminar 2/20/2020 IPSRT I Psychodynamic-8 Psychodynamic Child Seminar 2/27/2020 IPSRT II Psychodynamic Supervision-10 Child Seminar 3/5/2020 Psychotherapy Demo-MT Psychodynamic Supervision Child Seminar 3/12/2020 Research: Rumble Sleep Psychodynamic Supervision Child Seminar 3/19/2020 Ethics-EC Psychodynamic Supervision Child Seminar 3/26/2020 Research: Anxiety-JC Psychodynamic Supervision Child Seminar 4/2/2020 Psychotherapy Demo-EH Psychodynamic Supervision Child Seminar 4/9/2020 Diversity: TBD-GS CBT-10 Supervision Child Seminar 4/16/2020 Research-Interns-7 CBT Supervision Child Seminar 4/23/2020 Research-Interns CBT Supervision Child Seminar 4/30/2020 Research-Interns CBT Supervision Child Seminar 5/7/2020 Research-Interns CBT Professional Development-6 Child Seminar 5/14/2020 Research-Interns CBT Professional Development Child Seminar 5/21/2020 Research-Interns CBT Professional Development Child Seminar 5/28/2020 Research-Interns CBT Professional Development Child Seminar 6/4/2020 Ethics-MT CBT Professional Development Child Seminar 6/11/2020 NO SEMINAR CBT Professional Development Child Seminar 6/18/2020 NO SEMINAR NO SEMINAR NO SEMINAR NO SEMINAR 6/25/2020 NO SEMINAR NO SEMINAR NO SEMINAR NO SEMINAR

PTSD Treatment Workshop: Th 9/5 1-5PM PE (James Lickel, Ph.D.); Fri 9/6 8-12PM CPT (Kristin Bull-Lyon, Ph.D.); Parent Skills Training Workshop: Wed Sept 25, 1-5PM (Carissa Dietzler, LPC); Self-Care: Feb 6, 2020 (Stephanie Steinman, Ph.D.)

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Seminars Overview 2019-2020

Seminars covering a broad range of topics are offered throughout the training year. In addition, each track offers didactic content specific to the needs of the track.

Thursday

8 – 9 a.m. Clinical Science and Consultation (CS&C) Includes guest speakers, faculty presentations, and presentations by interns on various topics including research, ethics, diversity and multicultural issues, and clinical presentations. See 2019-20 CS&C overview document and Seminar Grid 2019-20.

9 – 10 a.m. Psychotherapy Seminars

Behavioral Activation (BA) Erin Costanzo, Ph.D. (2 sessions; 8/1 – 8/8/19)

Behavioral Sleep Medicine (BSM) Meredith Rumble, Ph.D. (4 sessions; 8/15 – 9/5/19)

Motivational Interviewing (MI) Daniel Dickson, Ph.D. (2 sessions; 9/12 – 9/19/19)

Interpersonal Psychotherapy (IPT) Gregory G. Kolden, Ph.D. (7 sessions; 9/26 – 11/14/19)

Acceptance and Commitment Therapy (ACT) Erin Costanzo, Ph.D. (10 sessions; 11/21 – 2/13/20)

Psychodynamic Psychotherapy Jane Gogan, Ph.D. (8 sessions; 2/20 – 4/2/20)

Cognitive Behavioral Therapy (CBT): Advance Techniques Meredith Rumble, Ph.D. & Daniel Dickson, Ph.D. (10 sessions; 4/9 – 6/11/20)

10:00 – 11:00 a.m. Clinical Seminars

DBT Overview Stephanie Steinman, Ph.D. (6 sessions; 7/25 - 8/29/19)

Mindfulness-Based Cognitive Therapy (MBCT) Stephanie Steinman, Ph.D. and Gregory G. Kolden, Ph.D. (8 sessions; 9/5 – 10/24/19)

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Alcohol and Substance Use Disorders Assessment & Intervention Stephanie Steinman, Ph.D. (6 sessions; 11/7 – 12/19/19)

Unified Protocol (UP) Daniel Dickson, Ph.D. (6 sessions; 1/9 – 2/13/20)

Supervision Meredith Rumble, Ph.D. & Gregory G. Kolden, Ph.D. (10 sessions: 2/27- 4/30/20)

Professional Development Meredith Rumble, Ph.D. & Gregory G. Kolden, Ph.D. (6 sessions: 5/7 – 6/11/20)

11 a.m. – 12 p.m. Child Seminar Includes guest speakers, faculty presentations, and presentations by interns on various topics including research, ethics, diversity and multicultural issues, and clinical presentations. See 2019-20 CS&C overview document and Seminar Grid 2019-20.

Other Seminars

Mondays - Adult Track

3 – 4 p.m. Couple Interventions Michael Thalasinos, LMFT (10 sessions; 7/8 – 9/16/19)

Tuesdays – Pediatric Track

11 a.m. – 12 p.m. Pediatric Case Conference Stephanie Farrell, Ph.D. (10 sessions; Monthly-Aug. thru May)

Wednesdays - Adult/Child Track

11 a.m. – 12 p.m. Assessment Seminar Stephanie Steinman, Ph.D. and Daniel Dickson, Ph.D. (48 sessions)

Thursdays – Adult/Child Track

12 – 1 p.m. DBT Consultation Group Stephanie Steinman, Ph.D. (48 sessions)

38

Fridays – Child Track

3 – 4 p.m. Family Interventions Michael Thalasinos, LMFT (10 sessions; 7/12 – 9/20/19)

Workshops

9/5/19 1-5:00 pm PTSD Treatment Workshop: PE Michael Messina, PhD and James Lickel, PhD

9/6/19 8-12:00 PTSD Treatment Workshop: CPT Kristin Bull-Lyon, PhD 9/25/19 1-5:00 pm Parent Skills Training Workshop Carissa Dietzler, LPC 11/7/19 1-5:00 pm Multicultural Workshop: Implicit Bias Training Erri Hewitt, PhD 2/6/20 11-5:00 Self-Care Workshop Stephanie Steinman, PhD

39

Clinical Science and Consultation 2019-2020

Thursday 8-9:00 AM WISPIC - Room 1414

The Seminar in Clinical Science and Consultation is a weekly seminar attended by psychology faculty, postdoctoral fellows, and interns. Presentations are offered in four broach areas: ethics (monthly), research, clinical topics, and professional development. This is an excellent forum for conversations on research ideas and projects in progress as well as current clinical practice issues. Furthermore, it is a “friendly” venue for practicing more formal presentations (e.g., dissertation proposals, dissertation defenses, meeting/conference talks, job talks) as well as a chance to learn what others are doing.

Dates Topic Presenter 7/4/19 NO SEMINAR NO SEMINAR 7/11/19 Crisis Management and Hospitalization I Meredith Rumble, PhD 7/18/19 Crisis Management and Hospitalization II Meredith Rumble, PhD

7/25/19 Practical Epic I Michael Thalasinos, LMFT,

Daniel Dickson, PhD & Stephanie Steinman, PhD

8/1/19 Psychosocial Oncology I Erin Costanzo, PhD 8/8/19 Psychosocial Oncology II Erin Costanzo, PhD 8/15/19 Eating Disorders Research Katherine Schaumberg, PhD

8/22/19 Practical Epic II Michael Thalasinos, LMFT,

Daniel Dickson, PhD & Stephanie Steinman, PhD

8/29/19 Research: Maternal mental illness Zac Stowe, MD 9/5/19 Diversity: Family Caregivers Lori DuBenske, PhD 9/12/19 Child Psychopharmacology Rolando Gonzalez, MD 9/19/19 Ethics: Case Discussion Gregory G. Kolden, PhD 9/26/19 Postdoctoral Training Meredith Rumble, PhD 10/3/19 Psychotherapy Demonstration/Discussion Jane Gogan, PhD 10/10/19 Child Psychopharmacology Rolando Gonzalez, MD 10/17/19 Sleep in Children Justin Moore, PsyD 10/24/19 Postdoctoral Training Meredith Rumble, PhD 10/31/19 Postdoctoral Training Meredith Rumble, PhD 11/7/19 Psychotherapy Demonstration/Discussion Daniel Dickson, PhD 11/14/19 Child Psychopharmacology Rolando Gonzalez, MD 11/21/19 Ethics: Case Discussion Lori DuBenske, PhD 11/28/19 HAPPY THANKSGIVING Tom T. Turkey, PhD 12/5/19 Psychotherapy Demonstration/Discussion Stephanie Steinman, PhD 12/12/19 Child Psychopharmacology Rolando Gonzalez, MD 12/19/19 Research: Novel Strategies and Treatments Steven Garlow, MD, PhD 12/26/19 Happy Holidays Feliz Navidad, PhD

