Experience

Fellows will meet criteria of the Wisconsin State Statute to be eligible for licensure of having a minimum of two (2) hours of supervision per week of fellowship training. This will amount to at least 100 hours of supervision time upon completion of the fellowship.

Fellows are offered an average of two hours of didactic training per week (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 their fellowship. Most of these training opportunities are being provided virtually. Within this area, fellows are required to complete a minimum of the following:

• Weekly Friday Didactic: Fellows are required to attend a minimum of 80 percent of the weekly Friday didactic offerings over the course of their training year. These are scheduled from 1 to 3 p.m.
• Gundersen Expert Lecture Series (GELS): Fellows are encouraged to attend GELS opportunities out of the selected topics identified by their supervisors, as available.
• Ethics: Fellows are strongly encouraged, but not formally required, to use one half of a meeting time day to attend the annual Ethics Conference presented virtually or onsite.
• Case Presentation: Fellows are required to complete two formal case presentations by the end of their fellowship.
• Journal Club: Fellows are required to complete and present at two journal clubs by the completion of their fellowship. 

Fellows receive two hours of formal, scheduled, face-to-face or virtual individual supervision by doctoral-level licensed psychologists, with the intent of supervising psychological services rendered directly by the fellow. Fellows attend one hour per week of Professional Development Seminar, as well as one hour per week of regularly scheduled Didactic Training, which may be virtual or in person. Additional continuing education opportunities are offered throughout the year as available to the hospital staff.

Pediatric

Adult

The training program is directed and managed by Gundersen Medical Education. The program is assigned a medical education specialist, who is the go-to person for fellows regarding attending interviews, accepting an offer, relocating, onboarding, housing, insurance and benefits. The specialist also assists fellows with documentation required for licensure, if this is requested. Fellows have two actively practicing licensed PhD-level psychologist supervisors available on-site or virtually five days/45 hours per week, with the exception of illness, vacation and holidays. Supervisors are credentialed within the hospital system, are independently practicing and have clearance for patient care in inpatient and outpatient settings. Supervising psychologists have physical offices located near the fellows' office and are available by page, email, phone and/or Skype at all times during office hours. In Gundersen Behavioral Health, fellows have their own office, computer, printer, furniture, phone and panic alarm system.

Fellows have access to the DSM-5, testing kits and manuals, as well as online scoring systems (e.g., Q-Global) within the department and/or their office. They are given business cards and office supplies. They also are assigned an administrative assistant to help with any clerical needs and are assigned a patient liaison to aid patient scheduling and check-in and general schedule management. Fellows are provided a $1,000 allowance to assist with purchasing materials related to continuing education, which may include books, EPPP study materials, journal subscriptions, professional memberships and/or licensing fees. Fellows also have access to the hospital's journal subscriptions, both in print in the Medical Library and online using the hospital's intranet for any research needs.

*This is a required rotation

Faculty: Erin L. Beinborn, PsyD, LP, ABPP

Time Commitment (number of hours/week): 5 to 10 hours per week. 

The expectation is one testing case, report writing and feedback session per week. Fellows will have the option to do more as desired.

Goal of Rotation: To become proficient utilizing cognitive, achievement and executive functioning psychological testing measures; to integrate data to provide diagnoses and recommendations in a user-friendly report and communicate findings with caregivers.

Description of Patient Population: Children and adolescents (ages 3-18). Patients are typically referred from therapists, psychologists, psychiatrists, integrated care teams, and/or pediatricians looking for diagnostic clarification and assistance with treatment recommendations

Setting: Outpatient Behavioral Health, with occasional consultation to Inpatient Adolescent Psychiatric Unit. Testing is being conducted in-person. Feedback sessions occur in-person and virtually, depending on the state of patient residency.

Opportunities for Program Development: There are opportunities to expand testing and to integrate new tests to current protocols.

If yes, current projects: n/a

Opportunities for Research: No projects currently

If yes, current projects: N/A

Objectives:

At the end of this rotation you will be able to:

Utilize standardized objective assessment measures following standardized protocols

Score and interpret data findings and utilize in diagnostic decision making

Write succinct, user-friendly reports, including practical recommendations tailored to the patient needs

Conduct feedback sessions with caregivers answering questions and providing recommendations

Provide feedback to referring clinicians.

