PRE-DOCTORAL PSYCHOLOGY INTERNSHIP

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					                      PRE-DOCTORAL PSYCHOLOGY INTERNSHIP

                                        Accredited by
                            The American Psychological Association
                                     750 First Street NE
                                Washington, D.C. 20002-4242
                              (202)336-5979/(202)336-6123 TDD


                                   HUMAN SERVICES, INC.
                                   OAKDALE, MINNESOTA
                                      Revised 8-18-09


INTRODUCTION:
Human Services, Inc. is a private, non-profit corporation that has been providing services to the
residents of Washington County since 1969. Human Services, Inc. (HSI) was formed through
the efforts of a citizens’ board and continues to be led by a Board of Directors who reside in the
geographic areas served by HSI, which now goes beyond the boundaries of Washington County
to surrounding metro regions and Western Wisconsin. The 2008 Annual Budget was
approximately $14.6M.

Washington County is in the eastern section of the metropolitan area of St. Paul and
Minneapolis. The county is approximately 45 miles long and 15 miles wide. It extends from
suburban St. Paul on the west to the St. Croix River on the east, and from Forest Lake in the
north and Hastings in the south. Washington County encompasses suburban communities, as
well as rural and small-town areas. Stillwater is the county seat. Other major population centers
in the county include Cottage Grove, Forest Lake, Oakdale, and Woodbury. The population of
the county, which currently is approximately 210,000, includes the full range of socioeconomic
classes. In the 2000 census, approximately six percent of residents were non-white. This low
level of ethnic diversity is changing steadily as the population grows and becomes less rural.
HSI is committed to enhancing the health and access to treatment for diverse populations in the
county, including having a special outreach project for the county’s Latino population. HSI is
also committed to training diverse psychology interns. In the past ten years, a third of our interns
have been from ethnic, cultural, or other minority groups.

The main office for HSI is located in suburban Oakdale, approximately 15 minutes from
downtown St. Paul. The facilities were constructed in 1980, and include the main administration
offices, large modern therapy offices, a day treatment program, a large community room for
public meetings, video tape equipment, and observation rooms. An addition to the building was
completed in 1995; this space houses HSI’s adolescent day treatment program, and includes
classrooms and a gymnasium, as well as additional office and meeting rooms. A medical office
building purchased and refurbished by HSI in Stillwater is the central office for the Chemical
Health Division, Children’s Services, and a mental health outpatient clinic. In 2002, HSI opened
a second adolescent day treatment program at another facility in Stillwater, and began a third in
2003. HSI also maintains branch offices in Cottage Grove and Forest Lake so that residents of
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these communities in the southern and northern parts of the county are able to access mental
health services more easily. HSI buildings are attractive, well designed, and well maintained.

AGENCY ORGANIZATION
HSI has five main divisions: Resources for Eldercare and Transportation, Children and Family
Services, Outpatient and SPMI services, Psychiatry Services and Chemical Health Services.

1. Resources for Eldercare and Transportation Division includes Circle of Friends Adult Day
Program, , Meals on Wheels and Congregate Dining, Community Support Services,
Transportation and Volunteer Services.

2. Children and Family Services Division includes Therapeutic Learning Center I & II,
Therapeutic Elementary Education, Therapeutic Learning Alternatives, Place II, Therapeutic
Preschool, Children’s Case Management, Early Childhood Behavioral Assistance, Family
Treatment, and the Fetal Alcohol Spectrum Disorder Regional Network.

3. Outpatient and SPMI Division includes Adult and Child Outpatient Services, Rehabilitative
Services, Adult Day Treatment, Mosaic Homes (long term housing for MI persons), Transitional
Housing (short term recovery supported housing), Home Free (housing for young adults with
mental illness), Share Housing (housing for chemically dependent and mentally ill parents and
children), Emergency Services and Mobile Crisis Response Services, services for Serious and
Persistent Mental Illness (SPMI), Abuse Intervention and Recovery, Psychology Services and ,
Custody and Mediation Services.

4. Psychiatry Services provides assessment, therapy, and medication evaluation and
   management for children and adults.

5. The Chemical Health Division includes Assessment and Consultation services, Case
   Management, Insight Programs (education and evaluation), Community Options (treatment),
   SHARE (supported housing), New Choices for Recovery (jail program) and the Drug Free
   Community Project.


The agency has strived to develop programs and services that assist the most vulnerable citizens
of the county, and to collaborate with other community agencies, systems, and service providers.
Innovative programming includes transportation and Meals-on-Wheels services to a mix of rural
and suburban clients. HSI works to develop services that integrate the efforts of schools,
healthcare providers, county service programs, the legal system, and consumers of mental health
services. HSI provides transportation for seniors and persons with disabilities who are residents
of the county to their destinations in the county or in the metropolitan area. Resources For
Eldercare provides community services, including day programming for impaired seniors, home-
delivered meals, peer counselors, and information and referral services. The Chemical Health
Division provides chemical dependency evaluations, referrals, treatment and education for
county residents of all ages. Treatment services are provided for teens with persistent and
complicated addictive problems, and for inmates in the county jail. The Chemical Health staff
maintains active involvement with chemical dependency treatment programs in the area, serves



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on the Pre-petition Team for the Washington County civil commitment process, and provides
aftercare services for families and individuals. The agency is a part of the SAMSHA Integrated
Dual Disorder Treatment Program, an evidence–based treatment initiative, and does training in
Motivational Interviewing for its staff (available to interns as well).

The outpatient mental health budget for 2008 was approximately $4.8M. Mental health staff
served 2,341 adult and child clients. Psychiatry provided evaluation and medication services to
1,348 patients. 410 walk-in crises were evaluated, and over 2,500 clients were served by
Emergency Services crisis line, with 340 mobile crisis response clients. 413 psychological
evaluations were completed. 296 persons were seen for domestic abuse treatment, 814 persons
were given victim intervention and recovery services, 246 persons called our Rape and Sexual
Assault Crisis Line, and 2,354 chemical health evaluations were completed.

The Mental and Chemical Health programs have a combined staff of approximately 120 full- and
part-time professionals. In addition to the accredited Pre-Doctoral Psychology Internship
Program, training is offered for students in Social Work and Marriage and Family Therapy and
Post-Doctoral Fellows in a non-accredited program. Fellows are usually focused on assessment
training, are a part of the training cohort, and may be housed with the intern group. Fellows may
track the same didactic seminars as pre-doctoral interns, or may pursue a separate independent
study project in assessment or treatment services. In 2002-03, 2004-05, 2006-07, and again in,
2007-08 there were three pre-doctoral interns, a social work intern, and a post-doctoral fellow. In
2008-09, there were two postdoctoral fellows but we did not have a social work trainee.

Training for pre-doctoral psychology interns is focused in the Mental Health Division. The
programs of the Mental Health Division include:

       Adult Outpatient Program serves clients with a broad range of presenting problems.
       Short and long-term individual psychotherapy, conjoint therapy, and family therapy are
       offered. Group therapies also are offered, including open-ended therapy groups, time-
       limited, problem-focused groups, and Dialectical Behavioral Therapy (DBT) groups.
       Interns are part of the ongoing DBT program for both adult and child and adolescent
       outpatient programs, and receive substantial supervision and training in DBT skills.

       Child/Adolescent Outpatient Program provides therapeutic services to children, their
       parents and families. The staff provides assessments of children and consultations to
       schools, the courts, and Social Services. Individual, family, and group therapy is
       provided for children and youth. Parent education, counseling, and support groups also
       are offered.

       Family Treatment Program was developed to provide a diversionary treatment program
       for children and adolescents identified as having Serious Emotional Disturbance (SED),
       who would otherwise be referred to residential treatment, or are being discharged by
       hospitals or residential programs. The staff works intensively with families for up to six
       months, using a variety of systemic therapies. Therapy sessions are frequently held in the
       families’ homes and may include multiple sessions each week.




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       Therapeutic Learning Centers I and II and Alternative Learning Program (adolescent day
       treatment program) serve middle/junior high school and high school age youth with
       severe emotional and/or behavioral problems who meet criteria for severe emotional
       disturbance (SED) and are unable to function in a mainstream classroom or even in an
       EBD classroom within a regular school. The program includes an on-site school program
       in the morning, followed by group therapy four days per week, and daily expressive and
       recreational therapies. The Therapeutic Elementary Education Program provides similar
       services to an elementary age group

       Child Case Management Program provides coordination of care for children identified as
       SED. Case managers assist the children and families obtaining a comprehensive
       assessment, if needed, developing a community support plan and obtaining needed
       services by coordination with other agencies and assuring continuity of care.

       Early Childhood Behavior Assistance Program (ECBA) offers consultation and
       assessment services to families of preschool children and childcare programs when
       persistent or severe behavior problems occur.

       Psychiatry Programs evaluate children and adults, and treat with medication when
       appropriate. Psychiatry provides consultation to staff from other programs, as well as to
       staff from the county social and court service agencies, concerning cases in which
       psychiatric or other medical issues are prominent.

       Psychology Services Program provides diagnostic and consultation services for children
       and adults to internal and external referral sources. Externally referred evaluations
       include forensic assessments regarding questions of diagnosis, placement and treatment,
       custody, civil commitment, and competency.

       Abuse Intervention and Recovery Services (AIRS) and its companion program Victim
       Intervention and Recovery Program (VIRP) provides a range of services for perpetrators
       and victims of abuse. AIRS provides domestic abuse assessment and treatment and also
       treats clients with other acting-out behavior problems. It provides group and individual
       therapy for voluntary and court mandated men and women. VIRP provides crisis
       counseling, support and survivor groups as well as advocacy for victims of sexual assault
       and abuse. VIRP offers community education and prevention services in schools and in
       the community around issues of abuse, victimization and safety in relationships.