40

2020

1/2/2020 HOLIDAY HOLIDAY 1/9/2020 Research: BMT I Erin Costanzo, PhD 1/16/2020 Research: BMT II Erin Costanzo, PhD 1/23/2020 Research: Technology as Adjuvant Therapy Lori DuBenske, PhD 1/30/2020 Clinical: Patient Decision Making Lori DuBenske, PhD 2/6/2020 Psychotherapy Demonstration/Discussion Meredith Rumble, PhD 2/13/2020 Research: MBCT Simon Goldberg, PhD 2/20/2020 Clinical: IPSRT I Gregory G. Kolden, PhD 2/27/2020 Clinical: IPSRT II Gregory G. Kolden, PhD 3/5/2020 Psychotherapy Demonstration/Discussion Michael Thalasinos, LMFT 3/12/2020 Research: Sleep Meredith Rumble, PhD 3/19/2020 Ethics: Case Discussion Erin Costanzo, PhD 3/26/2020 Research: Anxiety Josh Cisler, PhD 4/2/2020 Psychotherapy Demonstration/Discussion Erri Hewitt, PhD 4/9/2020 Diversity: TBD Gwyneth Schell, PhD 4/16/2020 Research: Intern TBD 4/23/2020 Research: Intern TBD 4/30/2020 Research: Intern TBD 5/7/2020 Research: Intern TBD 5/14/2020 Research: Intern TBD 5/21/2020 Research: Intern TBD 5/28/2020 Research: Intern TBD 6/4/2020 Ethics: Case Discussion Michael Thalasinos, LMFT 6/11/2020 NO SEMINAR NO SEMINAR 6/18/2020 NO SEMINAR NO SEMINAR 6/25/2020 NO SEMINAR NO SEMINAR

41

Child Seminar Overview

The Seminar for Children and Adolescents is a weekly seminar attended by psychology faculty, postdoctoral fellows, and interns. Presentations are offered across a wide variety of clinic topics. Goals include developing knowledge and intervention tools for use in multiple clinical settings with a diverse group of clients. It is also an opportunity to discuss difficult patients with faculty and staff with specific areas of expertise.

Dates Topic Presenter 7/4/19 NO SEMINAR NO SEMINAR 7/11/19 Intro to Child Clinic Jason Horowitz, PhD 7/18/19 First Sessions Jason Horowitz, PhD 7/25/19 Risk Assessment & Safety Issues Anne Totero, LMFT 8/1/19 ADOS and Autism Assessment Aisha Rosh, PhD 8/8/19 Working with families with divorce Jason Horowitz, PhD 8/15/19 Normative Child Development Erri Hewitt, PhD 8/22/19 School Psychology Aisha Rosh, PhD 8/29/19 School Psychology Aisha Rosh, PhD 9/5/19 Risk and Resilience in Youth Erri Hewitt, PhD9/12/19 Psychopharmacology (8:00) Rolando Gonzalez, MD 9/19/19 NICU and Post-partum depression Emily Schweigert, PhD 9/26/19 Behavioral Interventions in Medical Settings Jenni LeNoble, PhD 10/3/19 Adherence Emily Schweigert, PhD 10/10/19 Psychopharmacology (8:00) Rolando Gonzalez, MD 10/17/19 Sleep Disorders (8:00) Justin Moore, PhD 10/24/19 Primary Care Behavioral Health Shanda Wells, PhD & Meghan Fondow, PhD 10/31/19 Primary Care Behavioral Health Shanda Wells, PhD & Meghan Fondow, PhD 11/7/19 Primary Care Behavioral Health Shanda Wells, PhD & Meghan Fondow, PhD 11/14/19 Psychopharmacology (8:00) Rolando Gonzalez, MD 11/21/19 Adolescent Treatment Issues Anne Totero, LMFT 11/28/19 HAPPY THANKSGIVING Tom T. Turkey, PhD 12/5/19 Sentinel Injury and Mandatory Reporting Jessica Wipperfurth, LCSW/Amanda Palm, PA 12/12/19 Psychopharmacology (8:00) Rolando Gonzalez, MD 12/19/19 Adjustment to Chronic Illness Stephanie Farrell, PhD 12/26/19 Happy Holidays Feliz Navidad, PhD

42

2020

1/2/2020 HOLIDAY HOLIDAY 1/9/2020 TF-CBT Paula Witt, LCSW 1/16/2020 Eating Disorders Katherine Schaumberg, PhD 1/23/2020 Eating Disorders Katherine Schaumberg, PhD 1/30/2020 Medically Unexplained Symptoms Jenni LeNoble, PhD 2/6/2020 Self-Care Day Self-Care Day 2/13/2020 Unified Protocol with Kids Aisha Rosh, PhD 2/20/2020 MDFT Paula Witt, LCSW 2/27/2020 MDFT Paula Witt, LCSW 3/5/2020 Families Coping with Illness and Death Erri Hewitt, PhD 3/12/2020 Autism Treatment Katie Watermolen, PsyD 3/19/2020 Autism Treatment Katie Watermolen, PsyD 3/26/2020 Gender Transitions Melissa Heinemann, PsyD 4/2/2020 Gender Transitions Melissa Heinemann, PsyD 4/9/2020 In-home Family Therapy Mike Thalasinos, LMFT 4/16/2020 Sports Psychology Rolando Gonzalez, MD/Aisha Rosh, PhD 4/23/2020 Mindful Parenting Stephanie Steinman, PhD 4/30/2020 Talking about sex in therapy Stephanie Steinman, PhD 5/7/2020 Social Skills Training Liz Bartholomew, LCSW 5/14/2020 Termination issues Mike Thalasinos, LMFT 5/21/2020 Health Care Systems Greg Rogers, PhD 5/28/2020 Play and Experiential Therapy Stephanie Steinman, PhD 6/4/2020 6/11/2020 6/18/2020 NO SEMINAR NO SEMINAR 6/25/2020 NO SEMINAR NO SEMINAR

43

Preview FormPrinted on May 06, 2019

Psychology Trainee Competency Assessment Form (PTCAF)

Insufficient contact to evaluate (delete evaluation)

1 2 3 4

Quarter Evaluating

Please specify clinical activity/service for which intern isbeing evaluated. *

Competency Assessment Methods

Direct Observation* No

Videotape/Audiotape* No

Review of written work* No

Review of testing data* No

Case presentation* No

Discussion of clinical interaction* No

Comments from other clinical staff* No

Patient feedback* No

Competency 1: Research

Understanding of research. Respect for scientifically derived knowledge.

N/AEntry Level-

Remedial-Intensive supervisionIntermediate-

Routine supervisionHigh Intermediate-

Occasional supervisionAdvanced skills-

Independent practice

0 1 2 3 4 5 6 7 8 9 10

Element 1.1 Scientific mindedness: Seeks and appliesscientific knowledge to the solution of clinicalproblems.*

N/AEntry Level-





44

0 1 2 3 4 5 6 7 8 9 10

Element 1.2 Scientific foundation: Demonstratesknowledge and respect for scientific bases of behavior.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 1.3 Evidence-based practice: Understands andapplies evidence based practice concepts in caseassessment, conceptualization, treatment planning, andinterventions.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 1.4 Scientific evaluation: Applies scientificmethods to evaluation of own clinical practice.*

Competency 2: Ethical and Legal Standards

Application of ethical concepts and awareness of legal issues regarding professional activities. Seeks consultation as needed.

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 2.1 Knowledge and understanding of ethical,legal, and professional standards and guidelines.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 2.2 Awareness and application of ethicaldecision making.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 2.3 Ethical conduct: Ethical values integratedinto clinical practice.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

45

Element 2.4 Risk management: Effectively evaluates,manages and documents risk. Collaboratively developssafety plans.*

Competency 3: Individual and Cultural Diversity

Awareness, sensitivity and skills in clinical work with diverse individuals and communities.

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 3.1 Cultural self-awareness: Monitors andapplies in assessment, conceptualization, treatment andconsultation.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 3.2 Cultural awareness of others: Monitors andapplies in assessment, conceptualization, treatment andconsultation.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 3.3 Cultural awareness in interactions: Monitorsand applies in assessment, conceptualization, treatmentand consultation.*

Competency 4: Professional Values, Attitudes, and Behaviors

Comportment that reflects the values of integrity and responsibility.

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 4.1 Integrity: Honesty, personal responsibility,and adherence to professional values.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 4.2 Deportment: Professionally appropriatecommunication (language and demeanor) and physicalconduct including attire consistent with context.*

46

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 4.3 Accountability: Promptly and responsiblycompletes patient care tasks (e.g., documentation,phone calls, letters).*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 4.4 Seeks consultation/supervision as neededwith appropriate preparation and uses it productively,including being open and responsive to feedback.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 4.5 Engages in self-care: Uses positive copingstrategies with personal and professional stressors andchallenges.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 4.6 Administrative efficiency: Prioritizes tasksappropriately, effectively manages time, minimizesunplanned leave.*

Competency 5: Communication and Interpersonal Skills

Relates effectively and meaningfully. Demonstrates personal and professional self-awareness.

