1. Child/Pediatric Psychology Specialization SOPMarch 2009 MCHK-PHMEMORANDUM FOR RecordSUBJECT- Standing Operating Procedures for the Child/Pediatric Psychology Specialty Track Training, Post-Doctoral Training Program in Clinical Psychology, Department of Psychology, Tripler Army Medical Center (TAMC).1. PURPOSE: To establish the description, policies and procedures for conducting the Child/Pediatric Psychology Specialty Track Training within the Postdoctoral Training Program in Clinical Psychology.2. REFERENCES:AR 351-3, Professional Training of Army Medical Department Personnel.MEDCOM Regulation 40-3, Use and Control of Psychological TestingMaterials.American Psychological Association (APA) Criteria for Accreditation ofPostdoctoral Residency Training Programs.Association of Psychology Postdoctoral and Internship Centers (APPIC)Criteria for Postdoctoral Residency Training Programs.American Board of Professional Psychology (ABPP) Criteria for SpecialtyTraining.3. SCOPE: This standard operating procedure applies to all faculty, fellows and support staff assigned to work with Child/Pediatric Psychology Fellowship training activities in the Department of Psychology, Tripler Army Medical Center (TAMC). Additionally, individuals assigned to other organizations who contribute to this program as consultants, supervisors, or in some other capacity are required to adhere to the standards of this policy.4. MISSION: To provide a comprehensive and intensive two-year training program in the specialty area of Child/Pediatric Psychology. Emphasis will be placed on a scientist-practitioner model, which is both programmatic and competency-based.5. RESPONSIBILITIES:a. The Chief, Department of Psychology, TAMC has overall responsibilityfor the Postdoctoral Training Program in Clinical Psychology. b. The Director of Fellowship Training is responsible for the administration and direct supervision of this program. In addition, the Director of Fellowship Training will establish and supervise the training of fellows, which develops their advanced competence as a professional psychologist based on sound scientific

2. and professional practice foundations. This training will consist of core seminars, lectures and case conferences that will be attended by all fellows. The core education will include the following content areas: psychopharmacology, consultation, program evaluation, and supervision; strategies of scholarly inquiry; organization, management and administration issues pertinent to psychological service delivery and practice, training and research; professional conduct, ethics and law; and issues of cultural and individual diversity. c. The Director of Training for the Child/Pediatric Psychology Specialty Track is responsible for developing the content of the program, day-to-day administration and activities of the program, and the documentation of training. This includes coordinating with other clinic staff, hospital staff, and staff of other institutions to establish training opportunities for child/pediatric psychology fellows. The Director of Training will report directly to the Director of Fellowship Training on all matters pertaining to the fellowship. d. Postdoctoral Fellows have as their primary responsibility, the acquisition of a knowledge base and clinical skills to develop advanced competence in the practice of clinical psychology and the practice of child/pediatric psychology. Fellows will be expected to meet the exit criteria of this program prior to their graduation (For list of exit criteria, see appendix 1). The postdoctoral fellows are expected to reach an advanced level of competence in the specialty of child/pediatric psychology necessary for independent practice as a child/pediatric psychologist.6. GOALS: The Child/Pediatric Psychology Specialty Track is structured to ensure the development of advanced professional and technical expertise in the practice of Child/Pediatric Psychology by each fellow based upon sound scientific and professional practice foundations. The primary goal of the specialty area is to use the scientist-practitioner approach to train clinical Child/Pediatric psychologists to be prepared to work in a variety of child/pediatric psychology- related clinical, research, and academic settings. The long-term goal of the fellowship is to train psychologists who are interested in pursuing careers in clinical child/pediatric psychology and make significant contributions in clinical, research, or teaching activities. The specific goals and objectives of the specialty area are listed in Appendix 2. a. The primary training method is supervised service delivery with direct patient care. However, fellows' service delivery activities are intended to be primarily learning oriented and training considerations are given precedence over service delivery and revenue generation. Each fellow receives 3 to 4 hours of supervision per week, with a minimum of at least 2 hours involving individual, face-to-face supervision. In addition, fellows have access to supervisor consultation and intervention in emergencies.b. Educational