       Emergency Services Program responds to clients in crisis. A walk-in clinic is available
       each day, including weekends and holidays. Crisis phone consultation is available after-
       hours. A mental health professional is on-call at all times to consult with social services,
       law enforcement units, and hospital personnel to facilitate appropriate referral of crisis
       cases. HSI also manages a crisis phone line for community members who are not HSI
       clients.




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       Mobile Crisis Response Team is a part of a metro-wide system to provide community-
       based crisis mental health care. Staff provide 24 hour coverage and can do brief,
       intensive home and community treatment to prevent unnecessary hospitalizations.

       Adult Day Treatment Program and SPMI Services provide clinical and rehabilitative
       services for individuals experiencing major mental illness. These clients may be acutely
       distressed or psychotic, returning from hospitalization and/or would need to be
       hospitalized except for their participation in the Adult Day Treatment Program or
       intensive outpatient care. Treatment is provided through a therapeutic community milieu,
       and makes extensive use of group therapy and DBT. Eligible clients also can receive
       one-to-one and group interventions designed to help them address functional impairments
       related to Serious and Persistent Mental Illness.

       Mediation and Custody Solutions uses mediation, custody evaluation and psychological
       evaluations for custody to serve families in divorce and similar transitions.




MISSION AND TRAINING PHILOSOPHY:
The mission of the Pre-Doctoral Psychology Internship Program at Human Services, Inc is to
train interns in the practice of clinical psychology in a community mental health center. The
psychologists in this setting apply the empirical knowledge and conceptual models of
psychology to the mental health and behavioral problems experienced by the individuals and
families in the community. We believe that internship is a time for generalist, rather than
specialized training. Therefore, HSI trains interns in the broad range of skills needed by clinical
psychologists in a community setting. HSI considers its internship a practitioner-scholar
program.

Clinical psychologists working in the community must be able to assess and intervene in the
wide range of psychological problems encountered in the general population. In addition to
understanding the psychological functioning of the individual, psychologists should strive to
understand all the systems which impact that person, including family, culture, the impact of
ethnicity, health and disability, economic conditions, peer relationships, the living environment,
the work or school setting, the legal system, the healthcare system and the social services system.
Understanding how clients influence, and are influenced by, each of these systems enables
psychologists to consult effectively with members of these systems.

Understanding clients in their full context allows psychologists to select the most potent
strategies for intervention. Because no single approach has been found to be most effective for
all problems, psychologists must be able to evaluate and utilize a variety of evidence-based
therapeutic approaches. They must be skilled in relationship development and repair. They must
be skilled and knowledgeable in both the science and art of assessment and therapy. In the
community setting, psychologists represent psychology to clients, the legal system, the general
health system, the educational system, other professionals, and the general public. Therefore,
interns must develop well-defined professional roles that incorporate APA ethical standards and



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knowledge of the law regulating the practice of psychology. HSI’s training program is designed
to offer supervised practice to develop those skills and roles.

The HSI internship is focused on clinical care. The program’s practitioner scholar focus means
that interns from programs with similar focus may find the easiest fit. However, we welcome
interns from diverse training models, including those with strong research interests and
backgrounds. Research at HSI is taught and practiced as a tool to support more effective
diagnosis or treatment. Interns do extensive preparation and literature reviews for two case
conferences per year. HSI’s own assessment instrument, developed by staff along with a former
intern, is an example of the agency’s support for research designed to improve care. Interns may
conduct research relevant to the client populations and services provided at HSI. This may
concern their dissertations only if the dissertation involves HSI. Up to four hours per week may
be devoted to on-site research. Interns are also invited to participate in ongoing development and
research with HSI’s assessment instrument.

HSI values the exploration of individual and cultural diversity, and promotes staff and intern
awareness of their own and others’ cultural identity and its impact on personal experience,
vulnerability, and appropriate diagnostic and treatment decisions. The training program supports
this process through a year-long counter-transference process group, and a series of consultation
seminars. In addition, the program includes didactic seminars on diversity, culture, and their
impact on mental health. Interns also select and read three to four books and various essays each
year as a group with staff participation, and attend theater events, films, and explore cultural
resources in the area, and discuss these events as a part of the process of enhancing their
understanding of the effects of culture and diversity on the practice and mission of psychology.
These events vary each year as opportunities and special interests present themselves.

HSI intends that by the completion of the internship, interns will have gained supervised
experience and refined their skills with a spectrum of clients, diagnoses, and clinical problems.
They will have assessed and treated individuals representing a broad range of psychopathology.
They will have conducted crisis interventions and assessed persons who are potentially suicidal
or violent. They will have worked with male and female clients, with clients from diverse
economic, racial and cultural backgrounds, and with clients who voluntarily sought treatment, as
well as those required to participate in treatment. Further, by completion of the internship,
interns will have developed advanced, post-internship levels of competence in the goal areas
described below, so they can function independently as professional psychologists, requiring no
more than the two hours of weekly supervision required by the Minnesota Board of Psychology
to prepare for licensure:


GOALS OF THE INTERNSHIP:
1.a. Psychological Assessment: Interns are expected to develop the skills necessary to
independently complete a comprehensive psychological assessment. They enter the internship
program with all the necessary fundamental skills and knowledge about the statistical
foundations, construction, and administration of basic clinical instruments. At the conclusion of
the internship, they should be able to use tests and examination methods to diagnose the full
range of psychopathology, including personality disorders, thought disorders and major affective


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disorders in adults, and behavioral and emotional disorders in children. Interns receive direct
training in formal psychological assessment. Under supervision, interns learn to consult with
referral sources to clarify the referral question, select and administer appropriate psychological
tests, conduct thorough clinical interviews, integrate the test findings and other data, prepare
clear and cogently written reports which can be readily understood by referral sources who are
not psychologists, and provide follow-up consultation as needed.

1.b. Diagnostic Assessment In addition to the more specific psychological assessments with
testing, interns are trained in the assessment and triage of clients presenting for treatment with
diverse problems and needs. These assessments are brief but must take a comprehensive view of
illness, risk, and needs for recovery, and also use interviews and screening and outcomes
measures.

2. Psychotherapy: Interns are expected to refine and broaden their skills in individual, family,
and group psychotherapy and psychological interventions. They are expected to increase their
competence in several psychotherapeutic approaches to treatment and to be knowledgeable about
the empirical foundations for the treatment they provide. Interns learn to provide effective
psychotherapeutic treatment within the constraints imposed by managed healthcare plans, and
how to effectively document medical necessity and the nature of their treatments. Interns learn
to recognize their own emotional feedback and use it to guide interventions.

3. Consultation and Use of Supervision: Interns are expected to learn the role of the psychologist
as a consultant to other professionals and programs. This consultation typically is focused on
clients with whom the interns are conducting psychological assessments or psychotherapy, but
also may be offered to staff or programs working with clients the interns will never see. In this
consultation, interns use their expertise to assist other professionals in developing effective
strategies for working with their clients. Interns learn essentials of case presentation and how to
seek, use and provide effective consultation and supervision. As HSI does not have practicum
students, however, opportunities for actual supervision are not commonly available.

4. Preparation for Ethical Practice: Interns are provided a year of supervision and practice in an
environment that supports and prepares them for ethical practice and for the cooperative
provision of culturally appropriate health care in a multi-disciplinary setting, with psychiatry,
social work, marriage and family therapists and nurses.

Further description of these goals is available for review at the Goals/Objectives of HSI’s Pre-
doctoral Internship, 2009-10 section at the end of this document.




INTERN ASSIGNNMENTS AND SERVICE EXPECTATIONS
An intern whose primary rotation is in the Child/Adolescent Outpatient Program, who also has
interest and experience in working with adults, will typically work with a few Adult Outpatient
Program clients and vice versa.




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In keeping with our training philosophy, interns spend at about 35% of their time throughout the
internship participating in one of our generalist treatment programs, the Adult Outpatient
Program or the Child/Adolescent Outpatient Program, throughout the training year. The clients
served in these programs range from preschoolers to senior adults, from the wealthy to the
impoverished, and represent diverse cultural and ethnic backgrounds, health and abilities,
presenting problems, and diagnostic categories. This diversity of clients provides an excellent
setting for psychology interns to learn a variety of clinical skills. Within the Adult Outpatient
and Child/Adolescent Outpatient Programs, interns are trained in careful diagnostic assessment,
individual therapy, family therapy and group therapy. The community mental health setting
provides a unique opportunity for interns to learn consultation skills in relation to a variety of
community agencies and social service professionals. Psychology interns function as consultants,
and experience consultation themselves, from the social workers, probation officers, teachers,
and other professionals involved with their clients.

The Psychology Services Program rotation also continues throughout the training year. Interns
attend a weekly psychology assessment seminar, as well as the monthly psychology staff
meeting. Interns are expected to complete a minimum of 35 basic psychological evaluations (or
the equivalent in more complex evaluations) during the year. These evaluations are conducted
with examinees referred by court and social service programs, with inmates referred by the Court
and in the jail, and with clients from HSI who present diagnostic dilemmas. Interns often have
the opportunity to observe psychology staff as they conduct forensic evaluations and provide
court testimony.

