I. INTRODUCTION 1 A. 1 B. 2 C. 2 D. 2 II. GENERAL CLINICAL AND ADMINISTRATIVE DUTIES 3 A. 3 B. 3 III. ETHICAL STANDARDS 4 IV. DUE PROCESS 5 A. 7 B. 8 C. 10 D. 15 E. 15 V. EVALUATION PROCESS 16 VI. EXIT CRITERIA 19 VII. MULTIPLE-ROLE RELATIONSHIP GUIDELINES 22 VIII. CONSORTIUM-WIDE DIDACTIC ACTIVITIES 23 A. 23 B. 25 IX. INTERN RIGHTS AND RESPONSIBILITIES 28 X. CONSORTIUM GOALS, OBJECTIVES, AND TRAINING PLAN 29 A. 30 B. 31 C. 31 XI. SELECTION CRITERIA 40 XII. INTERN SELECTION PROCEDURES 41 XIV. SITE DESCRIPTIONS 44 57 APPENDIX A: 58 APPENDIX B: 60 APPENDIX C: 61 APPENDIX D: 62 A ACTIVITIES TRAINING INFORMATION OF OF PROGRAM THE ON PAGE
APPENDIX E: 64 APPENDIX F: 73 APPENDIX G: 77 APPENDIX H: 85 APPENDIX I: 86 APPENDIX J: 87 APPENDIX K: 88 APPENDIX L: 96 APPENDIX M: 97 APPENDIX N: 98 APPENDIX O: 99 APPENDIX P: 101 APPENDIX Q: 105 APPENDIX R: 117 APPENDIX S: 119 CLINICAL EVALUATION (CSI) DIDACTIC SUMMARY EVALUATION COMPETENCIES EVALUATION OF INTERNSHIP END-OF-ROTATION/END-OF-YEAR AGREEMENT
Individualized Training Plan is reviewed and updated, if necessary (Date Received:_______________) Self-Assessment – Evaluation of Intern Competencies Form, completed by intern (Date Received:_______________) End of Third Rotation Quarter (3/31/2018) Intern Evaluation Form/Clinical Supervisory Inventory, completed by supervisor (Date Received:_______________) Time Analysis Log (Date Received:_______________) Individualized Training Plan is reviewed and updated, if necessary (Date Received:_______________) End of the Training Year (6/30/2018) Intern Evaluation Form/Clinical Supervisory Inventory, completed by supervisor (Date Received:_______________) Time Analysis Log (Date Received:_______________) Program Evaluation Form, completed by intern (Date Received:_________________) Self-Assessment – Evaluation of Intern Competencies Form, completed by intern (Date Received:_______________) Intern Contact Information Form, completed by intern (Date Received:______________) Other Information Required by End of Training Year Didactic Presentation and Summary of Evaluations; Date:_________________________ Assessment Presentation and Summary of Evaluations; Date:_______________________ Intervention Case Presentation and Summary of Evaluations; Date:__________________ Outreach/Consultation Project Summary Copy of Research Project Poster
Overall score Professionalism: 1 2 3 4 5 NA Please provide formal, written evaluation of the Ethical/Legal and Professional Identity skills, knowledge and attitude (you may use a separate sheet of paper): Professional Presentation/Communication Skills, Research/Evaluation. Generating professional presentations and research that contribute to the professional knowledge base and/or evaluates the effectiveness of various professional activities. Preparation for presentation(s) 1 2 3 4 5 NA Organization and quality of presentation(s), literature review 1 2 3 4 5 NA Appropriate level of presentation(s) 1 2 3 4 5 NA Integration of research and clinical issues 1 2 3 4 5 NA Skill 1 2 3 4 5 NA Participation in others' presentations/professional activities 1 2 3 4 5 NA Scientific Mindedness 1 2 3 4 5 NA Scientific Foundation of Psychology 1 2 3 4 5 NA Scientific Foundation of Professional Practice 1 2 3 4 5 NA Overall score for Presentation, Research Methods 1 2 3 4 5 NA Please provide formal, written evaluation of the Professional Presentation/Communication skills, knowledge and attitude (you may use a separate sheet of paper): ADDITIONAL COMPENTENCY/EVALUATION AREAS: Reflective Practice/Self-Assessment/Self-Care: Practice conducted with personal and professional self-awareness and reflection; with awareness of competencies; with appropriate self-care. Reflective Practice 1 2 3 4 5 NA Self-Assessment 1 2 3 4 5 NA Self-Care 1 2 3 4 5 NA Overall score for Reflective Practice 1 2 3 4 5 NA Please provide formal, written evaluation of the above area (you may use a separate sheet of paper): Relationships: Relates effectively and meaningfully with individuals, groups, and/or communities. Interpersonal Relationships 1 2 3 4 5 NA Affective Skills 1 2 3 4 5 NA