and training activities also comprise a large portion of the fellow's training and are designed to be cumulative, graduated in complexity and 3. structured (See Appendix 4 for a listing of educational and training activities during the fellowship and Appendix 5 for the list of recommended readings).7. COMPETENCY REQUIREMENTS: During the first week of the program the Training Director meets with each fellow and reviews the list of required competencies for the specialty training experience (See list of competencies at Appendix 3). The competency list specifies fellowship requirements in terms of assessment competencies, treatment competencies, knowledge required, and research activities. Each fellow works with the Director of Training to develop an initial training plan based on the fellows previous training and experience related to the competencies as well as the fellows areas of interest. Required activities are listed in Appendix 4.8. FACILITATING TRAINING AND EDUCATIONAL EXPERIENCE OF FELLOWS a. This program is both programmatic and competency-based, so integrating service provision and educational/training experiences in Clinical Child/Pediatric Psychology is necessary. Each fellow presents with different degrees of specialty knowledge and skills acquired at various levels of their training throughout their doctoral studies and internship. At the conclusion of each quarter, each fellow is provided feedback on his/her strengths and weaknesses. To the degree possible, supervision and training for each fellow is tailored to their individual needs and interests. In order to facilitate this, goals and objectives for each quarter are developed collaboratively between the supervisor and fellow. b. In order to maximize the quality and effectiveness of the fellows' learning experiences, fellow-faculty relations are collegial and conducted in a manner consistent with ethical principles and professional conduct standards. c. The Director of Fellowship Training will meet with all fellows weekly in order to obtain feedback about the program, any concerns fellows may have and information on specific changes that would facilitate further development and learning.9. EVALUATIONS AND FEEDBACKa. At the conclusion of each quarter, the rotation supervisor will evaluate the fellow and provide a copy of the evaluation to the Director of Training for the Child/Pediatric Psychology Specialty Area. b. At the conclusion of each quarter, the Director of Training for the Child/ Pediatric Psychology Specialty Track will evaluate the fellow's academic and professional progress. These evaluations are recorded and signed by both the Director of Training and the fellow. The results are utilized to develop individual 4. goals for the fellow in subsequent rotations. The quarterly evaluations will also address the fellows progress towards completing the exit criteria. If the fellows progress is unacceptable, the fellows will be provided timely, written notification of all shortcomings. They will be given the opportunity to discuss their performance and will receive guidance regarding any necessary remedial training. Additionally, written feedback on the outcome of any remedial training from the previous quarter will be provided. c. At the conclusion of each quarter, the fellow will be asked to provide formal written feedback on their experience. The fellows evaluations focus on the extent to which the fellowship is meeting their needs and expectations, as well as recommendations for changes in the program. Fellows are also invited to provide verbal feedback during their individual feedback session at the conclusion of each quarter.d. At the completion of the training program and after progress evaluations have been given, fellow are asked to provide their evaluation of the entire training experience. In particular, they comment on any areas for improvement with recommendations, as appropriate.e. The Director of Fellowship Training will keep all fellow evaluations and they will not be released to any agency outside TAMC without written permission of the fellow. Upon satisfactory completion of the Fellowship, a certificate will be issued to each fellow attesting to his/her completion of a Postdoctoral Fellowship in Clinical Psychology with a specialization in Child/Pediatric Psychology at TAMC. GEOFFREY CHUNG, Ph.D. Clinical Psychologist Director, Child/Pediatric Psychology SpecializationAPPROVED Rafael A. Salas, Psy.D. CAPT, USPHS Director of Fellowship Training 5. RAYMOND A. FOLEN, Ph.D, ABPP Clinical Psychologist Chief, Department of Psychology) 6. APPENDIX 1: Exit CriteriaThe following exit criteria will be included in a formal evaluation of the fellow's competency in Child/Pediatric Psychology: 1. Attain basic knowledge of normal and abnormal child and adolescent development. 2. Obtain substantial experience and developed expertise in child and pediatric psychological evaluation and assessment, including basic interviewing skills with children, adolescents, and families; substantial experience and expertise in conducting child and family intake evaluations and in the differential diagnosis and biopsychosocial formulation of child and adolescent psychopathology; Develop basic skills in psychological assessment (including administration, scoring, and interpretation of psychological tests, as well as preparation of written reports). 