*This is a required rotation

Faculty: Erin L. Beinborn, PsyD, LP, ABPP

Time Commitment (number of hours/week): 5 hours every other week.

Goal of Rotation: To become proficient with evaluating for headache and co-morbid concerns; to work collaboratively with multiple clinicians; to communicate behavioral health concerns; to develop an integrated treatment plan; and to teach pain management strategies to children, adolescents and their families to assist with management of headaches.

Description of Patient Population: Children and adolescents (ages 10-18) referred from across the hospital system, presenting with a variety of headache concerns.

Setting: Outpatient Neurology. Patients attend appointments in-person. 

Opportunities for Program Development: Yes. We have in the past run a headache pain management group. This is an option for interested fellows to conduct as is or to modify and improve. This group would be provided via telehealth. 

If yes, current projects: n/a

Opportunities for Research: Yes.

If yes, current projects: We recently concluded collecting data of numerous patients that received care in the headache clinic, as well as those who received standard care. We have significant data that can be utilized to investigate a wide range of research questions. Opportunities are available to an interested fellow.

Objectives:

At the end of this rotation you will be able to:

Complete brief and focused initial evaluation of pediatric headache and co-morbid concerns

Understand and integrate information and recommendations obtained from other clinicians (e.g., neurologists, nurse practitioners and nutritionists) to enhance case

Conceptualization, diagnosis, and the development of treatment recommendations

Provide effective, evidence-based interventions to address headache and pain management concerns; Common interventions include relaxation strategies; assistance with modification of daily life habits; problem solving strategies; behavioral reward plans to improve school attendance; recommendations for parents and positive self-talk.

Collaborate with interdisciplinary team members; efficiently communicate treatment recommendations; and introduce/reinforce the benefits of behavioral and psychological interventions to address headache concerns

Independently present information on the assessment and treatment of headache concerns to other clinicians and/or families at hospital or in the community

*This is a required rotation

Faculty: Erin L. Beinborn, PsyD, LP, ABPP

Time Commitment (number of hours/week): 12 hours per month. 

Goal of Rotation: To describe and explain the disease cystic fibrosis, as well as the challenges that lead to less than ideal management of the illness; To assess for mental and behavioral health concerns and provide intervention and recommendations to manage these concerns as they arise.

Description of Patient Population: Patients in the clinic are all ages. Patients are followed birth to death. 

Setting: Outpatient Pediatric Specialties

Opportunities for Program Development: Yes. 

If yes, current projects: We have current quality improvement projects regarding mental health screening as well as transition from dependent to independent care that fellows could participate or modify, if interested.

Opportunities for Research: Yes.

If yes, current projects: We currently do not have any projects but opportunities are available. 

Objectives:

At the end of this rotation you will be able to:

Define and explain the disease cystic fibrosis

Identify barriers to care for patients with cystic fibrosis along the lifespan

Assess for anxiety and depression in patients, communicate findings and provide recommendations as needed to manage these concerns

*This is a required rotation

Faculty: Sarah Long, PhD, LP

Time Commitment (number of hours/week): 10 hours per week

Goal of Rotation: To competently provide inpatient consultation/liaison services to Gundersen Pediatrics, Neonatal Intensive Care Unit and Pediatric Intensive Care Unit, joining with various medical teams to offer needed psychological services to children and teens with a variety of complex medical and mental health presentations.

Description of Patient Population: Children and adolescents (birth to 18 years) admitted to the hospital presenting with a variety of medical and psychological concerns including, but not limited to, psychogenic non-epileptic seizures; functional abdominal pain; uncontrolled diabetes mellitus; and chronic pain. A major component of the rotation is assessing safety after self-harm attempts. Family support is also provided in the NICU, including brief management of maternal mood concerns and difficulty coping with the stressors of their child's medical condition.