Adult psychology interns complete a 6 month rotation in the Adult Day Treatment SPMI
Program. Clients in this program are acutely disturbed and are likely to have diagnoses such as
major affective disorder, schizophrenic disorder, or one of the severe personality disorders. This
rotation involves approximately 13 hours per week for 6 months. The intern serves as a
treatment group co-therapist, conducts intake assessments and psycho-educational presentations,
and participates in multi-disciplinary staff meetings.

In place of an Adult Day Treatment rotation, child psychology interns complete a 6 month
rotation in the Family Treatment Program (FTP). The Family Treatment Program offers training
in systemically focused family therapy, largely conducted in families’ homes. These families
have a child or adolescent who is being discharged from residential or hospital treatment, or may
require such placement without intensive treatment, and has not been treated successfully with
less intensive outpatient services. Interns function as co-therapists in these sessions. This rotation
gives an equivalent exposure to severe psychopathology in children, youth and their families to
that of the adult rotation in Day Treatment. Clients in FTP generally suffer from severe mood
and behavior disorders, autistic spectrum disorders, and psychoses. Systemic and other family
therapy models form a basis for treatment. This rotation requires 10-15 hours per week,
including staff meetings and travel time.

Adult interns select another 6 month rotation from one of two specialty programs; DBT, or
Family Treatment (FTP). Child interns select a DBT rotation in adolescent or adult DBT. These
Outpatient Dialectical Behavioral Therapy (DBT) rotations provide 6 months of group co-
therapy with adolescents or adults. An adult intern may request to participate in the Family



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Treatment Program (15 hours per week) as described above as an alternative if they already have
had sufficient DBT training.

In addition to the rotations described above, somewhat less structured training opportunities are
available in Emergency Services and the Therapeutic Learning Center (TLC) programs. In the
area of Emergency Services, interns may conduct intakes in the Crisis Clinic and crisis
evaluations at the Washington County Jail. In the TLC (HSI’s day treatment program for
adolescents), interns may serve as a group co-therapist or work in the milieu setting.

Interns spend one day per week doing outpatient care in HSI’s Stillwater or Cottage Grove
clinics. This allows them to experience a different setting and different staff, and eases the press
for office space in the Oakdale office. These clinics are approximately 15 and 25 minutes from
the Oakdale office.

Interns should expect to work an average of 45 hours per week on HSI work during the training
year, depending on their skill and facility in professional writing. One evening of work until 9
PM per week or service on Saturday is expected. They should also spend additional time reading
relevant clinical literature.


SUPERVISION:
Supervision and training of interns is highly valued by the HSI staff. Each intern has a primary
supervisor who is a licensed, doctoral-level clinical psychologist. That primary supervisor will
stay with the intern throughout the training year, and is a part of the outpatient team the intern
joins. The primary supervisor works with the intern to structure their internship experience, and
provides guidance, advocacy, continuity, role-modeling and feedback to the intern. In
cooperation with their primary supervisors, interns complete a written Training Plan, which
details the clinical experiences, rotations, supervision and other training activities of their
planned internship. Interns meet with their primary supervisors for a minimum of two hours
each week, and provide audio or video-taped sessions for review each week. In addition to the
administrative and case supervision provided by their primary supervisors, interns receive one
hour per week of individual supervision from other clinical supervisors in treatment rotations, as
well as at least one hour per week of group and individual supervision of assessments.

In accordance with APA Ethical Standard 7, Item 7.041, HSI supervisors generally do not require
interns to disclose personal information. However, in the process of learning and refining
psychotherapy skills, interns may benefit from selective sharing of personal information.
Supervisors strive to provide a space where the intern can be both competent and appropriately

1
    7.04 Student Disclosure of Personal Information
Psychologists do not require students or supervisees to disclose personal information in course- or program-related
activities, either orally or in writing, regarding sexual history, history of abuse and neglect, psychological treatment,
and relationships with parents, peers, and spouses or significant others except if (1) the program or training facility
has clearly identified this requirement in its admissions and program materials or (2) the information is necessary to
evaluate or obtain assistance for students whose personal problems could reasonably be judged to be preventing
them from performing their training- or professionally related activities in a competent manner or posing a threat to
the students or others.



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vulnerable at the same time. In fact, the ability to be vulnerable when appropriate is recognized
as an important skill for trainees to develop. Examples of information supervisors might request
include interns’ personal reactions during a therapeutic encounter, or that they reflect on their
own course of development of particular identity features. Such requests are made carefully, not
in an attempt to engage in therapy with interns. Rather, they are intended to further interns’
knowledge of their own vulnerabilities and strengths when these are clearly relevant to their
therapeutic encounters with clients. Interns who may benefit professionally or personally from
individual psychotherapy may be referred outside the agency for private therapy.

The program’s counter-transferrence/process group is a part of the training program, but is not
linked to the formal supervision process. It is designed to offer interns a chance to think, reflect,
and explore their experiences in training and in their professional experiences. Information from
this group is not shared with the supervisors or training director.

CASE CONFERENCES AND SEMINARS:
Each intern presents one assessment and one treatment case conference, illuminating their cases
with a review of relevant research and theoretical literature. These case conferences are
broadcast to other HSI offices to make them available to all interested staff, and interns are given
support and mentoring in their preparation of the presentation and use of technology as required.
Most years, the intern group receives opportunities to develop training for other community
professionals. For example, in the 2008-09 year, the intern group presented training on post-
traumatic stress disorders to a group of physicians, social workers, and other staff at a local
hospital.

Interns also attend a weekly didactic seminar presented by psychology and other professional
staff on a variety of clinical topics. The seminar series is the core didactic curriculum.

Didactic Seminars for 2008-09 included:

              Two sessions on ADHD fundamentals, co-morbidity and assessment
              Basic and advanced Rorschach training
              Legal basis and ethics of practice
              Introduction to forensics
              Ethics for psychologists
              Crisis assessment
              QA/QI in mental health care
              Attachment and brain development
              Integration of mental and chemical health treatment
              Culture and mental health
              The culture of poverty
              Civil and criminal competencies
              Hoarding and OCD
              Child sexual abuse evaluation


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              Integration of psychology in the health care system
              End of life care
              Asperger’s Disorder
              Neurobehavioral consequences of prenatal exposure to alcohol and illicit
               substances
              Using systems information to guide diagnosis
              Family therapy and systems applications
              Narcissistic injuries of training experiences
              Domestic abuse
              Assessment and treatment of children exposed to domestic violence
              Couples therapy
              EMDR and hypnotherapy
              Therapy termination issues
              Spirituality in therapy
              Human sexuality
              Working with sex offenders
              GLBT identity development
              Psychological evaluation of seminarians
              Mediation and custody evaluation
              Leadership opportunities for psychologists

These offerings vary somewhat each training year.

Interns also are encouraged to participate in outside conferences and workshops. Five days for
conference attendance and $175.00 for registration fees are provided. At least one of these
workshops is expected to focus on diversity concerns. Interns also attend an annual day-long
conference sponsored by HSI, featuring training by clinicians of national reputation, and two
day-long conferences on diversity and on ethics and supervision, co-sponsored by HSI and the
other accredited pre-doctoral internships in Minnesota.




THE PSYCHOLOGY STAFF:
Raja M. David, Psy.D., is a staff psychologist with the Child Outpatient team. He earned his
doctorate in clinical psychology from the Minnesota School of Professional Psychology (Argosy
University). He completed his internship and post-doctoral training at a community mental
health center in Portland, Oregon. He provides therapy to families and children, and conducts
clinical and forensic assessments. Professional interests include delinquency, treatment of male
sexual abuse survivors, and use of the Rorschach with children. He is also an adjunct professor
at Argosy University, where he teachers psychopathology in the Masters’ program.


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Scott Fischer, Ph.D., provides clinical and forensic assessment for HSI, as well as some
treatment services. He is the supervisor of the Mediation and Custody Solutions program. He
received his doctorate from the University of Oregon, and did his pre-doctoral internship at Yale
University School of Medicine. His interests include ethics, forensics and assessment of children
and adults.

Liliana Freire-Bebeau, Psy.D., is a graduate of Argosy University Twin Cities. She was a pre-
doctoral psychology intern at HSI in the 2004-05 training year, and completed a post-doctoral
fellowship at HSI from 2005-2007. Her interests include forensic assessment, individual
therapy, community mental health, and Spanish language psychological services. She is
currently involved in HSI’s mental health outreach initiative for the Latino/Hispanic community
of Washington County. She has special research interest in the use of outcome tools in Spanish
speaking mental health settings, and comparing differences in the expression of emotions across
cultures.

Donna Johnson, Ph.D., is manager of Adult and Child Outpatient Programs. She earned her
doctoral degree in clinical psychology at the University of Rhode Island and completed her
internship at HSI. Professional interests include group therapy, personality disorders, forensic
evaluation, and couples therapy.

Dan Johnson, Psy.D., L.P., is a graduate of Argosy University, and did his internship at the Four
Winds Hospital in Katonah New York, and then did post-doctoral training at the Hawthorne
Knolls Residential Treatment Center in Hawthorne, New York. He manages the Cottage Grove
outpatient treatment process and provides therapy and psychological assessment to adults and
adolescents. His professional interests include assessment and supervision.

Mark S. Kuppe, Psy.D. LP, LMFT, is Chief Executive Officer of HSI. He received his doctoral
degree in Counseling Psychology from the University of St. Thomas and completed his
internship training at both the Wilder Child Guidance Clinic in St. Paul and the Washburn Child
Guidance Center in Minneapolis. His professional interests include child and adolescent therapy,
marriage and family therapy, in-home therapy, wrap-around services, clinical supervision,
program and staff development, and community collaboration on systems of care for children.
He is a consultant to several child-serving agencies, and has provided training statewide and
nationally on family systems work and in-home therapy. He has served on the Board of
Directors for the National Association of Family-Based Services, the Minnesota Family-Based
Services Association and the Minnesota Association for Community Mental Health Providers.