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 5.1 Demonstrates productive and respectfulrelationships with clients, colleagues, supervisors andother professionals.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 5.2 Affective skills: Negotiates differences,manages conflicts, and effectively provides and receivesfeedback.*

47

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 5.3 Expressive skills: Clear and articulateexpression of ideas - verbal, nonverbal, and written.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 5.4 Self-Awareness: Clinical practice isconducted with personal and professional reflection.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 5.5 Effective use of emotional reactions inclinical interactions.*

Competency 6: Assessment

Evaluation and diagnosis of problems, issues and strengths of individuals and groups/communities.

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 6.1 Diagnosis and Formulation: Appliesconcepts of psychopathology, epidemiology, etiology,development, and diversity.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 6.2 Evaluation methods: Appropriately selectsinstruments with attention to reliability, validity, andutility.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 6.3 Conceptualization and recommendations:Systematically synthesizes data that informs clinicaldecision-making.*

48

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 6.4 Communication of findings: Accurately,clearly, and constructively discusses findings verballyand in writing.*

Competency 7: Intervention

Designs and implements treatment plans to alleviate suffering as well as promote health and well being.

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 7.1 Nonspecific skills: Establishes andmaintains the therapeutic relationship, includingcollaboration, empathy, regard, genuineness, and goalconsensus.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 7.2 Intervention planning: Caseconceptualization translates into treatment goals.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 7.3 Knowledge of interventions: Appliesprinciples of evidence based practice including empiricalbases, awareness of limitations, clinical expertise, andclient preferences.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 7.4 Intervention implementation: Implementsinterventions with fidelity to evidence based principles aswell as flexibility to adapt and modify as appropriate.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 7.5 Individual therapy skills and preparation.*

49

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 7.6 Group therapy skills and preparation.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 7.7 Couple/marital therapy skills andpreparation.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 7.8 Family therapy skills and preparation.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 7.9 Progress Evaluation: Develops andimplements plan for monitoring outcomes ofinterventions.*

Competency 8: Supervision

Understanding of supervision. Respect for supervisory process and functions.

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 8.1 Expectations and roles: Understandsexpectations of supervisor role including ethical, legaland context issues.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 8.2 Processes and procedures: Knowledge ofprocedures and practices of supervision.*

50

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 8.3 Understands and discusses howsupervisory relationships promote development ofsupervisees and foster effective clinical care.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 8.4 Participation in peer consultation process:Observes and participates in case discussions andproblem solving.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 8.5 Ethical and legal issues: Knowledge ofethical, legal, and professional standards and guidelinesfor supervision.*

Competency 9: Consultation and interprofessional/interdisciplinary skills

Awareness of concepts and issues in related disciplines. Cultivation of interactions with professionals in related disciplines. Provision of professional assistance andguidance.

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 9.1 Knowledge of the shared and distinctivecontributions of other professions.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 9.2 Participation ininterprofessional/interdisciplinary contexts. Collaboratesin order to foster positive outcomes.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 9.3 Respectful and productive relationships withindividuals from other professions.*

51

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 9.4 Role of consultant: Awareness ofexpectations of the consultant's role.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 9.5 Consultation assessment: Clarifies referralquestions and develops plan to gather data to answerreferral questions.*

N/AEntry Level-





0 1 2 3 4 5 6 7 8 9 10

Element 9.6 Communication of findings: Providesfeedback and clearly articulates recommendationsverbally and in writing.*

Supervisor Comments

Summary of Professional Development *

Recommendations for future training *

CONCLUSIONS

MINIMUM LEVELS OF ACHIEVEMENT (MLA) FOR REQUIRED PROFESSION WIDE COMPETENCIES DEFINEDPerformance expectations for interns for MLA should always take into consideration level of training, prior clinical experience, and stage of professional development. Ingeneral, interns are expected to demonstrate each competency with increasing levels of independence and complexity as they progress over the course of the trainingyear. Trainees will have met expectations for MLA for required profession wide competencies and successful program completion when they have achieved averageratings of 4 or higher for each competency domain across supervisors and clinical training activities. In addition, trainees will have no specific competency elementrated by any supervisor less than 4. That is, the trainee will not have received a rating on any element as "Entry Level - Remedial/intensive supervision required". In thesituation where it is recognized that a trainee is not meeting expectations for MLA, procedures for remediation should be initiated immediately.

REMEDIATION PROCEDURESOnce it is recognized that a trainee is falling short of expectations for MLA, a competency assessment form is to be completed immediately by the supervisor andshared with the trainee, Track Director, and Director of Psychology Training. In order to allow the trainee the opportunity to meet expectations for MLA, performance

52

expectations must be promptly developed and clearly specified within a reasonable time frame and included within a remediation plan agreed upon by all parties. At theend of the specified remediation period, expectations for MLA included in the remediation plan will be reviewed by the trainee, supervisor, Track Director and Director ofPsychology Training. If the trainee requires additional remediation, the procedural steps outlined above are to be repeated until the trainee has met expectations forMLA. Interns are required to meet performance expectations for MLA in order to successfully complete the training program.

The trainee HAS successfully met expectations forMinimum Levels of Achievement. We have reviewed thisevaluation together.*

No

The trainee HAS NOT met expectations for MLA. Wehave collaboratively developed a written remediationplan. This remediation plan has been reviewed by thetrainee, supervisor, Track Director, and Director ofPsychology Training.*

No

CONFIDENTIAL COMMENTS TO TRACK DIRECTORAND DIRECTOR OF PSYCHOLOGY TRAINING

* Required fields Option description (place mouse over field to view)

Reset Form Submit completed evaluation Submit

53


SUPERVISOR ASSESSMENT FORM (SAF)


1 2 3 4

Quarter Evaluating

Please specify clinical activity/service forwhich supervisor is being evaluated.

Strongly Disagree Neutral Strongly Agree

1 2 3 4 5 6 7

My supervisor prepared me for supervision:explained our roles, outlined expectations,and specified methods of evaluation.

My supervisor was available andaccessible at scheduled as well asunscheduled times.*

My supervisor observes my clinicalinteractions (directly or indirectly viarecordings) and gives feedback.*

My supervisor stayed well-informed aboutmy caseload.*

I feel comfortable and at ease with thesupervision process.*

My supervisor is accepting, nonjudgmental,and respectful.*

My supervisor carefully listens to my viewsand formulations of my clinicalinteractions.*

54

I feel I can share my shortcomings, doubts,and vulnerabilities with my supervisor.*

My supervisor provides me with helpfulfeedback on my clinical interactions.*

My supervisor provides me with helpfulfeedback on my professionaldevelopment.*

My supervisor provides me with helpfulfeedback on administrative tasks (e.g.,scheduling, documentation, coordination ofcare, case management).*

My supervisor communicated effectivelywith me: expectations were clear, feedbackwas constructive, and messages weretimely.*

I have learned new perspectives,approaches, and skills from mysupervisor.*

My supervisor is open to helping me learna variety of approaches without pushing aparticular model.*

My supervisor is open to input andfeedback.*

I am allowed to share differences of opinionwith my supervisor.*

My supervisor affirmed my strengths andareas of competence.*

My supervisor was a positive professionalrole model.*

My supervisor maintained appropriateinterpersonal boundaries.*

55

My supervisor encouraged an appropriatedegree of autonomy and independence.*

My supervisor was sensitive to multiculturalpractice issues.*

My supervisor was attentive to ethicalstandards, legal considerations, and riskmanagement.

Describe how the supervision could beenhanced. *

Describe how the clinical activity/servicecould be enhanced (e.g., greater variety ofcases/activities, more appropriatecases/activities, clearer expectations forcases/activities). *

Needs improvementin many areas

Needs improvementin some areas

Meets expectationsin all areas

Exceeds expectationsin some areas Outstanding

1 2 3 4 5

Overal rating of clinical activity/service.*



56


Seminar Evaluation - Psychology Training Program


Seminar Content


1 2 3 4 5 6 7

1. The material was easy to follow and understand.*

2. The material was relevant and applicable to my clinical work and professionaldevelopment.*

3. I will use this information to enhance my clinical work.*

4. The information presented will enhance my professional development.*

Presentation Feedback


1 2 3 4 5 6 7

5. The presenter spoke clearly and conveyed enthusiasm for the topic.*

6. The presenter was prepared and learning objectives were met.*

7. The amount of information presented was appropriate for the time allotted and thepresenter began and ended on time.*

8. The presenter fostered discussion and respectfully addressed comments andquestions.*

Comments and Suggestions

9. Please comment on the strengths of the seminar. *

57

10. Please offer suggestions for improving the seminar. *

11. Please offer recommendations to assist the presenter in becoming a more effectiveteacher. *



58


Psychology Training Program: End of Year Program Evaluation


We are interested in obtaining your feedback on your experiences over the past year in the University of Wisconsin Psychology Training Program. Thank you for yourthoughtful consideration.