Setting: Inpatient

Opportunities for Program Development: Yes

If yes, current projects: Opportunity for refinement of the C/L service always exists. Examples of possible quality improvement projects include standardizing assessment procedures and developing treatment protocols for specific patient groups.

Opportunities for Research: No projects currently, but opportunities exist for interested fellows.

If yes, current projects: N/A

Objectives:

At the end of this rotation you will be able to:

Complete a comprehensive inpatient consultation with children and their families that identifies emotional and behavioral comorbidities that are impacting a patient's medical care, barriers to treatment adherence and other psychosocial factors contributing to a patient's presentation.

Utilize evidence-based interventions including behavioral therapy, cognitive-behavioral therapy and motivational interviewing to address acute psychological concerns associated with a hospitalization, treatment and/or adjustment to medical condition.

Interact competently with inpatient and outpatient interdisciplinary team members, including physicians, nurses, physical therapists, speech therapists, occupational therapists, child life specialists, social workers and dieticians to promote the benefits of psychological services on the inpatient units of the hospital for children with acute and chronic medical conditions.

Understand the medical recommendations/considerations for children hospitalized with a variety of chronic conditions (e.g., chronic pain, diabetes mellitus, and psychogenic non-epileptic seizures) and incorporate them into treatment planning and interventions.

Provide clear and concise conceptualizations and recommendations to patients, families and the medical teams that identify present concerns/comorbidities, ongoing outpatient treatment needs and resources provided to the patient.

Faculty: Sarah Long, PhD, LP and Erin Beinborn, PsyD, LP, ABPP

Time Commitment (number of hours/week): 15-20 hours per week

The expectation is that the fellow is in Gundersen Behavioral Health conducting individual outpatient evaluations and psychotherapy under the supervision of Drs. Long and Beinborn during this time. The fellow conducts two to five new patient evaluations (varies depending on active caseload) during this time; 10 to 15 time slots are reserved for ongoing psychotherapy. Services are provided in-person and through telehealth. Approximately 75 percent of outpatient therapy services are provided via telehealth.

Goal of Rotation: Fellows will provide specialized outpatient pediatric psychology care to patients with chronic or acute medical conditions, as well as other general mental health concerns. Fellows will competently provide individual pediatric psychology evaluations and psychotherapy on an outpatient basis.

Description of Patient Population: Children and adolescents (birth to 18), generally with co-occurring medical and psychological concerns.

Setting: Outpatient within Gundersen Behavioral Health

Opportunities for Program Development: Yes

If yes, current projects: Opportunity for refinement of the outpatient service always exists. Examples of possible quality improvement projects include standardizing assessment procedures and developing treatment protocols for specific patient groups.

Opportunities for Research: No projects currently, but opportunities exist for interested fellows.

If yes, current projects: N/A

Objectives:

At the end of this rotation you will be able to:

Complete a comprehensive outpatient evaluation with patients that identifies emotional and behavioral comorbidities that are impacting a patient's medical care, barriers to treatment adherence, and other psychosocial factors contributing to a patient's presentation

Develop and implement a treatment plan with patients that include specific goals that address the physical and psychological health of patients

Implement evidence-based interventions including behavioral therapy and cognitive-behavioral therapy with children and teens diagnosed with a chronic or acute medical condition, as well as mental health concerns

Understand the medical recommendations/considerations for patients and incorporate these medical considerations into treatment planning and interventions; Function effectively and independently providing outpatient psychological services for children with chronic and acute medical conditions while communicating successfully with the medical team also involved in the patient's care.

Collaborate with interdisciplinary team members to coordinate patient care; efficiently communicate treatment recommendations; and introduce/reinforce the benefits of behavioral and psychological interventions to address relevant concerns.

*This is a required rotation

Faculty: Sarah Long, PhD, LP

Time Commitment (number of hours/week): 2-8 hours per week plus 1 hour for weekly Eating Disorder Team staffing

Goal of Rotation: To competently provide psychological evaluation and therapy for outpatients with eating disorder concerns. Fellows also attend the Eating Disorder staffing meeting and collaboration group, currently held virtually. 

