Doctoral Psychology Internship

The program seeks to train interns in the Profession-Wide Competencies determined by the APA Commission on Accreditation (CoA) for practice in health service psychology.  

Research

• Demonstrates the substantially independent ability to critically evaluate and disseminate research or other scholarly activities (e.g., case conference, presentation, publications).
• Disseminate research or other scholarly activities (e.g., case conference, presentation, publications) at the local (including the host institution), regional or national level.

Ethical and Legal Standards

• Be knowledgeable of, and act in accordance with, each of the following:  
  • the current version of the APA Ethical Principles of Psychologists and Code of Conduct;  
  • relevant laws, regulations, rules and policies governing health service psychology at the organizational, local, state, regional and federal levels; and  
  • relevant professional standards and guidelines.
• Recognize ethical dilemmas as they arise and apply ethical decision-making processes to resolve the dilemmas.
• Conduct self in an ethical manner in all professional activities.

Individual and Cultural Diversity

• An understanding of how their own personal/cultural history, attitudes and biases may affect how they understand and interact with people different from themselves.  
• Knowledge of the current theoretical and empirical knowledge base as it relates to addressing diversity in all professional activities including research, training, supervision/consultation and service.  
• The ability to integrate awareness and knowledge of individual and cultural differences in the conduct of professional roles.  
• The ability to apply a framework for working effectively with areas of individual and cultural diversity.  
• The ability to work effectively with individuals whose group membership, demographic characteristics or worldviews create conflict with their own.  
• Appropriately and assertively address cultural issues pertaining to patients with other members on a multidisciplinary team.

Professional Values, Attitudes and Behaviors

• Behave in ways that reflect the values and attitudes of psychology, including cultural humility, integrity, deportment, professional identity, accountability, lifelong learning and concern for the welfare of others.  
• Engage in self-reflection regarding one’s personal and professional functioning; engage in activities to maintain and improve performance, well-being and professional effectiveness.  
• Actively seek and demonstrate openness and responsiveness to feedback and supervision.  
• Respond professionally in increasingly complex situations with a greater degree of independence as they progress across levels of training.  
• Demonstrates awareness of the roles of other disciplines on a multidisciplinary team and acts professionally, demonstrating respect for other disciplines and appropriate boundaries of practice.

Communications and Interpersonal Skills

• Develop and maintain effective relationships with a wide range of individuals, including colleagues, communities, organizations, supervisors, supervisees and those receiving professional services.  
• Demonstrate a thorough grasp of professional language and concepts; produce, comprehend and engage in communications that are informative and well-integrated.  
• Demonstrate effective interpersonal skills and the ability to manage difficult communication well.  
• Communicates assertively, professionally and respectfully with other professionals on a multidisciplinary team making appropriate professional contributions to a patient’s care.

Assessment

• Demonstrate current knowledge of diagnostic classification systems, functional and dysfunctional behaviors, including consideration of client strengths and psychopathology.  
• Demonstrate understanding of human behavior within its context (e.g., family, social, societal and cultural).  
• Demonstrate the ability to apply the knowledge of functional and dysfunctional behaviors including context to the assessment and/or diagnostic process.  
• Select and apply assessment methods that draw from the best available empirical literature and that reflect the science of measurement and psychometrics; collect relevant data using multiple sources and methods appropriate to the identified goals and questions of the assessment as well as relevant diversity characteristics of the service recipient.  
• Interpret assessment results, following current research and professional standards and guidelines, to inform case conceptualization, classification and recommendations, while guarding against decision-making biases, distinguishing the aspects of assessment that are subjective from those that are objective.  
• Communicate the findings and implications of the assessment in an accurate and effective manner sensitive to a range of audiences.  
• Assess environmental factors that facilitate or inhibit patient knowledge, values, attitudes and/or behaviors affecting health functioning and healthcare utilization.  
• Assess biopsychosocial factors affecting adherence to recommendations for medical and psychological care. 
• Assess the biopsychosocial impact of medical procedures.  
• Demonstrates knowledge of DSM-V diagnostic criteria and able to appropriately diagnose psychological disorder in medical complicated patients.  
• Demonstrates ability to evaluate, manage and document patient risk related to suicidality, homicidality or other safety issues and able to collaborate with appropriate hospital and clinic systems to mitigate risk.