3. Develop comprehensive knowledge and demonstrated critical thinking concerning the nature and course of psychopathologies, as described in DSM-IV, key theoretical models, and the empirical literature 4. Learn to implement and became highly skilled in a wide range of state-of- the-art, developmentally sensitive, psychosocial treatments for children, adolescents, and families. 5. Gain experience and became skilled in rapid assessment and intervention in the primary care pediatrics setting and in interventions appropriate to the inpatient pediatrics setting. 6. Complete a scholarly activity that demonstrates individual competence of independent and systematic psychological research of publishable quality. While publication/presentation of the research project is not required, it is highly encouraged. 7. APPENDIX 2: Objectives and Processes for the Child/Pediatric Psychology Specialty Track Objective #1. Ensure acquisition of the basic knowledge and skills prerequisite to advanced training in Child/Pediatric Psychology. These prerequisites are as follows: (a) basic knowledge of normal and abnormal child and adolescent development, (b) basic interviewing skills with children, adolescents, families; (c) basic skills to conduct new patient evaluations and formulate cases using a biopsychosocial model that is sensitive to developmental issues; (d) comprehensive knowledge and critical thinking concerning the nature and course of psychopathologies, as described in DSM-IV, key theoretical models, and the empirical literature; (e) basic skills in psychological assessment (including administration, scoring, interpretation, and preparation of written reports).Processes1. (a). Based on a review and discussion of each fellow's previouscourse work, clinical practicum and internship training experiences,and personal comfort with knowledge/expertise in areas pertinent toChild/Pediatric Psychology, an initial training plan will be developed.This plan will be a collaborative effort of the postdoctoral fellow and thedirector of Child/Pediatric Psychology Training.(b). In areas where greater experience or knowledge is believed to be necessary prior to more advanced and autonomous training experiences, opportunities will be provided for the fellow to (1) observe others conducting intake evaluations or psychological assessments or (2) read key references in designated areas (3) attend relevant seminars or courses. Objective #2. Obtain substantial experience and develop a high level of expertise in the conduct of child and family intake evaluations and in the differential diagnosis and biopsychosocial formulation of child and adolescent psychopathology.Processes2. (a). Each fellow will regularly perform interviews/evaluations with newpatients in the schools, the child psychology clinic, in the pediatricsclinic or on the pediatrics ward.(b). Each fellow will conduct intake interviews/evaluations with multiple youth in each of the following groups of conditions/disorders, determining appropriate diagnoses and developing biopsychosocial formulations to guide further assessment and treatment recommendations: 8. Developmental and Neurological Disorders (e.g., mental retardation, pervasive developmental disorders, speech/language disorders, schizophrenia and other psychotic disorders, organic mental disorders, tic disorders)Externalizing/Internalizing Disorders, including comorbid conditions (e.g., attention-deficit hyperactivity disorder, oppositional defiant and conduct disorders, substance use disorders, adjustment reactions and stress-related disorders, mood and anxiety disorders including major depressive disorder, separation anxiety disorder, obsessive- compulsive disorder, social phobia) Situation/social environmental problems (e.g., abuse/neglect, bereavement/loss, parental separation/divorce, parent-child relational problems)Medical Disorders(e.g., diabetes, cystic fibrosis, headaches, GI disturbances, asthma,sleep disorders, cancer) (c). Fellows will discuss intake interviews and initial case formulations with a clinical supervisor prior to completing the case formulation, treatment plan, and feedback to family. This discussion may occur immediately following the interview, allowing for follow-up questions, clarifications, or direct faculty involvement with the family (pediatric clinic, pediatric ward). Generally, such discussions with supervisors will occur in regularly scheduled supervision sessions, scheduled prior to the scheduled feedback session with the family.(d). Fellows will document intake evaluations in a timely manner, obtaining written or verbal feedback on the evaluation reports from a licensed clinical psychologist.