Seminars

N/A - Not applicable Unsatisfactory Poor Average Good Excellent

0 1 2 3 4 5

Clinical Science and Consultation (Thursday 8AM)*

Psychotherapy (Thursday 9 AM)

Professional Development and Supervision(Thursday 11 AM)

Psychopharmacology for Non-medical Providers

Child Psychopathology and Treatment

DBT Consultation

Other Seminars: Adult


0 1 2 3 4 5

Adult Assessment Seminar (Wednesday 11 AM)

Couple Assessment and Intervention

Other Seminars: Child


0 1 2 3 4 5

59

Child Assessment Seminar (Wednesday 11 AM)

Family Assessment and Intervention

Other Seminars: Health


0 1 2 3 4 5

Health Psychology Training Forum

Health Special Topics ("brown bag")

Overall Training in Professional-Wide Competencies

Please offer an assessment of your training in the past year for the profession-wide competencies and associated elements.

RESEARCH

Understanding of research. Respect for scientifically derived knowledge.

Unsatisfactory Marginal Satisfactory Excellent Outstanding

1 2 3 4 5 6 7 8 9

Element 1.1 Scientific mindedness: Cultivated theapplication of scientific knowledge to the solution ofclinical problems.*

Element 1.2 Scientific foundation: Promotedknowledge and respect for scientific bases ofbehavior.*

Element 1.3 Evidence-based practice: Fosteredunderstanding and application of evidence basedpractice concepts in case assessment,conceptualization, treatment planning, andinterventions.*

Element 1.4 Scientific evaluation: Encouraged theapplication of scientific methods to the evaluation ofclinical practice.*

ETHICAL AND LEGAL STANDARDS

Application of ethical concepts and awareness of legal issues regarding professional activities.


60

1 2 3 4 5 6 7 8 9

Element 2.1 Fostered knowledge andunderstanding of ethical, legal, and professionalstandards and guidelines.*

Element 2.2 Promoted awareness and applicationof ethical decision making.*

Element 2.3 Ethical conduct: Cultivated theintegration of ethical values into clinical practice.*

Element 2.4 Risk management: Attended to theeffective evaluation, management anddocumentation of risk including collaborativedevelopment of safety plans.*

INDIVIDUAL AND CULTURAL DIVERSITY

Awareness, sensitivity and skills in clinical work with diverse individuals and communities.


1 2 3 4 5 6 7 8 9

Element 3.1 Cultural self-awareness: Fosteredapplication in assessment, conceptualization,treatment and consultation.*

Element 3.2 Cultural awareness of others: Fosteredapplication in assessment, conceptualization,treatment and consultation.*

Element 3.3 Cultural awareness in interactions:Fostered application in assessment,conceptualization, treatment and consultation.*

PROFESSIONAL VALUES, ATTITUDES AND BEHAVIORS

Comportment that reflects the values of integrity and responsibility.


1 2 3 4 5 6 7 8 9

Element 4.1 Integrity: Encouraged honesty,personal responsibility, and adherence toprofessional values.*

61

Element 4.2 Deportment: Encouragedprofessionally appropriate communication(language and demeanor) and physical conductincluding attire consistent with context.*

Element 4.3 Accountability: Encouraged prompt andresponsible completion of patient care tasks (e.g.,documentation, phone calls, letters).*

Element 4.4 Encouraged consultation/supervisionas needed including appropriate preparation andproductive participation with openness andresponsiveness to feedback.*

Element 4.5 Promoted self-care: Encouraged use ofpositive coping strategies for personal andprofessional stressors and challenges.*

Element 4.6 Cultivated administrative efficiency:Encouraged appropriate prioritization of tasks,effective time management, and minimization ofunplanned leave.*

COMMUNICATION AND INTERPERSONAL SKILLS

Relates effectively and meaningfully. Demonstrates personal and professional self-awareness.


1 2 3 4 5 6 7 8 9

Element 5.1 Encouraged productive and respectfulrelationships with clients, colleagues, supervisorsand other professionals.*

Element 5.2 Cultivated affective skills: Encouragednegotiation of differences, management of conflicts,and effectively provision and acceptance offeedback.*

Element 5.3 Cultivated expressive skills: Promotedclear and articulate expression of ideas - verbal,nonverbal, and written.*

Element 5.4 Cultivated self-awareness: Encouragedclinical practice with personal and professionalreflection.*

62

Element 5.5 Encouraged effective use of emotionalreactions in clinical interactions.*

ASSESSMENT

Evaluation and diagnosis of problems, issues and strengths of individuals and groups/communities.


1 2 3 4 5 6 7 8 9

Element 6.1 Diagnosis and Formulation: Promotedapplication of concepts of psychopathology,epidemiology, etiology, development, anddiversity.*

Element 6.2 Evaluation methods: Promotedappropriate selection of instruments with attention toreliability, validity, and utility.*

Element 6.3 Conceptualization andrecommendations: Promoted systematic synthesisof data informing clinical decision-making.*

Element 6.4 Communication of findings: Fosteredaccurate, clear, and constructive discussion offindings verbally and in writing.*

INTERVENTION

Designs and implements treatment plans to alleviate suffering as well as promote health and well being.


1 2 3 4 5 6 7 8 9

Element 7.1 Cultivated nonspecific skills:Establishment and maintenance of the therapeuticrelationship, including collaboration, empathy,regard, genuineness, and goal consensus.*

Element 7.2 Intervention planning: Caseconceptualization translates into treatment goals.*

Element 7.3 Cultivated knowledge of interventions:Application of principles of evidence based practiceincluding empirical bases, awareness of limitations,clinical expertise, and client preferences.*

63

Element 7.4 Intervention implementation: Promotedimplementation of interventions with fidelity toevidence based principles as well as flexibility toadapt and modify as appropriate.*

Element 7.5 Cultivated individual therapy skills andpreparation.*

Element 7.6 Cultivated group therapy skills andpreparation.*

Element 7.7 Cultivated couple/marital therapy skillsand preparation.*

Element 7.8 Cultivated family therapy skills andpreparation.*

Element 7.9 Promoted progress Evaluation:Development and implementation of plans formonitoring outcomes of interventions.*

SUPERVISION

Understanding of supervision. Respect for supervisory process and functions.


1 2 3 4 5 6 7 8 9

Element 8.1 Expectations and roles: Promotedunderstanding of expectations for supervisor roleincluding ethical, legal and context issues.*

Element 8.2 Processes and procedures: Promotedknowledge of procedures and practices ofsupervision.*

Element 8.3 Cultivated understanding of howsupervisory relationships promote development ofsupervisees and foster effective clinical care.*

Element 8.4 Cultivated participation in peerconsultation process: Observation and participationin case discussions and problem solving.*

64

Element 8.5 Ethical and legal issues: Promotedknowledge of ethical, legal, and professionalstandards and guidelines for supervision.*

CONSULTATION AND INTERPROFESSIONAL/INDERDISCIPLINARY SKILLS

Awareness of concepts and issues in related disciplines. Cultivation of interactions with professionals in related disciplines. Provision of professional assistance andguidance.


1 2 3 4 5 6 7 8 9

Element 9.1 Cultivated knowledge of the sharedand distinctive contributions of other professions.*

Element 9.2 Promoted participation andcollaboration in interprofessional/interdisciplinarycontexts.*

Element 9.3 Encouraged respectful and productiverelationships with individuals from otherprofessions.*

Element 9.4 Role of consultant: Cultivatedawareness of expectations of the consultant'srole.*

Element 9.5 Consultation assessment: Fosteredclarification of referral questions and developmentof plans to gather data to answer referralquestions.*

Element 9.6 Communication of findings:Encouraged feedback and clearly articulatedrecommendations verbally and in writing.*

ADMINISTRATION OF TRAINING PROGRAM

Unsatisfactory Marginal Satisfactory Very Good Excellent

1 2 3 4 5

Orientation materials and activities*

Internship handbook/training manual*

65

Psychology Training Web Site*

Internship Training Committee (ITC)*

Program Evaluation Forms and Procedures (e.g.,MedHub)*

Support Resources (e.g., clerical, IT, scheduling,HR)*

Leadership: Director of Psychology Training*

Leadership: Track Director*

Leadership: Internship Training Coordinator*

OVERALL EVALUATION OF INTERNSHIP TRAINING PROGRAM


1 2 3 4 5

Required clinical activities: Outpatient ClinicalService*


0 1 2 3 4 5

Required clinical activities: Child Clinic*

Required clinical activities: DBT*

Required clinical activities: Couples Clinic*

Required clinical activities: Family Clinic*

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Required clinical activities: Primary Care PediatricBehavioral Health*

Required clinical activities: Medical/SurgicalConsultation Service*

Required clinical activities: Pediatrics Service*

Required clinical activities: Health PsychologyOutpatient Service*


1 2 3 4 5

Elective Clinical Activities*

Quality of Faculty*

Quality of Supervision*

Overall Assessment if Internship TrainingProgram*

NARRATIVE SUMMARY OF TRAINING PROGRAM

Please share your reflections on ways that this training program has fostered and nurtured your professional development as a psychologist. Also, please candidlyshare your thoughts on aspects of the program that can be modified to improve the quality of training.