Ellen Lowery, Ph.D., is a Licensed Psychologist with the Child and Adolescent Outpatient
Program. She received her Ph.D., from the University of California at Santa Cruz. She then
earned an M.S.W. from the University of California at Berkeley and did the post-doctoral
program in Integrative Psychoanalytic Studies at the California School of Professional
Psychology at Berkeley. She has practiced as a generalist, but has special interest in early
childhood, families and training.




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Nicole Shackelford, Psy.D., is a graduate of Argosy University, did her internship at HSI, and is
completing a post-doctoral fellowship year at HSI. She is involved in a primary medical care
consultation clinic and evaluates adults and elderly persons including dementia and guardianship
and conservatorship evaluations. Special interests include OCD and hoarding, and human
interactions with animals.

Fran Osteen-Stawarz, Ph.D., is a Licensed Psychologist with the Adult Outpatient Program. She
received her doctoral degree from Florida State University, and did her internship at the
University of Minnesota Internship Consortium, with a rotation at HSI. She has worked in both
community mental health and inpatient facilities with a variety of clients. She joined HSI as a
staff member in 1999, and has been involved with the Dialectical Behavioral Therapy program,
psychological assessment of adults, and individual therapy. Areas of interest include personality
disorders and dissociative disorders.

Barbara Walker, Psy.D., is a Licensed Psychologist with the Adult Outpatient Program. She
received her Psy.D. from Argosy University, and did her Predoctoral Internship at the Multi-
Cultural Consortium of Washburn Child Guidance and the Indian Health Board, and a Post-
Doctoral Fellowship at HSI focused on clinical assessment. She has special interest in the impact
of domestic abuse trauma on children and adults.

Stefanie Varga, Ph.D., is a graduate of Fielding Graduate University, and did her predoctoral
internship at Primary Children’s Medical Center in Salt Lake City Utah. She is a post-doctoral
fellow at HSI performing fetal alcohol evaluations and providing neuropsychology consultations
from infancy through young adulthood.

James V. Wojcik, Ph.D., is Chief Psychologist and Director of Training. He received his
doctoral degree in clinical psychology from California School of Professional Psychology and
did his predoctoral internship at Fresno Community Hospital. His clinical training includes work
in school, substance abuse, corrections and medical settings. Dr. Wojcik is a consultant to the
Washington County court system. His professional interests include family psychology and
family therapy, addictive behavior, personality disorder, cognitive behavioral therapy, and
clinical and outcome assessments.




ADDITIONAL CLINCAL SUPERVISORS:

Martha Anderson, M.S., LMFT, is a therapist in the Family Treatment Program, and coordinates
training in that program.

Eileen Buringrud, M.A., Licensed Psychologist, clinical lead for HSI’s three day treatment
programs, facilitates intensive outpatient groups, and is a consultant to Willow Haven, an IRTS
facility. Special interests: community mental health, day treatment with the SPMI population,
developmentally disabled sex-offenders, DBT, and dual disorders.



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Greg Coleman, J.D., M.A., Licensed Psychologist, Family Treatment Program. Special interests:
Strength-based developmental-ecological perspectives, home-based therapy models, multi-
disciplinary perspectives, family reorganization.

Bruce Eisenmenger, M.A., Licensed Psychologist, Director of Outpatient and SPMI Services.
Special interests: Psychotherapy with schema focused assessment and brief dynamic
interventions. Competency in hypnotherapy, EMDR, and Thought Field Therapy.

Dean Gorall, Ph.D., therapist with the Family Treatment Program. He received his doctorate in
Family Social Science at the University of Minnesota and HSI clinical internship at HSI. Special
interests: research and measurement of family process.

Kevin Horst, M.A., Licensed Psychologist, Supervisor of Therapeutic Learning Center I and II.
Special interests: Treatment of children/adolescents, and families using the child’s/adolescent’s
environment as a therapeutic resource.

Anne St. Martin, M.A., program supervisor of Family Treatment Program and Therapeutic
Support Services. Special interest: Spirituality in therapy.


ELIGIBILITY:
Graduate students from APA accredited doctoral programs in professional psychology are
eligible to apply. HSI seeks interns with strong oral and written communications skills, thorough
preparation in clinical assessment and psychotherapy, efficient time management skills, comfort
and flexibility with emotionally challenging situations and conflict management, and personal
commitment to the profession. HSI is committed to fostering diversity in its training program;
members of ethnic and other minority groups are strongly encouraged to apply. Applicants
should have the following minimum qualifications:

      Graduate coursework and practicum training in intellectual and personality assessment of
       adults or children, and practicum or other experience in preparing professional
       psychological evaluations. Applicants should have competence in using cognitive,
       personality, and other diagnostic tests appropriate to their age specialty. Applicants
       should have written a minimum of 8 integrated psychological reports.
      Graduate coursework and practicum training in psychotherapy and psychological
       interventions with adults and/or children.
      Graduate coursework in psychopathology and familiarity with diagnostic practice.
      Verification from the Director of Training of the applicant’s graduate program that he/she
       will have completed all graduate coursework and any comprehensive examinations
       required by his/her program prior to internship start date.

Intern applications are screened by the Director of Training. All completed and appropriate
applications are read and ranked by at least one staff. Those meeting basic criteria are read and
rated by at least one other staff. Applicants are then ranked according to their written


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applications and the Training Committee’s judgment of their fit with the program, and the top
ranked applicants are invited for interview, in person or by phone. The rankings from the
interview are then added to the earlier rankings, and the Training Committee meets in January to
finalize the rankings and prepare for the selection process.

APPLICATION PROCEDURES:
If you wish to apply for the pre-doctoral psychology internship at HSI, please send:

      A completed APPIC Application for Psychology Internship form, filed electronically.
       You can access this form from APPIC’s web site: http://www.appic.org, and click on the
       AAPI Online link.
      Please include in your supplemental forms (a) a cover letter, and (b) a psychological
       assessment report prepared by you.
      Please indicate in your cover letter whether you are applying for the child or adult
       internship.
      In addition, please include with your letters of recommendation, one from the supervisor
       of your assessment practicum and one from the supervisor of your psychotherapy
       practicum, and (b) your graduate program transcript, as specified by the APPIC directions
       for the electronic application.

All materials should be directed through the APPIC process to:

                                    James V. Wojcik, Ph.D.,
                                      Director of Training
                                      Human Services Inc.
                                   7066 Stillwater Boulevard
                                   Oakdale, Minnesota 55128
                                        (651)777-5222
                                     jwojcik@hsicares.org

Application for internship for 2010-2011 should be completed by Monday, November 2, 2009.
After review of completed applications, applicants no longer under consideration will be so
informed. Remaining applicants will be either invited to HSI for an interview or may be ranked
but not interviewed at HSI’s discretion. If a personal visit to HSI is inconvenient, the applicant
will be interviewed by telephone without penalty. Final ranking of candidates is made by a
training staff committee.

As a member of APPIC, HSI 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.

If you have any questions about the internship, please contact Lori, Internship Coordinator, or
James V. Wojcik, Ph.D., Director of Training (651)777-5222.

The projected stipend for a 12-month, full-time internship for 20010-20011 is $20,500. Interns
are eligible for 22 days of paid time off. Malpractice insurance is provided. Individual health


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plan coverage is available at low cost to the intern, and family coverage is available with a
moderate monthly fee. The presumed starting date for the internship is September 1.


                         PREVIOUS HSI PSYCHOLOGY INTERNS


1989 – 1990            Randy Carter           Illinois School of Professional Psychology
                       Sue Feder              Wright State University
                       Deb Fisher             University of Northern Colorado

1990 – 1991            Michael Harris         United States International University
                       Jennifer Neeman        University of Minnesota
                       Donna Peterson         Minnesota School of Professional Psychology

1991 – 1992            Michael Brunner        University of Wisconsin
                       Michelle Dodds         University of Minnesota
                       Catriona Galloway      Northwestern University

1992 – 1993            Neisha Nelson      University of Minnesota
                       Marianne Schumacher University of North Dakota
                       Merna Terry        University of Montana

1993 – 1994            Lucien Larre           Wright State University
                       Rebecca Sharp          University of North Dakota
                       Annie Slobig           Illinois School of Professional Psychology

1994 – 1995            Sue Malouf             MN School of Professional Psychology
                       Don Stovall            MN School of Professional Psychology
                       Melissa Twernbold      University of Wisconsin

1995 – 1996            Donna Johnson          University of Rhode Island
                       Mary Harlow            MN School of Professional Psychology
                       Ivonne Fiol            Illinois School of Professional Psychology


1996 – 1997            Lora Sloan             University of North Dakota
                       Kerry VanDusen         MN School of Professional Psychology
                       Diane Zorn             MN School of Professional Psychology

1997 – 1998            Jane Lorentzen         MN School of Professional Psychology
                       Jennifer Norton        University of Colorado
                       Lise Osvold            University of Georgia

1998 – 1999            Dianne Berg            University of Illinois
                       Rob Cowle              University of Minnesota



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                     Tom Wolfe            Utah State University

1999 – 2000          Jill Klotz Flitter   Nova Southeastern University
                     Valerie Harrington   Temple University
                     Yvonne Nobles        University of St. Thomas