(e). Fellows will attend and participate in the Department of Psychologys monthly Case Conference Series. Fellows will be responsible for three formal case presentations each training year. Objective #3. Obtain substantial experience and develop a high level of expertise in child/pediatric psychological evaluation and assessment.Processes3. (a). Fellows will perform psychological assessments on all patients 9. seen in the child psychology clinic to include at a minimum broadbandinstruments and appropriate narrow band instruments. (b). Each fellow will conduct assessments with at least one, and oftenmultiple, youth with conditions/disorders in each of the followinggroups: Developmental and Neurological Disorders, Externalizing/InternalizingDisorders, including comorbid conditions, Situation/socialenvironmental problems, and Medical Disorders. (c). Each fellow will become highly skilled in selecting, implementing,scoring, interpreting, and communicating findings from a broad array ofpsychological assessment instruments, including experience in each ofthe following assessment domains: Cognitive/Intellectual and Achievement/Academic Assessment Broadband Instruments (e.g. Behavior, Psychopathology,Personality Traits) Narrow Band instruments (e.g. Depression, Anxiety, ADHD) Learning and Memory Assessment Adaptive Functioning (d). Each fellow will receive weekly individual supervision onpsychological assessment in the context of regularly scheduledsupervision time with a licensed clinical psychologist. This supervisionwill occur before the evaluation report is finalized and feedback isgiven to the family. Objective #4. Implement and become highly skilled in a wide range of state-of-the-art, developmentally sensitive, psychosocial and behavioral treatments for children, adolescents, and families.Processes4. (a). Each fellow will be scheduled weekly for a minimum of five hoursof face-to-face psychotherapy with children, adolescents, and theirfamilies. Each fellow will have opportunities to provide parentguidance/training, and individual, family and group therapy. (b). Each fellow will have the opportunity to participate in theAdvanced Psychotherapy Seminar for psychology postdoctoral fellowsand advanced child psychiatry fellows in the Child and AdolescentPsychiatry training program. Fellows may also participate in theweekly child psychology training program. As part of these trainingprograms, each fellow will learn parent education/training, family 10. therapy skills, social skills and communication training, cognitive-behavioral therapy for depressive and anxiety disorders,exposure/response prevention treatment of OCD; behavioraltreatments for ADHD, elimination disorders, sleep disorders, ODD,Aspergers/autistic disorders, and compliance with medical regimens. Successful completion of treatment/therapy training entails attendanceat pertinent seminars/demonstrations, completion of assignedreadings, individual clinical supervision, demonstrated competence indeciding when and how to employ the treatment techniques, anddemonstrated successful treatment outcomes using the methodstaught. (c). Fellows will participate in regularly scheduled, weekly supervisionmeetings to discuss psychosocial and behavioral treatments andpsychotherapy cases with a licensed clinical psychologist. Additionalspecialty consultation and assistance with crisis intervention will beavailable as needed. Each fellow will obtain clinical supervision from aminimum of two licensed clinical psychologists during their training. Objective #5. Obtain experience and become skilled in rapid assessment and intervention in the primary care pediatrics setting and in interventions appropriate to the inpatient pediatrics setting. Develop the ability to provide consultation to patients and professionals sufficient to practice on an independent basis.Processes5. (a). Each fellow will complete a nine-month rotation in the pediatrics clinic under the supervision of a pediatric psychologist. Fellows will attend pediatric morning report and the pediatric morning seminar on the days they rotate in pediatrics. (b). Each fellow will participate in one pediatric multidisciplinary clinic(e.g. Cystic Fibrosis Clinic, Oncology Clinic) and one of themultidisciplinary discharge rounds (e.g. 7-B, NICU, PICU). (c). Each fellow will participate in inpatient pediatric treatment/evaluation. (d). Fellows will learn rapid interventions for various commonproblems seen in the pediatric setting such as sleep problems, feedingproblems, elimination problems, behavior problems, problems withpain, and adherence problems with medical regimen. Suchinterventions will be not only taught in didactic seminars but viasupervised experience in the pediatrics clinic, pediatrics ward, and 11. child psychology clinic.Objective #6. Become competent and capable of independent, systematic research in Child/Pediatric Psychology.Processes6. (a). Each fellow will participate in ongoing research projects inChild/Pediatric Psychology, taking on responsibility for managingresearch databases and supervising research assistants as needed. (b). Fellows will complete a scholarly activity that demonstratesindividual competence of independent and systematic psychologicalresearch of publishable quality by the end of their training period.While publication/presentation of the research project outside of TAMCis not required, it is highly encouraged. (d). Each fellow will regularly discuss their research activities in theirsupervision sessions. 