Please share comments on aspects of the programthat especially enhanced your professionaldevelopment as a psychologist. *

Please share your thoughts on aspects of theprogram that require modification in order toenhance the quality of training offered. *

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Internship Training Committee (ITC) Meeting Schedule

August 2019-June 2020

(ITC meets 10 times/year; no meetings in July and January)

All meetings held 8:00-9:00 a.m. on the Second Wednesday of the month (unless notified otherwise) alternating between WisPIC and the UWHC

Psychiatry Track WisPIC

August 14 at WisPIC Audubon Room (1219)

October 9 at WisPIC Audubon Room (1219)

December 11 at WisPIC Audubon Room (1219)

March 11 at WisPIC Audubon Room (1219)

May 13 at WisPIC Audubon Room (1219)

Rehab/Pediatric Track UW Hospital

September 11 Room HSLC - Room 1202

November 13 Room G5/170 CSC

February 12 Room G5/170 CSC

April 8 Room G5/170 CSC

June 10 Room TBD

Committee Members: Greg Kolden, Stephanie Farrell, Jason Horowitz, Meredith Rumble, Stephanie Steinman, Michael Thalasinos, Jennifer LeNoble, Erri Hewitt, and adult, child, and pediatric track interns (interns attending ITC meetings will switch off in January).

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Internship Training Committee (ITC)

BY-LAWS

In accordance with American Psychological Association Committee on Accreditation (CoA) guidelines and principles, the Internship Training Committee (ITC) functions to ensure a commitment to excellence through self-study, which assures that program goals and objectives are met, enhances the quality of professional education and training by interns and training faculty, and contributes to the fulfillment of the mission of the University of Wisconsin School of Medicine and Public Health Psychology Internship Training Program. The ITC is committed to implementing an integrated, overarching set of unified program goals, objectives and outcomes in order to provide the highest quality of training for our interns.

The ITC will meet monthly in order to conduct the business necessary to implement the above stated mission.

A. ITC Membership

1. Voting members of the ITC will include:

a. Director of Psychology Trainingb. 2 Faculty from each track: Adult, Child and Pediatric

● The Directors of each of the respective tracks● One primary faculty member from each of the respective tracks

(appointments without term limits; serve at discretion of track directors)

c. One intern from each track (minimum). Each intern will serve for at least 6 months.d. Diversity Committee Chair

2. Nonvoting Members

a. Training faculty and trainees are welcome to attend ITC meetings and have a “voice” in thebusiness of the committee at any time.

3. Personnel issues regarding trainees or faculty will be limited to faculty discussion and vote. Traineesmay request representation in these discussions by a fellow trainee or faculty advocate, per “dueprocess” policy.

B. For Conducting ITC Business:

1. A quorum will be necessary, defined by at least one faculty member from each track and one intern.

2. For specific business that has been communicated via mail or e-mail two weeks prior to a scheduledmeeting, a proxy vote from a member who cannot come will be allowed.

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3. For a motion to carry (to be acted on), a simple majority will be sufficient.

4. To change By-Laws a 2/3 vote of all voting members will be required.

5. Day to day operating decisions that do not reflect policy making or interpretation of policy will beexecuted at the discretion of the directors of each Track and the Director of Psychology training butwill be communicated to the ITC.

6. The agenda will be set by the Director of Psychology Training.

7. For an item to be placed on the Agenda by other than the Director of Psychology Training, it must besubmitted in writing to the director 10 days prior to the next scheduled meeting. If not scheduledbecause of a full agenda, it will be mentioned at the next meeting as New Business to be addressed.

ITC-By-Laws As of 6/12/19

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Important Department Information Department Address: Wisconsin Psychiatric Institute and Clinics (WisPIC) 6001 Research Park Blvd Madison, WI 53719-1176 Phone: 608-232-3171 Mail Code (9601)

Links/Listings to Access Department Websites:

Psychology Internship Website: https://www.psychiatry.wisc.edu/education-training/psychology-internship/

PRAXIS: http://praxis.psychiatry.wisc.edu/

1. Course materials2. MedHub: All seminars are listed here under “Conferences”3. Conference list

Box Folder: https://uwmadison.app.box.com/folder/66967110456

Department of Psychiatry: https://inside.psychiatry.wisc.edu/

1. 2019-2020 Conference Schedule2. Quick Links:

UConnect PRAXIS - MedHub Psychiatry Home Page UW Home

Computer Support: [email protected] or https://helpdesk.psychiatry.wisc.edu

Front Desk: Messages, absences, etc.: [email protected] Provider Line: 608-232-3161 or 53161

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https://www.psychiatry.wisc.edu/education-training/psychology-internship/

http://praxis.psychiatry.wisc.edu/

https://uwmadison.app.box.com/folder/66967110456

https://inside.psychiatry.wisc.edu/


https://helpdesk.psychiatry.wisc.edu/


Pagers and Paging To switch over your pager, call Paging at 608-262-2122 and give them your pager number and ask them to switch it from the previous owner to you. They will ask for your cell number.

You must wear your pagers at all times when you are working. The pager is connected to the hospital paging system. For someone to page, they must dial 265-7000 (or 5-7000 on a UW phone line) and then follow the verbal directions.

You can also send a page from your computer. Got to U Connect (quick link on the left side of https://inside.psychiatry.wisc.edu) and click on Paging at the top. Enter the last name of the person to page and enter your message as directed.

Front Desk Paging Protocol 911 Emergency Call immediately (within 5 min) i.e. suicidal pt, safety concern, etc.

ASAP Non-emergency (call within 10 min) i.e. very distressed pt, pt very late for appt, otherprovider requesting urgent call back

FYI No call back necessary – unless questions Pt arrived >5 min late, pt cancel same day, etc.

Vacation and Personal Days You get 3 weeks of paid vacation and all major holidays off.

Phones Each of you will have a personal phone line in your office. You will give your patients the Psychiatry Department main phone number of 608-232-3171. Phones are answered by the front staff and messages are passed on to you via InBasket or an Encounter in EPIC. Any problems with your phone, see Megan (Room 1520).

Within the State system: use 5-digit numbers Local calls/faxes: dial 9+the 7-digit number Long distance calls/faxes: Dial 9+1+area code and 7-digit number

Fax Machine The department’s fax machine is located in Room 1520 with Jennifer and Megan who can teach you how to fax. The number is 608-263-0265.

Please follow the posted HIPAA-compliant procedure to preserve the confidentiality of faxed patient information. The online policy is located at http://www.wisc.edu/hipaa Go to “Health Information Privacy Manual,” Policy #8.5, “security of Faxed, Printed, and Copied Documents.”

Paper Shredders We work very hard on confidentiality at WisPIC. There are disposal boxes in both the B and C Chart Rooms and a shredding machine in the mail room for you to use as needed. Any materials that you are discarding that have patient information on them must be properly disposed of or shredded at the end of the day, do not simply leave them in your recycling bin.

Computer Set-up and Assistance Ryan Ashton and Vince Pascale are our full-time IT employees and are assisted by students. They are located up in Admin, Room 1202. Any computer or printer issues can be directed to them directly or emailed to the Help Desk at [email protected]

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https://inside.psychiatry.wisc.edu/

http://www.wisc.edu/hipaa


*Any issues with HealthLink/EPIC need to be directed to the UW HelpDesk (608) 265-7777 or through theHelpDesk icon in EPIC

Parking Issues There is no fee to park at WisPIC, but you need to park in the back lot. On certain days, it can be difficult to find a spot. You can also park on Tokay Blvd, near the bottom of the driveway for the back lot.

Business Cards The Department will supply you with generic business cards that you can give to patients. Jennifer keeps a box in her office if you need more.

Book Fund You have a book fund of $400 that you can use for books, conference attendance, or parking. After a purchase, you have 90 days to submit receipts and a completed Employee Expense Report form to Mary Zimmerman.

Professional development funds cannot be used for post-doc interview travel. The funds can be used for conferences, books, office toys, etc.

Mail/Mailroom You have a mailbox in the mailroom that should be checked periodically if it is not, Megan or Jennifer will send you an email reminding you to do so.

The mailroom is near the front entrance to the Clinic across from the Admin offices. You need your Wisc ID to open it. Only employees are allowed in the mailroom.

Outgoing mail should be placed in either the Outgoing US Mail bin (if stamped) or by the Stamping Machine (needs to be stamped) or you can put it in the appropriate slot in the shelf in one of the Chart rooms.

Mail is stamped every morning and gets picked up by 10:30am.

Office Supplies There are some basic office supplies in the mailroom in the filing cabinet. If you need more, Jennifer or Megan would be happy to show you the Supply Room.

Staff Lounge Staff Lounge (Room 1527) has coffee available throughout the day. There is also a refrigerator, 2 microwaves, and a toaster and tables for your dining needs.

Personal Office The desks in your office are equipped with a Panic Button so you cannot move your desk without first putting in a request to have that temporarily disabled. If you want to rearrange your furniture, hang pictures, etc. you can submit a Jira request for help from Facilities Manager, Brian Ringelstetter.

Wellness Room There is a Residency Wellness Room known as The FREUD that they are happy to share with you. It has a modest workout room with free-weights and elliptical.

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Stipend and Tax Withholding Due to the intern job classification, interns receive a “stipend” NOT wages. As such, state and federal taxes are NOT withheld.