Intervention

• Establish and maintain effective relationships with the recipients of psychological services.  
• Develop evidence-based intervention plans specific to the service delivery goals.
• Implement interventions informed by the current scientific literature, assessment findings, diversity characteristic and contextual variables.  
• Demonstrate the ability to apply the relevant research literature to clinical decision-making.  
• Modify and adapt evidence-based approaches effectively when a clear evidence-base is lacking.  
• Evaluate intervention effectiveness and adapt intervention goals and methods consistent with ongoing evaluation.  
• Integrate medical data, psychological data and behavioral observation to create a meaningful and coherent case conceptualization that is directly related to proposed interventions.  
• Be able to identify and utilize appropriate empirically supported treatment interventions targeted toward specific populations for adjustment, adherence, health promotion and health prevention.  
• Demonstrates ability to handle crisis situations with patients.

Supervision

• There will be an option to apply supervision knowledge in direct or simulated practice with therapy trainees, or other health professionals. Examples of direct or simulated practice examples of supervision include, but are not limited to, role-played supervision with others, and peer supervision with other trainees.  
• Apply the supervisory skill of observing in direct or simulated practice.  
• Apply the supervisory skill of evaluating in direct or simulated practice.  
• Apply the supervisory skills of giving guidance and feedback in direct or simulated practice.

Consultation and Interprofessional/Interdisciplinary Skills

• Demonstrate knowledge and respect for the roles and perspectives of other professions.  
• Apply the knowledge of consultation models and practices in direct or simulated consultation with individuals and their families, other health care professionals, interprofessional groups or systems related to health and behavior.  
• Demonstrates an ability to be assertive, yet interpersonally effective, respectful and appropriate on a multidisciplinary team.  
• Demonstrate awareness of and appreciation for the unique knowledge base, skill sets, roles in the healthcare team, and limitations and boundaries of professionals that provide services to populations being served.  
• Demonstrates skills in being able to communicate about and create mutual understanding about problems among individuals from diverse disciplines 

Interns receive a minimum of 5 hours of supervision each week, at least 2 of which are individual supervision. Each clinical experience has its own supervision structure, and efforts are made to allow each intern to have contact with as many supervisors as possible. We believe that the more people an intern can interact with, the more they will learn.  

Per APPIC requirements, the intern shall attend 2 hours of regularly scheduled face-to-face individual supervision per week; one with each co-director of the internship training program. Additional weekly supervision may be “on the fly” within intern’s rotations/tracks. Interns shall also attend 2 hours of group supervision per week. Supervision time will be documented on weekly hours logs. During scheduled supervision, interns are expected to arrive on-time and prepared for their supervision. After exclusion of allowed time away from internship (vacation and CE time), each intern shall have a total of at least 100 hours of individual supervision and at least 100 hours of group supervision upon the completion of internship.

Supervisors have full legal responsibility for the daily clinical activities of their assigned interns. They are designated by the hospital system as professionally responsible for cases. In clinical decisions, the interns will adhere to the direction of their rotation supervisor who has final authority over all clinical services. All interns and supervisors are required to comply with all laws and rules governing the practice of psychology in Wisconsin and the APA Ethical Principles and Codes of Conduct. Supervisors will maintain records of supervision. Individual supervision may be augmented by group or other formats of supervision. Interns have the responsibility of communicating with their supervisors if there is a problem fulfilling supervision requirements and if unresolved, informing the training co-directors. If still unresolved, interns are recommended to inform the vice president of Medical Education.

Interns will be offered an average of 2 hours of didactic training per week (though some weeks may be more or less) for a total of at least 100 hours of didactic and continuing education participation upon the completion of internship. Within this area, interns are required to complete a minimum of the following:

• Weekly Friday Didactics: Interns are required to attend a minimum of 80% of the weekly Friday didactic offerings over the course of their training year. These are scheduled on Fridays from 1 to 2 p.m.
• Weekly Professional Development: Immediately following the weekly Friday didactic hour, interns are required to attend a minimum of 80% of the weekly Friday professional development offerings over the course of their training year. These are scheduled on Fridays from 2 to 3 p.m.
• Today in Medicine Lecture Series: Interns are encouraged to attend opportunities on selected topics as identified by their supervisors.
• Ethics: Interns are strongly encouraged, but not formally required, to use one half day of a continuing education day to attend the annual Ethics conference presented onsite or virtually.
• Case Presentation: Interns will be required to complete one formal case presentation by the completion of their internship.
• Journal Club: Interns will be required to complete and present at one journal club by the completion of their internship.  

Sample didactic schedule

All interns have a half-day per week protected for research activities and/or other professional development. Your supervisor will work with you to figure out the best use of this time. Some interns use this time to complete their dissertations and/or apply for post-doctoral fellowship. There are also opportunities to engage with research at Gundersen Health System. The hospital has a robust research department that provides support on research design, biostatisticians, editors and scientific writers.  