Description of Patient Population: Children and adolescents (up to age 18), presenting with eating and feeding related concerns (e.g., Anorexia Nervosa, Bulimia Nervosa, ARFID) 

Setting: Outpatient within Gundersen Behavioral Health. Services are provided in-person and through telehealth, though most services are typically provided virtually.

Opportunities for Program Development: Yes

If yes, current projects: n/a

Objectives:

At the end of this rotation you will be able to:

Complete psychological evaluations with individuals referred for eating disorders

Utilize evidence-based interventions including behavioral therapy, cognitive-behavioral therapy and motivational interviewing to address behavioral and psychological symptoms.

Attend and participate in multidisciplinary team staffing and make recommendations/collaborate with the team, as appropriate.

*This is a required rotation

Faculty: Sarah Long, PhD, LP

Time Commitment (number of hours/week): Two to four hours per week plus one hour for monthly team staffing

Goal of Rotation: To competently provide psychological evaluation and therapy for outpatients with gender identity concerns; Fellows also attend the monthly transgender team staffing meeting (either in person or virtually)

Description of Patient Population: Children and adolescents (up to age 18) who present with gender identity concerns

Setting: Outpatient within Gundersen Behavioral Health; all evaluations completed in person with opportunities for virtual visits with ongoing follow up

Opportunities for Program Development: Yes

If yes, current projects: n/a

Objectives: At the end of this rotation, fellows will be able to:

Complete psychological evaluations with individuals referred for gender evaluations prior to medical intervention

Utilize evidence-based interventions, including behavioral therapy and cognitive-behavioral therapy, to address psychological symptoms related to gender identity concerns and other underlying psychological concerns, as needed

Attend and participate in multidisciplinary team staffing and make recommendations/collaborate with the team, as appropriate

Gundersen Behavioral Health is located on Gundersen Health System's La Crosse campus. Elevators are available for wheelchair accessibility. Convenient parking is accessible to fellows, along with private offices; a computer, printer and telephone; and patient seating. 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. Gundersen Health System uses Epic as its electronic medical record, and fellows have access to Epic on their office computer and their personal mobile device, if they choose. Fellows have an identified department patient liaison who assists in managing their calendar and meeting and didactic schedule and scheduling patients. An administrative assistant is available to fellows when they need help with patient correspondence, meeting room reservation or distance learning connectivity to off-site meetings. Fellows have a mailbox in the department for any interoffice mail communication. Supervision is conducted in the rotation supervisors' (Dr. Millard and Dr. Long) private office on the same floor as the fellows' office or virtually. The rotation supervisors provide varying levels of clinical supervision as fellows progress through the training year, including direct (present during visit in-person or virtually) or on-site (not present during visit) supervision and are immediately available during clinic hours by telephone, Skype and direct page. The director of training has a private office in this department and provides supervision for this rotation. Rotations in this space include: Eating Disorders Program, Psychological Testing and Outpatient Health Psychology Service. 

Multidisciplinary teams occur throughout the hospital system. The Cystic Fibrosis clinic is within Gundersen Pediatric Specialties on the La Crosse Campus. During these clinics, supervisors and fellows do not have their own office space but rather meet with the team in a reserved conference room setting and then rotate in to see patients in exam rooms. The Pediatric Headache Clinic is within Gundersen Neurology on the La Crosse Campus. Fellows and supervisors meet with team members in Neurology 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. Fellows and supervisors then return to their offices in Behavioral Health for charting/dictation These departments are within the La Crosse Campus and fellows do not need to walk outside to access these departments.

Gundersen Lutheran Medical Center, and Gundersen Pediatrics, Pediatric Intensive Care Unit and Neonatal Intensive Care Unit, are located on the La Crosse Campus (1900 South Avenue, La Crosse, WI 54601). Elevators are available for wheelchair accessibility. Convenient parking is available to fellows. 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/fellow's primary office in Behavioral Health. Clinicians requesting consultation contact the supervising psychologist directly to discuss concerns and the supervisor and fellow collaborate to create a plan for consultation completion before communicating results back to the requesting physician.  Supervision is conducted in the rotation supervisor's (Dr. Long) private office. The rotation supervisor provides varying levels of clinical supervision as the fellow 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, Skype and direct page. The Director of Training has a private office in Behavioral Health and only provides supervision for this rotation on a fill-in basis. Rotations in this space include: Consultation/Liaison Service. 