Interns need to pay quarterly estimated Federal Taxes to the IRS via the following web site: https://www.irs.gov/payments/direct-pay

Interns need to pay quarterly estimated WI State Taxes to the Department of Revenue via the following website: https://www.revenue.wi.gov/pages/onlineservices/home.aspx

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https://www.irs.gov/payments/direct-pay

https://www.revenue.wi.gov/pages/onlineservices/home.aspx

CLASS DEPT PROGRAM FUND Voucher #

EMPLOYEE #

NAME: Assigned Work Base

HOME ADDRESS:

G/L Acct # Type of Expense Date Description Dollar Amount

59010

59020 Non-Phys Dues/License/Member

61300 Non-Medical Supplies

(Office)

59530 Staff Relations

76240 Parking

76250 Business Auto Reimbursement

(.535 cents per mile 1-1-2017)

Other (description)

(Please add account #.)

TOTAL REIMBURSABLE EXPENSES

To ensure timely payment processing, please provide all requested information.

Incomplete expense reports will be returned to be completed and resubmitted for processing.

Signature Date

Approved by: Date

I certify that the expenses claimed on this form are true business-related expenses, are documented accordingly, and will not be paid from another source.

UNIVERSITY OF WISCONSIN MEDICAL FOUNDATIONEMPLOYEE EXPENSE REPORT

OPER UNIT PRODUCT

(Complete and Attach Mileage Tracking Form)

Miles from Employee's Residence to Employee's Assigned Work Base

Non-Phys Prof Development and Related Expenses

PLEASE INCLUDE AN EXPLANATION OF ALL EXPENSES. PLEASE ALSO ATTACH ALL ORIGINAL RECEIPTS, DOCUMENTS TO CONFIRM CREDIT CARD PAYMENTS AND/OR A COPY OF YOUR CANCELLED CHECK TO THE REPORT. PLEASE SEND COMPLETED FORMS TO UWMF ACCOUNTS PAYABLE AT 414-FIN-AP.

UNIVERSITY OF WISCONSIN MEDICAL FOUNDATIONMILEAGE TRACKING REPORT

0.575 per mile effective 1/1/2015



Assigned Work Base =

0.0 one way 0.0 round trip

Date Beginning Location Ending LocationReason for

TripTotal Miles

Driven

Normal Commute

Miles DifferenceReimburse

Amount Total Due4/22/20XX Home 20 S Park Float 10.5 10.5 0.0 $0.535 $0.004/22/20XX 20 S Park Home Float 10.5 10.5 0.0 $0.535 $0.004/23/20XX Home WI Sleep Staff Mtg 13.7 10.5 3.2 $0.535 $1.714/23/20XX WI Sleep Home Staff Mtg 13.7 10.5 3.2 $0.535 $1.714/25/20XX Home DW Eye Commute 10.0 10.5 -0.5 $0.535 $0.004/25/20XX DW Eye 20 S. Park Meeting 13.0 0.0 13.0 $0.535 $6.964/25/20XX 20 S Park Home Commute 10.5 10.5 0.0 $0.535 $0.00

Date Beginning Location Ending LocationReason for

TripTotal Miles

Driven

Normal Commute

Miles DifferenceReimburse

Amount Total Due0.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.000.0 $0.535 $0.00

TOTAL REIMBURSEMENT BEING CLAIMED $0.00

>>Enter your one way mileage in pink box<<**Do not type in any of the other shaded areas**

Miles from Employee's Residenceto Employee's Assigned Work Base

^ ^ ^ EXAMPLES ^ ^ ^

Normal commuting miles are not reimburseable. These are examples when you would qualify for mileage reimbursment. Please use two or more lines to record a round trip. There is no need to list the $0 reimbursement miles on normal commute days.

Please transfer this amount to the first page.

If you have questions completing the Expense Reimbursement Report,please call Accounts Payable at 821-4180.

The UWMF Expense Reimbursement Policy, Business Meals Policy, Mileage Policy and Mileage Rates are available on U-Connect under Finance.

NAME: DATE(S) OF TRIP:

PURPOSE:

[ ] Meeting Presenting [ ] Meeting Attending [ ] Meeting Other

(Attach proof of presentation) (Attach proof of attendance) (Attach proof of attendance)

NAME OF MEETING (CITY/STATE):

ITEM SUN MON TUES WED THURS FRI SAT SUN TOTALS

Airfare

MileagePersonal Car

.535 cents effective 1-1-2017

Rental Car

Taxi/Limo

Parking/Tolls

Hotel

Register Fees

Meals**

Misc:

Tips

Local Calls

Other

SubtotalLess Advance Paid by Dept

Total

Expense Reimbursement Policy and Business Meal Policy are available on U-Connect.

UNIVERSITY OF WISCONSIN MEDICAL FOUNDATION TRAVEL REIMBURSEMENT

**PLEASE ATTACH ALL RECEIPTS WITH EXPLANATIONS OF EXPENSES TO THE REPORT****FOR MEETING FOOD REIMBURSEMENT, DOCUMENT THE PURPOSE OF THE MEETING & ATTENDEES**

Employee Bus Passes 2019-2020 – updated June 11, 2019

https://uconnect.wisc.edu/inside-uw-health/getting-around/bus-pass/ Transportation Services administers an employee bus pass program, available at a greatly subsidized cost, to encourage employees to take transit to and from work. The employee bus pass allows for unlimited rides on Madison Metro Transit buses for eligible employees. Thousands of UW employees receive a bus pass every year!

Bus passes are valid from September 1 through August 31 of the following year. 2018-19 bus passes (valid Sept. 1, 2018 – Aug. 31, 2019) were available for purchase on Aug. 1, 2018. 2019-20 bus passes (valid Sept. 1, 2019 – Aug. 31, 2020) are available for purchase starting Aug. 1, 2019.

This page contains information on bus pass eligibility, how to obtain a bus pass, how to use a bus pass, and what to do if your bus pass is lost or stolen.

All employee bus pass rules and restrictions can be found in the bus pass policy (PDF).

Most UW-Madison faculty and staff and UW Health employees are eligible for a bus pass. Eligible employees must be located on the UW-Madison campus and have an active appointment.

Employees cannot obtain their bus pass before their first day of employment/appointment.

If you have questions about your eligibility, please call (608) 263-6667.

Starting August 1, employees can order or pick up an employee bus pass at one of the UW Transportation Services Offices for the upcoming parking year, September 1-August 31:

• American Family Children's Hospital, Room E004 • WARF Building, Room 124 • 21 N Park St, Ste 1200

Online Ordering Process

• Log-on with UW Health ID and Password o Visit the UW Transportation Services eBusiness portal o Select "Employee or Student Login" o Select "Log in with UW Health" o Select "Get Permits" and follow Steps 1-7.

Enter your mailing address, and your bus pass will be mailed to you at this address Make sure to select the employee bus pass for the correct parking year

o If you need help with your UW Health log-on, contact the UW Health Help Desk, (608) 265-7777

• Log-on with UW NetID o Visit the UW Transportation Services eBusiness portal o Select "Employee or Student Login" o Enter NetID and Password, and click "Log In" o Select "Get Permits" and follow Steps 1-7.

Enter your mailing address, and your bus pass will be mailed to you at this address Make sure to select the employee bus pass for the correct parking year

o If you need help with your NetID, recover your forgotten info by visiting the DoIT NetID Account Modification page

https://uconnect.wisc.edu/inside-uw-health/getting-around/bus-pass/

https://fpmts.wiscweb.wisc.edu/documents/bus-pass-policy/

https://transportation.wisc.edu/contact-us/

https://transportation.wisc.edu/contact-us/

https://uwtransservices.t2hosted.com/cmn/auth_ext.aspx


https://www.mynetid.wisc.edu/modify

https://www.mynetid.wisc.edu/modify

How to Request a NetID

Use your UW Health ID and password or follow these steps:

1. Get your Campus ID number o Email [email protected] with the subject line: "Need Campus ID o Aquire a free Wiscard at Union South (a Campus ID comes with it)

2. Activate your NetID. You will need to enter your Campus ID number (see #1) and date of birth 3. Record your NetID username and password; Log-in to the UW Transportation Services eBusiness portal

Employee Eligibility

• UWHC employees: No charge. UWHC covers 100% of the costs • UWMF employees: No charge. UWHC covers 100% of the costs • SMPH employees: Employees pay for the employee bus pass fee by credit card or payroll deduction • UW-Madison employees: Employees pay for the employee bus pass fee by credit card or payroll

deduction • UW Foundation employees, Wisconsin Historical Society, WARF/WICell, WI Crop Improvement

Association, Morgridge Institute for Research (MIR) employees can get a bus pass directly from their employer

For More Information

Visit the UW Transportation Employee Bus Pass Program webpage for more information.


https://wiscard.wisc.edu/id-card/how-to-get-your-wiscard/

https://www.mynetid.wisc.edu/activate


https://transportation.wisc.edu/bus/employee-bus-pass-program/

Leave Procedures – Psychology Training Program

Planned Absences

Any absence, (one day or longer), must be approved prior to the intern/postdoctoral fellow taking time off. Per UW Health Policy a planned absence greater than five days requires a twelve-week notice; less than five days requires a six-week notice. The Leave Request Form must be submitted accordingly and the Track Director must approve the request.