2000 – 2001          Colleen Biri         Georgia School of Professional Psychology
                     Jeff Brown           Fielding University
                     Christianne Lysne    University of Wyoming

                     Fellow:
                     Lisa Froehling       University of St. Thomas

2001 – 2002          Liz Downey           American School of Professional Psychology
                     Elizabeth Hayes      MN School of Professional Psychology
                     Rebecca Hammett      University of St. Thomas

2002 – 2003          David Hong           Argosy University MN
                     Gary Freitas         University of Maryland
                     Sara Bogestad        University of Denver


2003 – 2004          Charlene Forsyth    University of St. Thomas
                     Sue (High)Kottschade Argosy University MN
                     Krislea Wegner      University of North Dakota

2004 – 2005          Benita Amedee        University of St. Thomas
                     Isabel Grieco        Chicago School of Professional Psychology
                     Liliana Freire-Bebeau Argosy University MN
                     Fellow:
                     Barbara Walker       Argosy University MN

2005 – 2006          JulieAnn Stawicki    Michigan State University
                     Natalie Marr         Argosy University MN
                     Pat Kraemer          University of St. Thomas

2006 – 2007          Angela Emerick       University of Denver
                     Erin Guell           University of Toledo
                     Tina Shah            Argosy University MN
                     Fellow:
                     Joe Groninga         University of St. Thomas

2007-2008            Katy Baker           Argosy University VA
                     Melissa Boston       Argosy University MN
                     Nicole Shackleford   Argosy University MN
                     Fellow



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                      Stefanie Varga         Fielding University

2008-2009             Bridget Molitor        U of WI, Milwaukee
                      Saul Alamilla          UC Santa Barbara
                      Sarah Paper            Argosy University MN
                      Fellows
                      Stefanie Varga         Fielding University
                      Nicole Shackleford     Argosy University MN




The following outline was developed to reflect the training goals and objectives of the HSI
Internship, and may serve as a guide to the training experience that may be expected. It is subject
to change as determined by the Training Committee.


            Goals/Objectives of HSI’s Predoctoral Internship, 2009-10



  The following form displays the program’s goals and objectives for
 internship and fellowship training and the standards used to determine
               successful competence for each objective.



   Psychology Intern/Post-Doctoral Competency Assessment Form
                                           Revised 5-06

                                       Table of Contents
Page 1         Table of Contents
Page 1         Directions for use of computerized format
Page 2         Identification and definitions of competency ratings

               Goal 1. Competence in Theories and Methods of Psychological
               Assessment
Page 3         Objective 1.1. Interviewing and data collection for Formal Evaluation
Page 4         Objective 1.2. Effective interviewing skills for diagnostic assessment for
               treatment
Page 5         Objective 1.3. Accurate diagnosis and case formulation
Page 6         Objective 1.4. Appropriate use of tests and interpretation


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Page 7         Objective 1.5. Professional writing and feedback

Page 8         Goal 2. Competence in Psychotherapy and Psychological Interventions
Page 8         Objective 2.1. Patient risk management
Page 9         Objective 2.2. Appropriate case conceptualization and treatment planning
Page 10        Objective 2.3. Effective therapeutic interventions
Page 12        Objective 2.4. Sensitivity to individual and cultural diversity
Page 13        Objective 2.5. Group therapy skills

Page 13        Goal 3. Constructive Consultation and Use of Supervision
Page 14        Objective 3.1. Effective consultation and communication
Page 14        Objective 3.2. Effective use of supervision/consultation

Page 15        Goal 4. Ethics and Professional Behavior
Page 16        Objective 4.1. Respectful relationships and cooperation with other disciplines
Page 17        Objective 4.2. Ethical behavior
Page 18        Objective 4.3. Administrative competence and appropriate documentation
Page 19        Objective 4.4. Professional demeanor and identity

Page 20        Standards for Completion of Training
Page 21        Comments and Signatures

Directions for use of computerized format: This form may be completed on computer and
only the ratings being given to the intern or fellow need to be printed. Copy the document,
rename it, and delete the ratings not being given before printing.


                                    HSI
                Psychology Intern/Post-Doctoral Competency
                             Assessment Form
This form is to be filled out at least 3 times per year, or more often in cases of remediation.

Trainee ____________________________________

Supervisor _________________________________

Training Year _____________ Rotation _________________ date ______________



Assessment methods for this evaluation

Direct Observation      _____                 Review of written work ____
Review of raw test data ____ _                Case Presentation      ____
Videotape               _____                 Audiotape              ____


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Personal Supervision     _____                Collateral information   ____

Competency Ratings Definitions
NA: Indicates not applicable or not assessed by this evaluator
Advanced/Autonomous: Indicates skill set necessary for licensure. Typical rating for end of
Post-Doctoral training.
High Internship/Post-Doctoral: Typical skill set for end of internship or during post-doctoral
training. Requires supervision but displays highly developed professional skills and judgment.
Generally achieved in 6-12 months of internship.
Intermediate Internship: Typical skill set for practice during internship. Displays significant
knowledge of role, and can function professionally with regular supervision.
Entry Level: Typical Practicum level skill set. Requires continuous supervision, but accepts it.
Expected to last no longer than the first 1-3 months of internship.
Unsatisfactory/Needs Remediation: Displays significant problems beyond a lack of
opportunity to learn skills. May have apparent lack of aptitude for the task or role, or may be
avoiding or resisting changing clinical behavior or expanding skill set. This includes unethical
practice or repeated boundary violations. The evaluator is to specify what specific areas need
remediation in the comments section for any given objective and summarize a recommended
course of action at the end of this assessment form.

All higher level ratings are presumed to contain the lower level competencies as well.



Training Goals: By the end of the training year, a Post-Doctoral Fellow will be able to
demonstrate skills at the Advanced/Autonomous level for all objectives. By the end of the
training year, an Intern will be able to demonstrate skills at the High Internship/Post-Doctoral
level for all objectives.


Goal 1. Competence in Theories and Methods of Psychological Assessment
Objective 1. 1. Interviewing and Data Collection for Formal Evaluation
Interviews skillfully to collect relevant information. Uses understanding of behavior and mental
illness to shape interview questions. Establishes rapport and shapes interview process to collect
maximize range of data collection. Describes interview data effectively.

___ NA

___ Advanced/Autonomous
Reflexively helps referring parties define referral questions to better satisfy their needs for
decision making. Appraises referral questions and independently selects range of data required to
complete the assessment task. Matches style and approach to interviewing from a range of
options to comprehensively assess issues of concern. Effectively considers and rules out a broad
range of differential diagnostic possibilities. Continuously evaluates the credibility of
information.


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___ High Internship/Post-Doctoral
Refines referral questions and range of data necessary to address them with minimal prompting
and supervision. Has a variety of styles and approaches to collect data, and uses them with
familiarity and ease. Modifies approaches and topics easily to gain relevant data. Readily
recognizes the possibilities for bias and inaccuracy in data. Adopts role of authority in
interviewing as required.

___ Intermediate Internship
Understands need to refine referral questions and does so with supervision. Structures interviews
with familiar and standard formats that are generally successful in collecting the needed data and
can modify them as appropriate with supervision. Identifies ways data may be inaccurate or
biased by cultural or motivational factors. Has moderate knowledge of differential diagnostic
possibilities. Can look beyond attempts to mislead or avoid the interviewer’s scrutiny.
Discriminates roles and is not drawn into being inappropriately “therapeutic,” but still expresses
discomfort with “expert” role.

___ Entry Level
Uses structured formats to gather information as instructed, and modifies them based on
supervision. Uses a developing base of diagnostic possibilities to search for confirmatory
information. Requires supervision to adapt to the needs of referral sources, and to seek
clarification of referent needs. Can sound awkward in interviews, lose track of place or purpose,
and be misled by deceit or malingering. May confuse evaluation and treatment roles.

___ Unsatisfactory/ Needs Remediation
Demonstrates an insufficient knowledge of behavior, mental illness, or other diagnostic
concerns. Does not seek a broader understanding or base of knowledge. Misunderstands
information from examinee. Shows biases for certain problems that cause him or her to miss the
issues before them. Repeatedly violates roles of assessment. Misses important data and has to
work from insufficient data, or repeatedly call examinees back for extra interviews.

Comments:____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________

Objective 1.2. Effective Interview skills for Diagnostic Assessment for Treatment
Readily establishes rapport. Gathers sufficient clinical information in one hour to make at least a
provisional diagnosis and an initial disposition regarding treatment or safety needs. Informs
clients of status, data privacy and confidentiality concerns. Attends to relevant administrative
details and paperwork. Balances above needs in a way that leaves client satisfied that their needs
were addressed. Diagnoses entered into computer and discussed with other members of the
treatment team as appropriate.

___ NA




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___ Advanced/Autonomous
Possesses excellent interview skills and is capable of assessing complicated diagnostic cases
and/or cases where assessment may be difficult due to client factors, crises, etc. Has a strong
understanding of how to balance the assessment process with the need to build rapport, and is
capable to doing so with a wide variety of clients. Properly tends to administrative details
related to intakes.

___ Internship/Post-Doctoral
Has a sound understanding of the interview process. Is able to complete most intakes
independently. Continues to require supervision to address difficulties with interviewing certain
types of clients or resolving difficult diagnostic issues. Has a good understanding of how to
balance the assessment process with the need to build rapport. Assessments are organized and
coherent. Administrative tasks are dealt with appropriately with minimal direction.