*This is a required rotation

Faculty: Bryan Kolberg, PsyD, ABPP

Time Commitment (number of hours/week): 20-24 hours per week.

The expectation is 16-24 hours of on-call coverage for the inpatient rehabilitation unit. If the fellow desires outpatient experiences, up to 4 hours of clinic contact per week can be added with concomitant decrease in inpatient hours (e.g., up to 20 instead of 24).

Goal of Rotation: To competently provide the spectrum of psychological and neuropsychological services to patients on an inpatient rehabilitation unit. The fellow will be able to assess patients from a psychological and neuropsychological standpoint and assist in behavioral management of, and treatment planning for, neurologically-compromised patients. The fellow will be able to implement evidence-based psychotherapeutic interventions tailored to the unique needs of rehabilitation populations, and will provide close consultation to the interdisciplinary rehabilitation team across the continuum of care.

Description of Patient Population: Adults (age 18 to 90+) as well as occasional older adolescents (age 16+) hospitalized on the acute rehabilitation unit. Populations also include individuals who are presenting for outpatient care following a rehabilitation stay. The fellow is expected to work with the full-spectrum of rehabilitation patients, including individuals with stroke, traumatic brain injury, spinal cord injury, limb amputation, other neurologic conditions (i.e., Parkinson's Disease and related movement disorders), and other medical and metabolic disorders. The fellow will also be expected to evaluate and treat psychological and substance use disorders within these populations.

Setting: Inpatient Rehabilitation primarily. Neurosciences Clinic (if outpatient training is desired)

Opportunities for Program Development: Limited; The fellow may have the opportunity to participate in the development or modification of patient care procedures/models of care for inpatient rehabilitation.

If yes, current projects: Opportunity for refinement of service delivery and operation of the Rehabilitation Psychology service always exists. Additional opportunities to further refine models of care specific to each separate rehabilitation patient population exist as well.

Opportunities for Research: No projects currently, but opportunities exist for interested fellows.

If yes, current projects: N/A

Objectives:

Inpatient Rehabilitation

Conduct psychological and neuropsychological evaluations of patients hospitalized on the inpatient rehabilitation unit. Evaluations include assessment of patient and family adjustment to physical and/or cognitive disabilities, evaluation of pre-existing or resulting psychological disorders, as well as evaluation of pre-existing substance use disorders in this patient population.

Utilize effective behavioral management principles to guide rehabilitation care in individuals with cognitive impairments.

Utilize short-term, evidence-based psychotherapeutic interventions that are tailored to the unique needs of individuals with cognitive and physical disabilities (when appropriate).

Provide direct consultation regarding patients to the interdisciplinary team, which consists of psychiatrists, physician assistants/nurse practitioners, nursing, therapy staff (PT, OT, Speech Therapy, Therapeutic Recreation), nutritionists, chaplains, and social workers in order to guide care.

Provide clear and concise conceptualizations and recommendations to patients, families, and the interdisciplinary team that identify barriers to discharge, needs for supervision/assistance at discharge, and recommendations for guiding inpatient rehabilitation therapies.

Neurosciences Clinic (Optional as above)

Complete a comprehensive outpatient evaluation of patients that identifies cognitive, emotional, and behavioral comorbidities and provides recommendations to guide outpatient rehabilitation therapies.

Provide direct consultation to outpatient therapists (PT, OT, Speech Therapy) to guide outpatient therapies and address barriers to participation.

Provide direct consultation to medical staff (Physiatrist and Mid-Level (PA and NP) staff regarding patients' capacity to return to work and/or driving.

Provide short-term, evidence-based psychotherapeutic interventions that are tailored to the unique needs of individuals with cognitive and physical disabilities (when appropriate).