Trainees are also responsible for finding coverage for their patients while on leave. Trainees must assign their Health Link In Basket to the covering person prior to the leave.

Medical Appointments

If a trainee has a doctor's appointment that will last less than one day:

• no need to fill out any forms• either cover yourself or indicate who is covering during that time• of course, be professional and clear this with supervisor(s), and block out WisPIC template, (if

necessary), via Health Link message to the front desk staff• no Health Link-specific procedure as long as trainee can check In Basket during that day

If trainee has a medical issue that will take an entire day and it is planned and anticipated:

• fill out a leave request form per usual procedures• indicate that Medical Leave is being taken• arrange coverage for In Basket, including setting up Health Link ("Out" function) so that coverage

person will get In Basket messages

Illness

If a trainee is sick (i.e., unplanned medical issue), the following steps are to be followed:

1. Please send a high priority In Basket message to P WPIC PSYCH RECEPTION by 7:15 a.m. indicatingthe timeframe/day(s) you will likely be out.

2. If you are able to provide the following, it would be helpful for the front desk staff. It is not required.o Who will be covering your In Basket.o If you have any high-risk patients who should be seen and/or contacted by a provider that day.o Options for rescheduling patients that may need to get in earlier than your schedule currently

allows.3. If you would like to talk with somebody regarding your schedule, please call the Doctor Line (608-232-

3161) after 7:30 a.m.

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Leave Request Form

Name: ____________________________________

Start Date: ____________________________________

End Date: ____________________________________

NOTE: Per UW Health Policy a planned absence greater than five days requires a twelve-week notice; less than five days requires a six-week notice.

Type of Leave (circle one): VACATION MEDICAL PROFESSIONAL OTHER

Please identify the service (left column) and a supervisor (right column) for each clinical activity that you will miss during your leave.

Service Supervisor 1._______________________________ __________________________ 2. _______________________________ __________________________ 3. _______________________________ __________________________

Name of person(s) providing backup and dates:

1.

2.

3.

Please be sure to follow the Provider Cancelation Policy when submitting an absence request. ___ (check) I have arranged coverage using the "Out" function in HealthLink.

Copies of this form should be sent to:

• Director of Psychology Training and Track Director

• Program Coordinator

• Susie Hartman and front desk staff (they will block your WisPIC schedule.)

• The supervisors you listed above

Please contact Program Coordinator with any questions.

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UW Health Non-Employee ID Badge New or Replacement Form Department Coordinator must sign off approval.

The photo identification (ID) office is located at G5/146.

In accordance with UW Health Photo ID Badge Guidelines – All UW Health employees are required to clearly display their photo ID

badge at all times while at work; it should be visible and displayed at a chest high level.

Non-employees will be charged for an original or replacement photo ID badge at a cost of $12.00, at the time of production/pickup. This

can be done by the department completing an “Internal Requisition” form, completion of the direct bill information below, or the

individual providing a receipt of purchase from Four Lakes/Mendota Market.

Source of Record (Department requesting badge creation. More than one can be selected):

SMPH (faculty, fellow, MD, student) UWMF (faculty, fellow, MD, resident) Contractor

Other: ____________________________

Reason for Badge:

New/Original Replacement: Lost/Damaged Replacement: Information Change

Replacement: Badge Access Not Functioning Other: _________________________

List all Needed Access: UH AFCH

Required Department Coordinator Approval:

Coordinator’s Name (print):_________________________________________________________________Phone Number: _______________________________

Coordinator’s Signature: _______________________________________________ Date: ______________ Email: _______________________________________

***PLEASE NOTE A DEPARTMENT NUMBER, INTERNAL REQUISITION NUMBER, OR FUNDING STRING IS

REQUIRED IF NOT PAYING BY RECEIPT***

Internal Requisition Number: __________________

Dept#:_________ Fund#: _____________ Program#: _______________ Project #: _____________ Account#: _______________

Non-Employee Information

Barcode #

Department Name: __________________________________________

First Name:

Middle Initial:

Last Name:

☐ First name & Last initial (exceptions are supervisor level and above)Highest Educational Degree if it Directly Relates to Your Position: BSN, LPN, MD, MSN, PhD, Other: ______________________________________

I hereby acknowledge that the above information provided is complete and accurate, and I have provided a form of payment.

Signature: _______________________________________________________________ Date: _____________________________________________

For Badge Staff Use Only

Proximity Number: _______________________________________________

Issued by (PRINT): ________________________________________________Date:______________________________________

Has all information been entered into Security Systems? Y or N

Photo ID Badge The photo identification badge (ID badge) will serve as the official tool for providing identification, security and access. Security Services is responsible for administration of the ID Badge and access program. ID badges must be worn by all UW Health employees, volunteers, contracted and agency staff, faculty (i.e., physicians, pharmacists and nurses) and those here for clinical experience or clinical research (e.g., students). ID badges cannot be loaned to other persons for their use. The photo ID badge is to be worn for employment, training or business purposes only. Individuals shall not wear their UW Health ID badge when they are not at work or while in the role of patient or visitor.

Obtaining A BadgeID badges will be distributed at New Employee Orientation (NEO) and at the ID Badge Office (G5/146) at University Hospital. As appropriate, non-employees may be charged a fee that is the responsibility of the individual or the sponsoring department or school. Security staff will produce duplicate replacement ID badges only in exchange for the current ID badge for the following reasons:

II. Legal name change or name change due to gender transitionIII. Job or department transfer/changeIV. Damaged/worn-out badgeV. Each five (5) year service anniversary

The ID badge shall contain ONLY the following information:

1. First and last names1. Shortened first names are permissible (i.e., Robert to Bob); nicknames are not permissible (i.e.,

Robert to Bud)2. Employees assigned to the Forensic unit, Psychiatry unit, Surgical Trauma unit and Emergency

Department will be provided photo ID badges which display their first name and first initial oflast name. This option is also available to other employees, with the exception of GraduateMedical Education trainees and employees in the role of supervisor or higher.

2. The following shall appear below the name:1. For employees in positions below director level, the department name2. For employees in titles of director and above, the job title3. For Faculty physicians, pharmacists, nurses, etc., "Faculty." This applies to any individual who

needs an ID badge, but their primary employment status is as a school faculty member.4. For Residents and Fellows, “Resident”5. For medical students, “Student"

For clinical positions, the photo ID badge may also contain one educational degree (i.e., BSN, MD) if it directly relates to their position. There shall be no other information, including credentials, included on the badge. Approved role-based badge backers will be provided by Security Services for employees who have direct patient care to further identify staff (i.e., Nurse, Physician, Nursing Assistant, etc.). The individual's photo must not be altered or defaced. Tape, stickers, pins or anything that impacts the ability to interact with the badge reader are not allowed. Punctures to the photo ID badge will damage and de-activate it.

Use of Badges for Facility Access/Security ID badges issued to employees also serve as access cards for University Hospital entrances and the employee’s work site/building. Restricted card access areas in the University Hospital and in off-campus facilities that are not the employee’s primary work site will require management approval to enable individual ID badges to function as access cards for these areas.

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Submit a request for security access Department managers will identify which personnel require this access and are responsible for authorizing the required access for their employees and for ensuring employees comply with this policy. Failure to comply with this policy may result in counseling or disciplinary action up to and including separation of employment. Staff who are not issued University Hospital security access may enter the building with a standard ID badge through security checkpoints after 9:00pm. Photo ID badges may also be activated for:

1. Automated Time and Attendance system2. Cashless Convenience program; and/or3. Admin-RX system

All staff are authorized to request appropriate identification from any person at any time.

Lost, Damaged and Replacement Badges Staff should immediately contact the Security Department when an ID badge is lost, missing or stolen, or is failing to provide facility access. Management approval is not required for staff to replace a lost, missing, stolen or defective photo ID badge.

Worn or damaged badges, unless caused by an employee's negligence, will be replaced at no charge. In certain situations, replacing worn or damaged badges will be billed to the employee or the employees work unit cost center. When staff report a card access feature is defective, and Security verifies that, there will be no replacement fee charged to staff.

Replacement of lost or intentionally damaged ID badges will result in a fee charged to the individual. Fees must be paid prior to replacement and payment may be made at the Culinary Services cash registers. The payment receipt is then provided to Security prior to making the replacement badge. Fees for lost (legacy UWHC) employees’ badges may also be paid using payroll deduction. Photo ID Badge Replacement Forms are available in the ID Badge Office (G5/146). Replacement badge fees may be adjusted as needed based on costs. Replacement badges can be obtained at the Security's ID Badge Office (G5/146) during weekdays when the office is open. When closed, staff should stop at the University Hospital Security Office (E6/206) to provide proof of payment to replace a lost ID badge.