12. APPENDIX 3: Child/Pediatric Psychology Specialty Area Competence/Knowledge ChecklistFellow______________________ Training Year_______________ (N/A = experience not available)Objective 1: Prerequisites/knowledgeCompleted 1. Review of knowledge, experience, skills_______________2. Initial training plan developed_______________3. Psychopharmacology (90% attendance)_______________4. Psychotherapy (lecture, readings)_______________5. Child Development (lecture, readings)_______________6. Autism Spectrum Disorders (lecture, readings)_______________7. Elimination Disorders (lecture, readings)_______________8. Sleep Disorders (lecture, readings)_______________9. Mental Retardation (lecture, readings)_______________10. Asthma/ Diabtes (lecture, readings)_______________11. Cancer/Pain Management (lecture, readings)_______________12. Headaches (lecture, readings)_______________13. Anxiety Disorders (lecture, readings) 13. _______________ 14. Obsessive Compulsive Disorder (lecture, readings)_______________ 15. ADHD (lecture, readings)_______________ 16. Mood Disorders (lecture, readings)_______________ 17. Genetic Disorders (lecture, readings)_______________ 18. Learning Disorders (lecture, readings)_______________ 19. Tourettes Syndrome (lecture, readings)_______________ Objective 2: Intake assessments/evaluations Completed_______ 1. Clinical interview with parents (20)_______________ 2. Clinical interview with a child (15)_______________ 3. Clinical interview with an adolescent (15)_______________ 4. Pediatrics intake/interview (20)_______________ 5. School intake/interview (10)_______________ 6. Evaluation of developmental disorder/mental retardation (3)_______________ 7. Evaluation of internalizing disorders (3)_____________ 8. Evaluation of externalizing disorders (3) 14. _______________9. Evaluation of situational/environmental problems (5) ______________10. Evaluation of medical disorders (5) _______________11. Documentationa. Timely (check one) _____ reports and encounter notes are consistently late _____ reports and encounter notes are often late _____ reports and encounter notes are generally completed on time _____ reports and encounter notes are nearly always completed on time _____ reports and encounter notes are always completed on timeb. Accurately (check one) _____ reports and encounter notes are consistently inaccurate _____ reports and encounter notes are often inaccurate _____ reports and encounter notes are generally accurate/complete _____ reports and encounter notes are nearly always accurate/complete _____ reports and encounter notes are always accurate/complete12. Case presentationsa. Make presentations to fellows and staff (3 per year) ______________b. Make presentations at child/pediatric case conferences (2) ______________ Objective 3: Assessment Completed 15. 1. Cognitive/ Intellectual (10) _______________2. Achievement/Academic (8) _______________3. Memory and Learning (2) _______________4. Broad band Instrument (20) _______________5. Narrow band Instruments (20) _______________6. Adaptive Functioning (2) _______________ Objective 4: Treatment Completed1. Enuresis (2) _______________2. Encopresis (2) _______________3. Sleep Disorders/Problems (3) _______________4. Anxiety Disorders (3) _______________5. Mood Disorders (3) _______________6. Disruptive Behavior Disorders (3) _______________ 16. 7. Adjustment Disorders (3) _______________8. Pervasive Developmental Disorders (2) _______________9. Self-Esteem Problems or Concerns (3) _______________10. Social Skills Deficits (3) _______________11. Individual Treatment (20) _______________12. Family Treatment/Parent Education (20) _______________13. Group Treatment (3) _______________14. School Consultation (10) _____________15. Consultation and Liaison (10) _____________16. Medical Patients (10) _______________Objective 5: Pediatric Consultation and Evaluation Completed 1. Primary Care Interventions and Assessment (20) _______________2. Primary Care Consultation and Collaboration (20) _______________3. Pediatric Ward (follow 2 cases until discharge) _______________4. Pediatric Multidisciplinary Clinic (e.g. Cystic Fibrosis Clinic) ____________ 17. 5. Attend Multidisciplinary Clinic Discharge Rounds (e.g. PICU)_______________ Objective 6: Research1. Project Title (30 NOV, 1st Yr)_______________ 2. Proposal Presentation/DCI (if applicable) (28 February, 1st Yr)_______________ 3. Faculty Update/DCI Approval (if applicable) (31 July, 1st Yr)_______________ 4. Faculty Update (30 November, 2nd Yr)_______________ 5. Faculty Update (28 February, 2nd Yr)_______________ 6. Project Completion (30 May, 2nd Yr)_______________ 18. Core Training Activities Completed 1. Postdoctoral Psychopharmacology Program Received satisfactory grades in each course _______________ 2. Ethics Seminara. Attended 90% of seminars _______________b. Participated in each seminar _______________ 3. Case Conferencesa. Attended 90% _______________b. Presented 3 cases to trainees and faculty _______________ 4. Fellowship seminars attended 90%_______________ 19. APPENDIX 4: Required Training Activities 1. Child Psychology Services, including work in outpatient clinic, supervision of practicum trainees, didactic seminars, and staff meetings (three days/week for fifteen months). 