Outpatient Behavioral Health

The Department of Behavioral Health (BH) is located on the 3rd and 4th floors of the 6-story Heritage Building on Gundersen Health System’s campus (1900 South Avenue, La Crosse, WI 54601). Elevators are available for wheelchair accessibility. Convenient parking is available to the intern. The intern has a workspace available to them with a computer, printer and telephone. Interns will share patient care offices, which may change depending on the day the intern is in the clinic. Each office has a “panic alarm” button on the underside of the desk for security and crisis situations. All office décor and office supplies are provided by the department. Copy equipment is available. Gundersen Health System uses Epic as its electronic medical record, and the intern has access to Epic on their office computer. The intern has a team of department patient liaisons who assist in managing their calendar, meeting and didactic schedule and scheduling of patients. A department secretary is available to the intern when patient correspondence, meeting room reservation or setting up of distance learning to off-site meetings are needed. The intern has a mailbox in the department for any interoffice mail communication. Patients seen by the intern in the department are checked in by front desk staff and wait in a waiting room; the intern then sees the patient in the available designated office for that clinic day after collecting them from the waiting room. Supervision is conducted in the supervisors' (Dr. Matheus and Dr. Tin) private office on the same floor of the Heritage Building as the intern’s office. The rotation supervisors (Dr. Matheus, Dr. Tin and all track/rotation supervisors) provide varying levels of clinical supervision as the intern progresses through the training year including direct (present during visit) or on-site (not present during visit in-person or virtually) supervision and is immediately available during clinic hours by telephone, Microsoft Teams messaging and direct page. The co-directors of training have private offices in this department and provide supervision for this rotation. Rotations in this space include Eating Disorders Program, Psychological Testing, one half-day of the Pediatric Gender Clinic and Outpatient Health Psychology Service.

Inpatient Behavioral Health

The Inpatient Behavioral Health Unit at 1901 Seventh St. S., La Crosse, WI 54601, is a 30-bed facility that provides acute mental health services. Patients are supported and protected in a healing environment during their hospitalization. Patients are encouraged to keep their daily routines and actively participate in their own care. A team approach provides consistent quality care. While staying in the Inpatient Behavioral Health Unit, patients are cared for by psychiatrists, nurses, internal medicine providers, psychologists, social workers, occupational therapists, pastoral care and other specialties, as needed. On the Inpatient Behavioral Health Unit, interns have workspace available to them with a computer, printer and telephone. Interns will have the opportunity to provide individual and group therapy to patients admitted to the unit. Interns will use Epic to document patient encounters and write progress notes. Supervision is conducted in the supervisor’s office (Dr. Ledoux) within the same building. The rotation supervisor (Dr. Ledoux) provides varying levels of clinical supervision as the intern progresses through the training year including direct (present during visit) or on-site (not present during visit in-person or virtually) supervision and is immediately available during clinic hours by telephone, Microsoft Teams messaging and direct page.

Multidisciplinary Teams (Pediatric Gender Clinic, Eating Disorder Clinic, Consultation and Liaison, Inpatient Behavioral Health)

Multidisciplinary teams occur throughout the hospital system. During these clinics, interns do not have their own office space but rather meet with the team in a reserved conference room setting or in their supervisor’s office, and then rotate in to see patients in exam rooms. Interns and supervisors meet with team members in the provider office to engage in warm handoffs. Patients are then seen in exam rooms and rounding occurs in a reserved conference room space. Computers with Epic for charting are available in the exam rooms of each department. The department hosting the multidisciplinary clinics is in charge of scheduling, rooming and collecting necessary insurance paperwork for patients seen.

Integrated Behavioral Care Clinic

Gundersen Health System’s Primary Care Clinic in Tomah, Wis., is a rural primary care clinic. It is located at 505 Gopher Drive, Tomah, WI 54660. Each intern will participate for one day per week at this location. This clinic uses a Primary Care Behavioral Health (PCBH) model. The PCBH model is an integrated model that places the mental health professional directly alongside the primary care provider (PCP) to provide intervention. Interns learn how to perform brief functional consults and communicate recommendations both to the PCP and patient effectively and efficiently. The supervision is immediate as interns are paired with a staff member, which means that the trainee works alongside a psychologist and learns how to present cases efficiently. As interns develop their skill in this area, they will be expected to provide services independently. Interns are also expected to attend integrated care team meetings every Thursday. While participating in this clinic, interns will have a separate workspace to complete clinical documentation and review patient charts. They will then see patients in exam rooms. Warm handoffs will be completed in provider offices. Ample parking is provided to interns.