___ Intermediate Internship
Covers most areas of the interview well, but continues to need refinement of interviewing skills.
Critical or risk management areas of the assessment are being addressed but may require some
structure. Rapport is generally being established with most clients, although structure may
interrupt attention to rapport building. Some administrative details are neglected without
reminders.

___ Entry Level
Has basic interview skills, but requires substantial feedback around the interview process. Has a
basic sense of how to establish rapport but has trouble balancing this with need to gather
sufficient diagnostic information. Needs hands on assistance attending to administrative tasks
related to intakes.

___ Unsatisfactory/Needs Remediation
Lacks basic interview skills. Important areas of assessment are not addressed and/or critical areas
(e.g., risk management issues) are not assessed. Rapport is not being established. Often neglects
administrative duties and record keeping, such as timely charting. Clients experience discomfort
or dissatisfaction more than rarely.
.
Objective 1.3. Accurate Diagnosis and Case Formulation
Makes diagnoses based on the best available interview and collateral data. Formulates
diagnostic, clinical and referral issues clearly. Integrates elements of cultural and individual
difference in conceptualization. Able to use the Health Dynamics Inventory (HDI) and other
diagnostic instruments effectively to support diagnosis.

___ NA

___ Advanced/Autonomous
Has a strong grasp of the DSM and diagnostic nomenclature. Is able to formulate an accurate
diagnosis using interview data, observations and collateral reports. Case conceptualization takes
into account the DSM, but also goes beyond basic DSM terminology and singular models of
psychopathology. Assessments are professionally written.



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___ High Internship/Post-Doctoral
Has a thorough understanding of the DSM. Is able to independently complete most assessments,
but continues to require supervision to resolve difficulties in diagnosing. Assessments are well
written. Summary contains well formulated case conceptualization, as a well as a foundation
from which the course of treatment naturally follows.

___ Intermediate Internship
Is able to competently complete a diagnostic interview and reach, at a minimum, a working
diagnosis. May miss some diagnoses but recognizes the presenting or primary one. Gathers
critical information well, but still misses necessary details for complete diagnosis. Assessments
are generally well written, although areas of refinement in formulation may be evident.

___ Entry Level
Understands the DSM and the process of diagnosing, but will miss relevant diagnostic
possibilities or fail to gather relevant information. Assessment writing is satisfactory, but needs
supervision to improve style, structuring of information, and/or wording. Case formulation
requires hands on assistance from supervisor.

___ Unsatisfactory/Needs Remediation
Lacks basic understanding of the DSM. Case formulations don’t accurately reflect client
presentation or are poorly organized. Lacks knowledge of theories of pathology or personality
and does not develop a working understanding of treatment and options. Assessments are
consistently poorly written.

Comments:_____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________

Objective 1.4. Appropriate Use of Tests and Interpretation
Selects appropriate tests for task. Understands roles and limits of tests and of specific tests.
Administers tests accurately and according to standard protocols. Interprets tests within range of
accepted and supported hypothesis. Integrates implications of cultural variations in test results.
Integrates test and interview data to form sound hypotheses and formulations. Makes effective
recommendations to referral sources.

___ NA

___ Advanced/Autonomous
Uses tests with proficiency and ease. Seeks new assessment skills and independently masters
new tests or assessment techniques. Understands manuals and follows directions without
prompting. Accurately and efficiently uses data for maximum interpretive benefit. Obtains
positive feedback from referral sources on helpfulness of report.

___ High Internship/Post-Doctoral



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Selects tests with minimal guidance. Understands how to learn new tests and techniques and
when to utilize them. Prepares sufficiently when learning new tests or assessment techniques.
Adequately addresses referral questions in majority of cases but still needs input on
interpretation to maximize benefit from results. Understands limits of computerized
interpretations, and uses them effectively.

___ Intermediate Internship
Requires some guidance in test selection and interpretation. Requires support in learning new
assessment techniques and over which tests to use in an evaluation. May over or under-interpret
data and can over-rely on computerized interpretations. Understands and uses essential statistical
knowledge. May use rote interpretive strategies and fail to integrate assessment data into more
meaningful formulations.

___ Entry Level
Requires significant and regular supervisory input about test usage, scoring, and interpretation.
Has basic understanding of assessment and statistics but demonstrates some difficulty in
integrating testing into practice. Is learning interpretive strategies, but is not confident in how to
apply them. Unfamiliar with many computerized evaluation systems.

___ Unsatisfactory/ Needs Remediation
Does not understand basic statistical theory or application. Mis-uses data. Fails to maintain test
security. Offers incorrect or irrelevant interpretations. Makes errors in administration or scoring.
Fails to check work and relies on supervisor to ensure accuracy Misunderstands test
fundamentals. Makes errors more than once.

Comments:____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________

Objective 1.5. Professional Writing and Feedback
Writes clearly, communicates effectively and organizes information efficiently. Uses appropriate
grammar and effective rhetorical skills. Avoids jargon, and communicates clinical information
meaningfully to non-psychologists.

___ NA

___ Advanced/Autonomous
Writes clear, useful, well-integrated reports. Edits own writing, with minimal need for
supervisory editing or help in planning feedback.

___ High Internship/Post-Doctoral
Writes effectively and clearly but requires regular input and restructuring of reports and
feedback. A clear sense of client emerges in writing. Displays good self-editing skills. Uses
dictation effectively.




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HSI Pre-Doctoral Psychology Internship
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___ Intermediate Internship
Developing skill with report writing formats. Communicates information clearly in reports but
first drafts lack focus. Is learning dictation skills. Can help peers edit and write results. Needs
some guidance and preparation for feedback sessions.

___ Entry Level
Needs training to use report formats and templates. May need to be re-trained after practicum site
has taught different formats. Is not comfortable with dictation. Still uses jargon unnecessarily.
Blurs concepts and data occasionally. May have some habitual language errors.

___ Unsatisfactory/ Needs Remediation
Uses poor grammar, or poor organization of ideas. Reports lack coherence and value to referral
source. Does not follow formats and templates as requested. Blurs concepts and data frequently.
Uses jargon frequently, obscuring meaningful communication. Does not do self-editing. Is
unprofessional or insensitive in giving personal feedback.

Comments_____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________


Goal 2. Competence in Psychotherapy and Psychological Interventions
Objective 2.1. Patient Risk Management.
Effectively evaluates, documents, and manages clinical risk, including suicidality, homicidality,
abuse of others, child neglect, or other safety concerns. Manages privacy issues in risk situations.
Develops plans for safety and collaborates with clients, family, and other providers and
personnel including hospitals and law enforcement.

___ NA.

___ Advanced/ Autonomous
Assesses and documents all risk issues fully. Acts independently to initiate necessary safety
actions in crises. Routinely obtains consultation, with well developed understanding and
options, and obtains supervision within expectations of supervisor. Uses resources of the unit,
agency, and community to manage risk.

___ High Internship/Post-Doctoral
Accurately assesses crises and uses supervision to plan and initiate interventions in non-routine
situations. Needs minimal guidance about evaluating risk or developing safety plans, and does so
routinely and continuously as indicated by the case. Documents all actions and supervision
immediately and effectively. Makes minimal, minor errors in documentation. Interactions are
supportive and therapeutic, and emotional context is responded to accurately. Responds to
emotional content of crises systematically and confidently.




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___ Intermediate Internship
Recognizes crises and severity of distress but may be unsure how to structure responses. May not
recognize full extent of risk without supervision. Needs some guidance about evaluating risk,
and may occasionally forget to do so in the course of treatment. Needs some supervision to
develop plans for intervention and safety. May miss elements of risk or planning in
documentation. Is supportive and attentive to client’s emotional needs. May react to emotion
with more personal stress than experienced staff would, but not to the detriment of patient care.

___ Entry Level
Appreciates the need for, but is not familiar with risk assessment. Demonstrates basic
interviewing and support skills. Misses some information about risk and the severity of distress,
but generally recognizes the urgency of a situation. May forget to track ongoing risk. May forget
to document important elements of assessment of risk. Needs supervision to buffer emotional
reactions. Cannot practice in risk situations without continuous supervision.

___ Unsatisfactory/Needs remediation
Does not follow supervision or guidance. Resists or avoids supervision in risk situations. Does
not provide emotional responsiveness to clients in crisis or risk situations. Fails to document
essential elements of situation. Develops inappropriate plans or adds to the risk of the situation.
Otherwise demonstrates failure to respond to situation or to supervision.

Comments:____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________

Objective 2.2. Appropriate Case Conceptualization and Treatment Planning
Recognizes and structures treatment based on scientific, theoretical and practical principles of
client care. Writes collaborative treatment plans reflecting a scientific and theoretical framework.
Researches diagnoses and incorporates scientific knowledge into treatments. Individualizes
treatment to accommodate individual and cultural differences. Designs coherent objectives of
treatment. Documents outcomes.

___ NA.

___ Advanced/Autonomous
Independently develops meaningful, coherent treatment plans based on assessment data, and
describes them in clear writing. Communicates essential elements of conceptualization to client
as appropriate, without jargon. Works from a consistent but flexible theoretical base. Sets
realistic and well devised goals for treatment in a broad range of disorders and client abilities.
Able to engage in discussion with supervisor utilizing divergent frameworks.

___ High Internship/Post-Doctoral
Develops meaningful treatment plans with some support and supervision. Completes plans and
documentation in timely manner. Is sometimes ambiguous or unclear about goals and objectives
of treatment. Consistently collaborates with clients in development of treatment. Recognizes and



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appropriately communicates underlying issues and defenses. Is developing a consistent and
coherent theoretical framework.