2. Rotation in Pediatrics, including morning report, pediatrics morning seminar, work in outpatient clinic (two days/week for nine months). 3. Training at a community site (e.g. public school, pediatric outpatient clinic, or Native Hawaiian Community Health Center (one day/week). This two-year training experience will be arranged at the beginning of fellowship training. 4. Child and Pediatric Psychology Seminar and Teaching Clinic (two hours/week). 5. Fellowship Seminar and Director of Training Meeting (1.5 hours/week) a) Fellowship Case Conferences b) Ethics Seminar Series c) Didactic Seminars 6. Psychopharmacology Coursework with option of Masters Degree in Advanced Psychopharmacology (6 hours/week). 2. Distinguished Visiting Professor Workshops sponsored by fellowship and workshops as available dependent on interests (2 days each). 20. APPENDIX 5: List of Recommended Readings*Health-Related Disorders in Children and Adolescents: A Guidebook for Understanding and Educating, Phelps, LeAdelle (Ed.), 1998, APA Books*The Explosive Child: A New Approach for Understanding and Parenting Easily Frustrated, Chronically Inflexible Children, Greene, Ross W., 1998, Harpercollins *Assessment of Childhood Disorders, 3rd Ed., Mash, Eric J. and Terdal, Leif G. (Eds.), 1997, Guilford *Adaptation to Chronic Childhood Illness, Thompson, Robert J. and Gustafson, Kathryn E., (Eds.), 1996, APA Books *Psychosocial Treatment for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice, Hibbs, Euthymia D. and Jensen, Peter S., 1996, APA Books *Treatment of Childhood Disorders, 2nd Ed., Mash, Eric J. and Barkley, Russell A., 1998, Guilford *Handbook of Pediatric Psychology, 2nd Ed., Roberts, Michael C. (Ed.), 1998, Guilford, Attention-Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment, Barkley, Russell A, 1998, Guilford *Pediatric Neuropsychology: Research, Theory, and Practice, Yeates, Keith Owen, Ris, M. Douglas, and Taylor, H. Gerry, 1999, Guilford *Handbook of Neurodevelopmental and Genetic Disorders in Children, Goldstein, Sam and Reynolds, Cecil R., 1999, Guilford *Child Psychopathology, Mash, Eric J. and Barkley, Russell A., 1996, Guilford *Anxiety Disorders in Children and Adolescents, March, John S. (Ed.), 1995, 21. Guilford The Explosive Child, Greene, Ross W. 1998, HarperCollins Treatments That Work With Children, Christophersen, Edward R. & Mortweet, Susan L. 2001, APA. Solve Your Childs Sleep Problems, Ferber, Richard, 1985, Simon & Schuster. The Difficult Child, Turecki, Stanley, 2nd Ed. 2000, Bantam. Taking Charge of ADHD: The Complete, Authoritative Guide for Parents, Barkley, Russell A., 1995, Guilford *Assessment of Children, 3rd Ed, Sattler, Jerome, 1992, Amazon.com WAIS-III supplement WISC-III, WPPSI-R Supplement *Intelligent Testing with the WISC-III, Kaufman, Alan S., 1994, John Wiley & Sons. 22. APPENDIX 6: EvaluationFellowship Rotational Competency EvaluationPostdoctoral Fellowship in Clinical PsychologyDepartment of PsychologyTripler Army Medical CenterChild Specialty Track Fellows Name ____________________________ Date:___________________ Supervisor: _______________________________Rotation: ________________ Self evaluationSupervisor evaluationSatisfactory rating indicates that student is currently making appropriate, expected progress toward competency. Please provide comments on any item rated 1, 2, or 5. A rating of 1 or fail on any item will require a remediation. Ratings of 2 or Needs Improvement may result in a remediation plan, depending on the judgment of the supervisor. (DK = Dont Know, NA = Not Applicable)A. Objective 1 Advanced Practice Skills and KnowledgeEthical Behavior: Behavior is consistently ethical and reflects a mature understanding of ethical principles.FailNeeds Improvement SatisfactoryAbove Average Exceptional DK/NA12 3 4 5Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________Ethical/Legal Knowledge: Aware of ethical and legal issues and can articulate ethical dilemmas.FailNeeds Improvement SatisfactoryAbove Average Exceptional DK/NA12 3 4 5Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________Cultural Competency: Demonstrates sensitivity to issues of diversity and takes into account cultural issues in the delivery of services.FailNeeds Improvement SatisfactoryAbove Average Exceptional DK/NA12 3 4 5Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 23. Professional Responsibility: Maintains schedule as agreed; follows agency procedures; relates well with staff, support staff, fellow students, and other professionals; maintains professional behavior with others; handles clinic details.Fail Needs ImprovementSatisfactory Above AverageExceptional DK/NA1 