Gundersen Lutheran Medical Center

Gundersen Lutheran Medical Center, and in particular the Pediatrics, Pediatric Intensive Care, and Neonatal Intensive Care Units, are located on the 5th floor of the 6-story Legacy Building on Gundersen Health System’s campus (1900 South Avenue, La Crosse, WI 54601). Elevators are available for wheelchair accessibility. Convenient parking is available to the intern. Consultation is completed in the patient room, or in consultation rooms on the hospital unit. Computers with Epic and phones are available in multiple workstations outside patient rooms, though typically documentation is completed in the provider/intern's primary office/workspace in Behavioral Health. Medical providers requesting consultation contact the supervising psychologist directly to discuss concerns, and the supervisor and intern collaborate to create a plan for consultation completion, before communicating results back to the requesting physician. Supervision is conducted in the supervisor's (Dr. Long or Dr. Anderson) private office in the Heritage Building. The rotation supervisor -- Dr. Long (pediatric) or Dr. Anderson (adult) -- provides varying levels of clinical supervision as the intern progresses through the training year including direct (present during visit) or on-site (not present during visit) supervision and is immediately available during clinic hours by telephone, Microsoft Teams messaging and direct page. The co-directors of training have private offices in Behavioral Health and only provide supervision for this rotation on a fill-in basis. Rotations in this space include Consultation/Liaison Service.

Adult and Pediatric Primary Care/Behavioral Health (PCBH) 

Internal Medicine Onalaska is located on the first floor of Gundersen’s Onalaska Clinic Campus (outpatient clinic located at 3111 Gundersen Drive, Onalaska WI, 54650). Convenient parking is available to the intern. The intern has an exam room to utilize during their time on this rotation with a computer, telephone and patient seating. All exam room décor and office supplies are provided by the department. Copy and printer equipment is available. Gundersen Health System uses Epic as its electronic medical record, and the intern has access to Epic on their office computer. The intern will utilize the Internal Medicine department Patient Liaison staff who assists in managing scheduling of patients during this rotation. Patients seen by the intern in the department are checked in by front desk staff and wait in a waiting room; the intern then sees the patient in their exam room after collecting them from the waiting room. Patients will also be seen during integrated care, where the intern will join other exam rooms to jointly provide services where primary care providers are providing care to patients. Supervision is conducted in the supervisor’s private office on the same floor of the Gundersen Onalaska Clinic as the intern’s exam room. The rotation supervisor provides varying levels of clinical supervision as the intern progresses through the training year including direct (present during visit) or on-site (not present during visit but located in the building) supervision and is immediately available during clinic hours by telephone and direct page. The co-directors of training has a private office in another campus building and does not provide supervision for this rotation.

Interns will be expected to complete all of the following at every Outpatient Behavioral Health Intake appointment:

1. Consent for treatment: Interns will be expected to discuss their intern status, provide information regarding their supervision along with contact information and discuss the limits of confidentiality with patients and parents. Patients (over age 12), parents (of patients under age 18) and the intern will all sign a formal consent form. Per Wis Psy2.10-2: Clients shall be informed that the psychological trainee is receiving supervision and that the client's case will be discussed in the context of required supervision. The trainee must inform potential clients in writing of his or her trainee status and lack of license.
2. ACE Assessment: Parents of children under age 18 and patients over age 18 will complete the Adverse Childhood Experience (ACE) Screening tool. Interns will enter the score into Epic, send communication to the patient’s PCP regarding results and provide feedback to parents/patients.
3. PHQ-9: Patients over age 12 will complete the PHQ-9 independently. Parents should not be completing this for patients. Interns will enter score into Epic. Interns will also assess for risk concerns by reviewing item #9 and following up with the CSSR-S as necessary (when anything other than “0” is noted on question #9).
4. C-SSRS: Columbia –Suicide Severity Rating Scale: If a patient answers anything but “0” on the PHQ-9, interns will follow up using the CSSR-S, document findings in Epic, contact their supervisor to review the assessment and provide recommendations as appropriate. Interns will not release patient from their care until they have reviewed the case and concerns with their supervisor any time they complete the C-SSRS. The C-SSRS is also required to be administered to patients age 12 and older during their initial intake, regardless of their response on the PHQ-9 question #9. The intern is not required to discuss the case with their supervisor prior to the patient leaving if their C-SSRS screen is negative and was only administered because of this rule.
5. GAD-7: Patients over the age of 13 will complete the GAD-7. Interns will enter the score into Epic.
6. Tobacco Screening: Patients will be asked about their substance use at intake appointment. Substance and tobacco use will be recorded in Epic under “Extended Vitals”.

Internship Due Process Policy                 

Internship Grievance Procedures Policy