___ Intermediate Internship
Treatment plans may lack sufficient behavioral focus or clarity. Not consistently collaborative in
treatment planning. May be occasionally rigid or vague about theoretical frameworks. Needs
some supervision to recognize underlying issues. Distinguishes realistic from unrealistic goals.
Identifies and fosters client strengths in most instances. Recognizes goals beyond those
expressed by the client. May need prompts to complete documentation on time. Explores or is
familiar with research concerning client diagnoses and treatment needs and options.

___ Entry Level
Needs significant supervision and guidance to conceptualize cases and develop treatment plans.
May not understand or recognize client abilities to respond to intervention. May be rigid or
vague about theoretical frameworks and identity. Misses roles of systems, cognition or emotion
in some cases. Misses or misunderstands underlying or emotional issues. Narrowly defines the
range of concerns relevant to treatment. Requires limited, selected caseload with high
supervision. Displays basic treatment strategies and knowledge. Provides supervisor with all
requested taping or documentation.

___ Unsatisfactory/Needs Remediation
Takes dogmatic or irrelevant positions regarding clinical issues or client care, or misses key
elements in client communications. Case conceptualization or treatment plan inadequate for
effective intervention. Unresponsive to corrective supervisory input.

Comments:____________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________




Objective 2.3. Effective Therapeutic Interventions
Uses appropriate and targeted clinical interventions. Uses empirically validated interventions
where possible, or can justify reasons to do otherwise. Implements interventions skillfully.
Communicate empathy to clients. Manages expected caseload effectively.

___ NA

___ Advanced/Autonomous
Selects and implements interventions accurately and consistent with case needs. Seeks deeper
knowledge of treatment options. Recognizes and implements referrals to other helpful
interventions. Demonstrates accurate empathy and rapport even with difficult clients. Clinic
receives consistent positive feedback from clients. Outcomes are average or above. Manages a
full professional caseload.



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___ High Internship/Post-Doctoral
Displays consistent performance in designing and using interventions. Selects from a broad
range of possible interventions, with a preference for empirically supported interventions when
available. Seeks supervision consistently, and uses supervision to shape intervention behavior.
Recognizes errors and can recover from them without injury to client. Demonstrates generally
accurate empathy. Recognizes needs and usually can implement referral to other needed
treatment resources. Manages expected, moderate caseload.



___ Intermediate Internship
Seeks and learns new interventions and implements them with reasonable skill. Evaluates
empirical evidence for interventions effectively, and implements them accurately. Seeks
supervision and feedback about methods of treatment, but may fail to implement some ideas or
methods accurately. Clinical timing may be off at times and may miss opportunities to explore
difficult content. Listening skills need shaping, but clients feel heard and that interventions are
relevant to them. Sometimes needs help in recognizing need for referral to other resources.
Manages a moderate but selected caseload.

___ Entry Level
Knows a few interventions and has beginning skill set in using them. Does not know referral
needs and options. Displays willingness to see and shape personal behavior therapeutically. Not
always sure what is important or how to set priorities. May miss opportunities to enhance
empathy and collaborative relationship or explore difficult content. Often fails to sufficiently
explore difficult content. Requires a selected, smaller caseload.

___ Unsatisfactory/ Needs Remediation
Uses inappropriate interventions despite supervisory guidance. Reflects inaccurate empathic
statements. Multiple clients indicate failure of empathy via complaints, discomfort in taped
sessions or premature terminations. Uses self inappropriately or not at all in treatment process.
Insufficient recognition of counter-transference issues, including over or under identification
with clients. Acts aggressively or passively in treatment sessions. Avoids taping or informing
supervisor of case issues. Hides errors.
Unable to meet caseload expectations or finds size of caseload unmanageable.

Comments:____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
_____________________________________________________

Objective 2.4. Sensitivity to Individual and Cultural Diversity
Accepts and seeks knowledge and understanding of individual and group differences, including
ethnicity, race, gender, religion, sexual orientation and other concerns. Responds with sensitivity
and respect to differences. Empowers clients to find resources relevant to their own identity.
Aware of impact of clinician’s own diverse identities. Recognizes own limits and prejudices.



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___ NA

___ Advanced/Autonomous
Reflects commitment, appreciation and sensitivity to diversity in self and others, and uses
techniques and instruments that display this. Seeks an expanding understanding of differences
and community resources that serve diverse populations. Uses sense of own identity to further
effectiveness of clinical interventions.

___ High Internship/Post-Doctoral
Regularly integrates factors of individual and group differences into clinical practice. Aware of
many community resources and seeks consultation when needed. Able to discuss matters of
diverse identities readily with clients and community stakeholders. Able to articulate ways
clinician identities impact clinical work.

___ Intermediate Internship
Displays interest and openness to issues of diversity, and responds to informative materials.
Responds to client diversity with sensitivity and can share clinician limitations appropriately.
Some awareness of community resources. Recognizes when consultation is needed and seeks it
out. Beginning awareness of how clinician identities impact clinical work.

___ Entry Level
May have early ideas or recognition of when issues of diversity intersect with presenting
problems. Occasionally makes awkward or clumsy references to a client’s diversity. Generally
unaware of community resources.

___ Unsatisfactory/Needs Remediation
Displays lack of awareness, concern, or sensitivity to individual or cultural differences. Denies
his or her own limits of understanding. Makes insensitive or offensive comment regarding the
individuality of clients or staff. Unwilling to explore own background or belief system. Causes
clients to feel disrespected or ill at ease.

Comments:____________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________

Objective 2.5. Group Therapy Skills
Understands group theory. Manages group process effectively and intervenes when appropriate.
Encourages participation of all while simultaneously fostering the development of group
cohesion. Functions well in different types of group settings. When appropriate, prepares and
effectively facilitates psycho-educational, experiential or skills-building in a group format.
Demonstrates firm understanding of group theory and didactic materials presented.

___ NA.




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___ Advanced/Autonomous.
Able to create, establish, and run own group in a professional, competent manner. Identifies,
promotes, and interprets group process effectively. Interpersonal conflicts are resolved
therapeutically. Elicits participation and cooperation from all members. Tends to problems in a
manner that addresses the group’s needs as well as the individual client’s needs. Independently
prepares didactic materials for group.

___ High Internship/Post-Doctoral
Thoroughly understands general and specific group theories. Demonstrates a strong grasp of how
to manage group and create a therapeutic environment. Able to identify aspects of group
process, but occasionally requires supervision to clarify understanding. Works well with primary
group leader in managing group and able to resolve conflicts with in the group with minimal
assistance. Can lead group on own with some supervision and preparation.

___ Intermediate Internship
Understands the basic theories and assumptions that are necessary to lead a group and utilizes
them. Participates appropriately, but may still overly defer to co-facilitator. Is able to identify
group issues/problems/dynamics, but needs assistance in addressing them. Co-leads group
competently, but occasionally has trouble structuring group interactions.

___ Entry Level
Understands most of the theories and assumptions that are necessary to develop and co-lead a
group. Initiates interventions at times but misses opportunities to provide useful feedback. Makes
limited observations regarding group process and requires supervisory encouragement to make
them. Assumes a more observant, less active co-leader stance.

___ Unsatisfactory/Needs Remediation
Fails to display understanding of basic group dynamics and lacks the skills necessary to manage
group. Intervenes in ways that are inappropriate and harmful to group process (e.g., overly
dominant, insensitive to client/group needs, fails to speak when necessary, is defensive). Causes
group members to be uncomfortable and does not accept his or her role in problems. Fails to
properly prepare for specific group tasks. Paperwork is not completed in a professional, timely
manner. Ignores co-leader’s directives.

Comments:_____________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________


Goal 3. Constructive Consultation and Use of Supervision
Objective 3.1. Effective Consultation and Communication:
Communicates concerns and recommendations clearly, both orally and in written form. Offers
useful feedback in clinical team meetings, in consultation with outside agencies and the public.




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Conceptualizes effectiveness of programs and interventions, and can communicate targets for
change.
___ NA

___ Advanced/Autonomous
Written and communication skills are strong and appropriate to the consultee. Offers alternative
perspectives in team meetings, offering alternative conceptualizations to co-workers as
appropriate. Readily bridges differences in language between professional disciplines. Requires
little supervisor input.


___ High Internship/Postdoctoral
Communicates clearly, meaningfully and professionally. Uses supervisor guidance to tailor
report or consultation to the consultee or to refine presentation style. Offers useful input in team
meetings and will present novel perspectives. Communicates well with others from different
disciplines.

___ Intermediate Internship
Communicates clearly and in a professional fashion, speaking directly and to the point. Seeks
assistance in tailoring consultation to the specific referral source, though generates own ideas as
well. Offers feedback regularly in clinical teams. May occasionally use psychological jargon in a
way that is counterproductive to understanding.

___ Entry Level
Generally communicates clearly, but not always in an effective fashion. Over relies on informal
or unfocused speaking style. May lack experience with professional writing. Makes good use of
supervisor suggestions or editing. Needs direction on tailoring consultation to needs of referral
source. Rarely speaks in team meetings unless specifically asked a question. May feel
intimidated or ill at ease in communicating with other professional disciplines.

___ Unsatisfactory/Needs Remediation
Communications often lack focus or suffer from a paucity of meaningful content. May present in
a superficial or overly self-important fashion. Does not accept supervisor suggestions regarding
modifying communication style. Lacks understanding of the need to tailor communication to the
referral source. Rarely speaks, interrupts others or speaks excessively in team meetings. May
often forget or come late to meetings. May show a lack of regard or sensitivity to those of other
disciplines.