2345Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ Written Material: Maintains records as required by site, in a timely manner. Please note what records are required; e.g., progress notes, assessment reports, case and termination summaries.Fail Needs ImprovementSatisfactory Above AverageExceptional DK/NA1 2345Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________Professional Writing: Well organized, clearly written, with meaningful content, and appropriate to referral question/presenting problem.Fail Needs ImprovementSatisfactory Above AverageExceptional DK/NA1 2345Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________Professional Consultation: Communicates information effectively with other professionals in a concise and understandable manner.Fail Needs ImprovementSatisfactory Above AverageExceptional DK/NA1 2345Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________B. Objective 2 Specialty Competencies: Child/Pediatric PsychologyKnowledge: Demonstrates knowledge of normal and abnormal child and adolescent development. Demonstrates knowledge of disorders, conditions, and developmental information necessary for advanced practice in child/pediatric psychology.Fail Needs ImprovementSatisfactory Above AverageExceptional DK/NA 24. 1 234 5Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________Interviewing and Assessment: Demonstrates basic interview skills with children, adolescents, and families; conducts new patient evaluations and formulates cases using a biopsychosocial model that is sensitive to developmental issues.FailNeeds ImprovementSatisfactoryAbove AverageExceptional DK/NA123 45Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________Diagnostic Skills: Demonstrates a comprehensive knowledge and critical thinking concerning the nature and course of psychopathologies, as described in DSM-IV, key theoretical models, and the empirical literature.FailNeeds ImprovementSatisfactoryAbove AverageExceptional DK/NA123 45Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________Treatment: Effectively provide direct individual and group patient care using evidenced-based treatment approaches. Individual treatments of adults with medical disorders is done with a variety of interventions.FailNeeds ImprovementSatisfactoryAbove AverageExceptional DK/NA123 45Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________Pediatric Consultation & Evaluation: Demonstrate skills in rapid assessment and intervention in the primary care setting and in interventions appropriate to the inpatient setting. Develop the ability to provide consultation to patients and professionals sufficient to practice on an independent basis. FailNeeds ImprovementSatisfactoryAbove AverageExceptional DK/NA123 45Comments_____________________________________________________________________ ______________________________________________________________________________ 25. ______________________________________________________________________________ C. Objective 3 - Research & Scholarly InquiryResearch: Developing the capabilities need to initiate and carry out scholarly inquiry and independent programmatic research.FailNeeds Improvement SatisfactoryAbove AverageExceptional DK/NA12 3 45Comments_____________________________________________________________________ _____________________________________________________________________________ ______________________________________________________________________________ D. Objective 4 Knowledge of Evidenced Based PracticeFund of Knowledge: Demonstrates an appropriate use of current literature and an advanced knowledge of the scientific basis for clinical psychological assessment and intervention.FailNeeds Improvement SatisfactoryAbove AverageExceptional DK/NA12 3 45Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ E. Objective 5 Professional DevelopmentSupervision and Teaching: Developing teaching or supervisory skills when experience is available.FailNeeds Improvement SatisfactoryAbove AverageExceptional DK/NA12 3 45Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________Professional Development: Takes advantage of opportunities for additional training events/conferences outside of required fellowship activities.FailNeeds Improvement SatisfactoryAbove AverageExceptional DK/NA12 3 45Comments_____________________________________________________________________ 26. ______________________________________________________________________________ ______________________________________________________________________________Professional Activities: Participates in professional or community activities to facilitate advancement of professional identity (e.g. SPTAs, pursuing licensure or ABPP).FailNeeds ImprovementSatisfactory Above AverageExceptionalDK/NA12345Comments_____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________Additional Comments:____________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________Signatures: ______________________________________________ Fellow Date______________________________________________ Supervisor Date______________________________________________ D.O.T. Date