*This is a required rotation

Faculty: Afton Koball, PhD, LP, ABPP

Time Commitment (number of hours/week): 3-12 hours per week.

The expectation is that the fellow will see a minimum of 3 bariatric psychological evaluations per week. Pre-bariatric surgery follow up visits are expected and may include 0-5 visits per week. Remaining time will be spent in provision of outpatient intervention for pre and post-operative bariatric patients. Patient is expected to attend bariatric team meetings bi-monthly and to facilitate at least 2 bariatric support groups each year.

Goal of Rotation: To competently provide psychological evaluations and intervention for individuals seeking or who have undergone bariatric surgery as part of the multidisciplinary bariatric surgery team.

Description of Patient Population: Adults (18+) who are being seen within the multidisciplinary bariatric surgery team.

Setting: Outpatient within the Department of Behavioral Health

Opportunities for Program Development: Yes

If yes, current projects: Opportunity for development of bariatric support group programming ideas exist for interested fellows.

Objectives:

Assess patients' readiness and candidacy for bariatric surgery from a psychological perspective by completing a comprehensive psychological evaluation including gathering of objective (test battery) and subjective (clinical interview) patient information.

Recognize the psychological risk factors of bariatric surgery and incorporate them into treatment planning, intervention, and team recommendations.

 Develop skills for collaborating with a multidisciplinary bariatric surgery team to provide excellent patient care.

*This is a required rotation

Faculty: Afton Koball, PhD, LP, ABPP

Time Commitment (number of hours/week): 4-6 hours per week.

The fellow will spend 1 morning per week at the Healthy Living Center (HLC) in collaboration with the multidisciplinary Dig DEEP (Diet and Exercise to Ease Pain) program. 3-5 hours will be spent in face to face patient time, 1 hour will be devoted to team staffing. 

Goal of Rotation: The fellow will work alongside a multidisciplinary group of providers (PM&R physician, bariatrician, physical therapist, and dietitian) to evaluate and treat individuals with comorbid chronic pain + obesity in the Dig DEEP program. The fellow will staff patients with this group of providers and make psychosocial recommendations to the team.

Description of Patient Population: Adults (18+) who have comorbid chronic pain and obesity.

Setting: Outpatient within the Department of Behavioral Health

Opportunities for Program Development: No

Objectives:

Complete psychological evaluations with individuals experiencing chronic pain and obesity

Utilize evidence-based recommendations/interventions including behavioral therapy, cognitive-behavioral therapy, and motivational interviewing to address behavioral and psychological symptoms.

Attend and participate in multidisciplinary team meetings and staffings and make recommendations to the team as appropriate.

*This is a required rotation

Faculty: Afton Koball, PhD, LP, ABPP

Time Commitment (number of hours/week): 2-8 hours per week plus 1 hour for weekly Eating Disorder Team staffings

Goal of Rotation: To competently provide psychological evaluation and therapy for outpatients with eating disorder concerns. The fellow will also attend the Eating Disorder staffing meeting and collaboration group as able.

Description of Patient Population: Adults (18+) 

Setting: Outpatient within the Department of Behavioral Health

Opportunities for Program Development: Yes

If yes, current projects: Opportunity for development of Dig DEEP individual and programming ideas exist for interested fellows.

Objectives:

Complete psychological evaluations with individuals referred for eating disorders

Utilize evidence-based interventions including behavioral therapy, cognitive-behavioral therapy, and motivational interviewing to address behavioral and psychological symptoms.

Attend and participate in multidisciplinary team staffings and make recommendations/collaborate with the team as appropriate.

*This is a required rotation

Faculty: Afton Koball, PhD, LP, ABPP

Time Commitment (number of hours/week): 2-8 hours per week

Goal of Rotation: The fellow will competently provide individual health psychology evaluations and psychotherapy on an outpatient basis.

Description of Patient Population: Adults (18+) generally with co-occurring medical and psychological concerns

Setting: Outpatient within the Department of Behavioral Health

Opportunities for Program Development: Yes

If yes, current projects: Opportunity for development of group health psychology programming exist for interested fellows.