Objective 3.2. Effective Use of Supervision/Consultation
Seeks supervision as needed. Keeps supervisor well informed of caseload. Comes prepared with
questions. Regularly tapes sessions. Generally non-defensive in response to constructive
feedback. Demonstrates a realistic sense of own skills and shortcomings. Responsive to
supervisory suggestions on how to address shortcomings. Able to voice respectful dissent or
disagreement within supervisory sessions.

___ NA


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___ Advanced/Autonomous
Works independently as appropriate but readily seeks out supervision as needed. Solid sense of
skills and limitations. Seeks out constructive feedback. Able to present alternative perspectives
readily.

___ High Internship/Postdoctoral
Generally works independently. Brings in tapes without prompting. Typically non-defensive.
Responds to most suggestions positively.

___ Intermediate Internship
Works independently on most cases, but needs regular input on more difficult ones. Needs
occasional reminders regarding tapes or coming prepared to sessions. May be mildly defensive in
one area of skill set. Agreeable to supervisory suggestions.

___ Entry Level
Often lacks confidence but is able to perform with supervisory support. May express anxiety
regarding taping and may occasionally come late to supervision. At times defensive in response
to feedback or suggestions but able to maintain dialogue with supervisor.

___ Unsatisfactory/Needs Remediation
Acts independently when requested to seek supervisory input first. Often misses or comes late to
supervision appointments. Actively rejects or fails to follow through on supervisory suggestions
on several occasions. Supervisory relationship(s) may be strained and not responsive to program
director’s mediation.

Comments:______________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________


Goal 4. Ethics and Professional Behavior
Objective 4.1. Respectful Relationships and Cooperation with Other Disciplines
Works smoothly with others. Makes contributions to a team commensurate with experience.
Resolves differences in a way that promotes quality work and maintains effective working
relationships. Able to work well with other professional disciplines.

___ NA

___ Advanced/Autonomous
Working relationships are seen by other professionals as excellent. Differences are consistently
handled tactfully. Functions as a productive team member contributing at a level typical of that
of a new professional. Consistently respects ethics and norms of other professional disciplines.


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___ High Internship/Postdoctoral
Working relationships are seen by other professionals as good, able to handle differences
tactfully and effectively though with occasional tentativeness or over-assertion, functions as a
productive team member who is generally treated as a peer by team members
Generally understands the basic practices and expectations of other professional disciplines.
Volunteers for activities that enhance the viability of the team.

___ Intermediate Internship
Working relationships are positive, able to function as a team member and open to input from
supervisor and others. Willing to volunteer at times to make unique contributions to team.
Respected by team members. Makes efforts to communicate with other professionals, despite a
small level of anxiety about doing so. Respects and treats support staff well.

___ Entry Level
Working relationships are positive, though may be limited because of intern’s unfamiliarity with
roles/systems or normal discomfort with responsibilities. Maintains professional boundaries and
treats others courteously. Accepts suggestions on how to contribute to staff cohesion.
Occasionally steps on toes of other staff, but attempts to correct this.

___ Unsatisfactory/Needs Remediation
Relationships may be fraught with unresolved conflict, problems with boundaries or lack of
sufficient social etiquette. Overly abrupt or dismissive of support staff or other colleagues. May
shirk responsibilities and leave own tasks to others. Several staff express discomfort or
frustration regarding behavior. Appears not to listen to or take concerns of other staff seriously.

Objective 4.2. Ethical Behavior:
Familiar with ethics and relevant state law and consistently applies this to practice. Maintains
appropriate interpersonal boundaries. Seeks consultation regarding ethical dilemmas as they
arise.

___ NA

___ Advanced/Autonomous
Very familiar with ethics code and state statutes and able to consistently integrate these into
practice. Recognizes common ethical/legal dilemmas without difficulty. Recognizes more
complex ethical/legal problems as potential difficulties and consults as needed.

___ High Internship/Postdoctoral
Familiar with ethics codes and state law. Recognizes common ethical/legal problems. Actively
seeks guidance from supervisor on more difficult ethical and legal concerns and shows evidence
of grappling with overriding ethical principles.

___ Intermediate Internship




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Conversant with ethics code and some exposure to state statutes. Requires only nominal
supervision regarding basic ethical issues. Accepts and learns from close supervision in more
difficult ethical areas.




___ Entry Level
Has read ethics code and has some familiarity with state statutes. Fully conversant with basic
ethical principles (confidentiality, non-malfeasance, dual relationships) and avoids serious
ethical problems. Accepts and learns from close supervision in the area of ethics.

___ Unsatisfactory/Needs Remediation
Ignorant of ethics code or state law and does not recognize or appreciate the significance of this.
Makes basic ethical errors or is judged at high risk to do so because of poor judgment. Places
self, supervisor, or others at liability risk or clients at risk because of ethical problems. Engages
in dual relationships.

Objective 4.3. Administrative Competence and Appropriate Documentation
Able to prioritize and complete administrative tasks and paperwork in ways that meet agency
standards and promote quality of service. Abides by principles of confidentiality and behaves in
manner fully consistent with HIPAA guidelines. Demonstrates time management skills in
juggling multiple expectations.

___ NA

___ Advanced/Autonomous
Completes administrative tasks and paperwork independently, with only occasional supervisor
input. Able to set priorities without difficulty.

___ High Internship/Postdoctoral

Little supervision required on paperwork or administrative tasks. May need some guidance
regarding priorities or workload management. Feels on top of things more often than feels
overwhelmed.

___ Intermediate Internship
Completes paperwork and administrative tasks responsibly, with moderate direction. Is
developing skills in the areas of time management and setting work priorities. May focus on less
helpful activities while neglecting more important ones. Still can easily feel overwhelmed.

___ Entry Level
Follows supervisor direction and agency policy in completing paperwork and administrative
tasks. Will make errors of ignorance but corrects these responsibly. Shows adequate judgment
regarding setting priorities and time management. Often gets stuck and may procrastinate on
important tasks.



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___ Unsatisfactory/Needs Remediation
Ignores supervisor direction or established policy in completing administrative tasks. Does not
correct, denies, or hides errors. Is irresponsible regarding administrative demands or may have
such difficulty managing conflicting demands on time as to be effectively paralyzed in
accomplishing needed tasks.

Objective 4.4. Professional Demeanor and Identity:
Sees self as a professional and is confident in this role. Able to convey a sense of confidence and
professionalism to others.

___ Advanced/Autonomous
Shows confidence at the level of a new professional as opposed to a trainee. Comfortable in what
he or she knows but also able to acknowledge areas of relative ignorance without defensiveness.
Is viewed by clients and colleagues as a fully functioning professional. Is able to serve as an
informal mentor or guide to others with less experience.

___ High Internship/Postdoctoral
Generally shows a mature confidence though may occasionally show normal apprehension or
defensiveness or overconfidence. Able to see self as a professional and also acknowledge areas
of ignorance. Clients and colleagues are comfortable with the trainee’s competence.

___ Intermediate Internship
Shows a level of confidence appropriate to training level. May show episodic apprehension or
defensive overconfidence but does so in ways that are recognized, correctable, and not an
obvious detriment to professional functioning. Clients and colleagues do not have major
reservations about working with a trainee.

___ Entry Level
Confident in trainee role and aware of need to build a professional identity. May have recurring
apprehension but aware of this and progressing to a greater level of comfort. Trainee status does
not interfere with ability to work productively with clients and colleagues. Dresses
professionally.

___ Unsatisfactory/Needs Remediation
Unrealistically confident or apprehensive to the degree the functioning is significantly impaired.
Conducts self as a student or more as a friend to clients and is unaware of the need to develop a
professional identity. Wears unprofessional clothing, or calls attention to self in an
unprofessional manner.

Comments:______________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________



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Summary of trainee’s main strengths and assets:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Areas of needed improvement:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Tasks or performance expectations indicated to correct or work on problem areas (and expected
time frame):
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________


Standards for Completion of Training
Goal for Internship evaluations during the training year: By the December feedback, all
competency areas should be rated Intermediate level or higher. No objectives should be rated
Unsatisfactory and Needing Remediation.

Goal for completion of Internship: No more than 3 objectives will be rated below High
Internship/Post-Doctoral level skills. No objectives may be rated at Unsatisfactory and Needing
Remediation to complete the internship.

Goal for Post-Doctoral Fellowship: All competency areas should be rated at High Internship or
at Advanced/Autonomous. No competency areas may be rated at Unsatisfactory and Needing
Remediation to complete the Fellowship.

Should an intern or fellow be determined to be functioning at the level of Unsatisfactory and
Needing Remediation in any area, this Assessment Form should be filled out immediately, and a
remediation plan developed by the intern or fellow, their primary supervisor, the Director of
Training, the Training Director of his or her graduate program, and any other members of the
Training Committee as appropriate. Areas of need for remediation will be specified and a
remediation plan will be detailed. That remediation plan will include timelines for re-revaluation
and objectives for the intern or fellow to comply with, and criteria for success and failure. Failure
to respond to the areas of remediation within the next assessment period may result in


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termination of training, or failure to complete the internship. Failure to complete work objectives
such as number of evaluations may require further, unpaid time spent in completion of the
objectives.



This assessment has been reviewed and discussed with the intern or fellow.


Supervisor ________________________________              Date _____________________


I have had this evaluation explained to me and accept this evaluation except as detailed below:

______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________

Intern/Fellow_________________________________ Date ______________________




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