Replacement badges for a lost or defective badge will normally be available for pick-up in the Security Office (E6/206) within 24 hours after requests are submitted to Security. In certain cases, Security may require more time to produce replacement badges with access privileges. Excessive requests by an employee to replace missing or lost badges will be referred to the employee's manager. Management approval will then be required for subsequent replacement badges.

Return of Badge Department managers are responsible for notifying Security staff when an individual has reached their end of appointment or their access to the facility should be suspended (e.g., termination, disciplinary suspension or leave of absence), by calling Security at (608) 890-5555 or emailing Security at [email protected], as it is important that Security staff are notified immediately as facility access must be disabled. Department managers are responsible for collecting ID badges from employees prior to them leaving UW Health; whether voluntarily or involuntarily. The badges should be sent to UW Health Security staff (E6/206) for deactivation and disposal.

Please contact Security at (608) 890-5555 or email at [email protected] with questions.

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https://uwhealth.service-now.com/sp?id=sc_cat_item&sys_id=00e42c0adb51cb007fa87ee5bf961920&sysparm_category=d2f7cae4c611227a018ddc481b34e099

https://uconnect.wisc.edu/depts/uwhc/security/photo-id-badges/resources/name-16612-en.file



Monthly Training Log Psychology Interns

Name: Month & Year: __________

CLINICAL EXPERIENCE

A) Assessment Experience:

Patient Initials Diagnosis

Demographics: Age/Sex/Ethnicity/

Sexual Orientation/Other

Supervisor Initials Setting Hours Per

Month

*Please be sure to keep a copy for your records and provide a copy to Jennifer, your Track Director, andDr. Kolden.

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B) Intervention Experience:

Patient Initials Diagnosis

Demographics: Age/Sex/Ethnicity/

Sexual Orientation/Other

Supervisor Initials Setting

Modality: Individual, Group,

Couple, Family

Hours Per

Month

C) Total child/teen clinical hours _______________ D) Total adult clinical hours ______________

E) Supervision Hours (per supervisor):

Supervisor Setting Hours

Other Clinical Activities

F) Team Meetings/Case Presentations/Rounds/Hours

G) Seminars Attended

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Department of Psychiatry - Office Contact List 2019-2020

Name Office # Phone # (608) Email Address

Brenda Hafenbrack, Clinic Manager

Aaron Webb, Operations Assistant

Room 1224A Room 1332

232-3338232-3170

[email protected] [email protected]

Check-In/Scheduling: Susan Hartman, Supervisor

Reception Area 1225B 232-3160 [email protected]

[email protected]

Jeanie Jundt Nurse Manager Room 1401 232-3162 [email protected]

Nurses Room 1330 Shared Phone# 608-232-3163

Jennifer Noll Internship Program Coordinator Room 1520 263-6273 [email protected]

Megan Kasdorf UW Services Associate Room 1520 263-6090 [email protected]

Martha Reck Residency and Fellowship

Program Manager Room 1555 263-6153 [email protected]

Carrie Schaub Residency Coordinator Room 1731 263-6106 [email protected]

Chelsea Wimmer Addiction, Child & Adolescent,

and Geriatric Psychiatry Fellowships Coordinator

Room 1732 265-8217 [email protected]

Scheduling Coordinators: Aaron Webb (manages templates)

Amy Schroeder (Back-up) Ext. 53170 Ext. 53173

232-3170232-3173

[email protected] [email protected]

KaBao Chang HR Manager Room 1202D 263-6062 [email protected]

Mary Zimmerman (Order supplies/materials) Room 1202G 265-4343 [email protected]

Brian Ringelstetter (Maintenance) Room 1636 265-5346 [email protected]

IT: Ryan Ashton Vince Pascale

Room 1220 Room 1202F

265-6686265-0213

[email protected] [email protected]@wisc.edu

[email protected]

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mailto:[email protected]@wisc.edu


Psychology Internship Training Faculty/Staff

Adult Track Primary Faculty and Staff Gregory G. Kolden, PhD Director of Psychology Training Meredith Rumble, PhD Adult Track Program Director Daniel Dickson, PhD UW Psychiatry Outpatient Clinic Jane Gogan, PhD UW Psychiatry Outpatient Clinic

Child Track Primary Faculty and Staff Jason Horowitz, PhD Child Track Program Director Liz Bartholomew, LCSW UW Psychiatry Outpatient Clinic Erri Hewitt, PhD Behavioral Health Psychologist, East Outpatient Clinic Aisha Rosh, PhD, NCSP Behavioral Health Psychologist Stephanie Steinman, PhD UW Psychiatry Outpatient Clinic & DBT Program Director Michael Thalasinos, LMFT UW Psychiatry Outpatient Clinic, Family/Couple Training Clinic Shanda Wells, PhD Behavioral Health Psychologist, Behavioral Health & Recovery Clinic Paula Witt, LCSW UW Psychiatry CAP Outpatient Clinic

Pediatric Track Primary Faculty and Staff Stephanie Farrell, PhD Pediatric Track Program Director Jennifer LeNoble, PhD Inpatient Pediatrics Justin Moore, PhD Clinical Health Psychologist, UW Outpatient Clinics Emily Schweigert, PhD Inpatient Pediatrics

Other Contributors Staff who are not involved in planning/implementation of the internship and who do not have direct contact with interns, but who provide training opportunities (e.g., didactic seminars)

Kristin Bull-Lyon, PhD Josh Cisler, PhD Denise Connelly, PhD Erin Costanzo, PhD Carissa Dietzler, LPC Lori DuBenske, PhD Meghan Fondow, PhD Steven Garlow, PhD Simon Goldberg, PhD

Rolando Gonzalez, MD Ashley Grosshans, LCSW Melissa Heinemann, PsyD Marc Kalin, MD Alana Kessler-Jones, PsyD James Lickel, PhD Lisa McGuffey, PhD Michael Messina, PhD Shilagh Mirgain, PhD

VA UW Psychiatry Outpatient Clinic, WisPIC Health Adult Inpatient Consultation Service Cancer Psychology, UW Hospital Child & Adolescent Therapist, Private Practice Cancer Psychology, UW Hospital Primary Care Behavioral Health Manager, Access Professor of Psychiatry, UW Clinics Affiliate Faculty, Center for Healthy Minds, Asst. Professor of Counseling Psychology UW Psychiatry Outpatient Clinic, Pediatric Psychiatry Access Community Health Centers UW Psychiatry Outpatient Clinic, Deming Way Clinical Assistant Professor UW Pediatric Neuropsychology VA Cancer Psychology, UW Hospital VA Senior Psychologist, SMPH Rehab Medicine

89

Amanda Palm, LCSW Erin Plumley, PsyD Greg Rogers, PhD Katherine Schaumberg, PhD Gwynneth Schell, PhD Erica Serlin, PhDRene Staskal, PhD Zachary Stowe, MD Michael Sweetnam, PhDAnne Totero, LMFT Catherine Treece, PhD Katie Watermolen, PsyD Jessica Wipperfurth, LCSW

Child Abuse & Bioethics, Dept. of Pediatrics Neuropsychologist, SMPH UW Psychiatry Outpatient Clinic, Deming Clinic UW Psychiatry Outpatient Clinic UW Psychiatry Outpatient Clinic, Deming Way Family Therapy Center of MadisonSchool Psychologist, East High School Women’s Mental Health, UW Psychiatry Outpatient Clinic Madison Psychiatric AssociatesUW Psychiatry CAP Outpatient Clinic, Deming Way Clinical Psychologist, Private Practice UW Psychiatry Outpatient Clinic, Deming Way Child Abuse & Bioethics, Dept. of Pediatrics

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External Contact Information:

Erica Serlin, PhD Family Therapy Center of Madison 700 Rayovac Drive Madison, WI 53711 Phone: 608-276-9191 (w) Email: [email protected]

Michael Sweetnam, PhD Madison Psychiatric Associates 5534 Medical Circle Madison, WI 53719-1298 Phone: 608-274-0355 Fax: 608-274-5546 Email: [email protected]

Catherine Treece, PhD 702 N. Blackhawk Ave. Suite 104 Madison, WI 53705-3357 Phone: 608-231-1960 Fax: 608-231-3794 Email: [email protected]

Ashley Grosshans, LCSW Access Community Health Centers 3434 E Washington Ave Madison, WI 53704 Phone: (608) 443-5480 [email protected]

Carissa Dietzler, MA, LPC Empowered Therapies & Education, LLC Madison, Wisconsin 53711 Phone: (715) 502-3010

Meghan Fondow, PhD Access Community Health Centers 2202 South Park Street Madison, WI 53713 www.accesscommunityhealthcenters.org direct: 608.443-5480 fax: 608.443-5554 [email protected]

Rene Staskal, PhD 545 W Dayton St. Madison WI 53703 Phone: (608) 204-1576 [email protected]

Simon Goldberg, PhD 335 Education Building 1000 Bascom Mall University of Wisconsin - Madison Madison, WI, 53703 [email protected]

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2019-2020 Trainee Pictures

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