Objectives:

Complete psychological evaluations with individuals referred for comorbid medical/psychiatric concerns.

Utilize evidence-based interventions including behavioral therapy, cognitive-behavioral therapy, and motivational interviewing to address behavioral and psychological symptoms.

Collaborate with referring medical providers to provide excellent psychological care.

Activities within the Rehabilitation Psychology portion of the training experience are supervised by Bryan Kolberg, PsyD, ABPP (training director) and take place at Gundersen Health System's main campus at 1900 South Ave., La Crosse, WI 54601.

The majority of fellows' time will be dedicated to working on the Gundersen Inpatient Rehabilitation Unit. This is a 20-bed, acute rehabilitation unit that serves nearly the full spectrum of rehabilitation populations, with the exception of patients requiring mechanical ventilation. Fellows will have access to a shared provider office (workspace shared by physiatrists, mid-level clinicians and social work) and will have a dedicated desk with a computer, phone, and internet access, in addition to necessary office supplies and a file cabinet. The provider office is adjacent to the Rehabilitation unit and allows for accessibility of provider staff to members of the interdisciplinary team. Fellows have access to inpatient therapy scheduling staff to assist in scheduling inpatients to be seen. Rehabilitation patients are seen in their hospital rooms by Rehabilitation Psychology clinicians. Supervision takes place in the training director's office or the provider staff office.

A portion of fellows' time will be spent providing outpatient services to patients involved with outpatient Physical Medicine and Rehabilitation. This takes place in the Gundersen East Building on the hospital's main campus. Patient populations include those who have discharged from the rehabilitation unit and who require follow-up services, including neuropsychological evaluations and/or psychotherapeutic interventions. Fellows will share an office with the Director of Training and will see patients in this location. Gundersen Health System uses Epic as its electronic medical record, and fellows have access to Epic on the office computer and their personal cell phone (if they choose). 

Fellows have an identified department patient liaison who assists in managing their calendar, meeting and didactic schedule and scheduling patients. A department administrative assistant is available when patient correspondence, meeting room reservation or distance learning set up is needed. There is a general waiting area. Patient liaisons check-in patients. Administrative staff and nursing staff handle phone calls and online messages from patients through the MyChart portal on behalf of provider staff, including fellows. Supervision takes place in the training director's office.

Gundersen Behavioral Health (BH) is located on Gundersen Health System's main campus at 1900 South Ave., La Crosse, WI 54601. Elevators are available for wheelchair accessibility. Convenient parking is available to fellows, as is a private office with a computer, printer, telephone, and patient seating. Each office has a "panic alarm" button on the underside of the desk for security and crisis situations. All office décor and supplies are provided by the department. Copy equipment is available. Gundersen Health System uses Epic as its electronic medical record and fellows have access to Epic on their office computer and their personal cell phone (if they choose). 

Fellows have an identified department patient liaison who assists in managing their calendar, meeting and didactic schedule and scheduling patients. A department administrative assistant is available to the fellow when patient correspondence, meeting room reservation, or distance learning set up is needed. Fellows have a mailbox in the department for any interoffice mail communication. Patients seen by fellows in the department are checked in by front desk staff and wait in a waiting room. Fellows see patients in their private office. Supervision is conducted in the supervisor's (Dr. Koball) private office on the same floor as the fellow's office. The rotation supervisor (Dr. Koball) provides varying levels of clinical supervision as fellows progress 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 director of training has a private office in another campus building and does not provide supervision for this rotation. Rotations in this space include: #1 The Bariatric Surgery Clinic, where fellows see patients for pre-surgical psychological evaluations and follow up pre and post-operative care; #2 The Eating Disorders Program, where fellows see patients for eating disorder intake psychological evaluations and provides time-limited psychotherapy, and #3 The Outpatient Health Psychology Service, where fellows see patients for intake psychological evaluations and time-limited psychotherapy for a variety of mental health (e.g., depression, anxiety, mood disorders) and medical (e.g., insomnia, chronic pain) concerns.

The Healthy Living Center (HLC) is a collaborative partnership between Gundersen Health System and the La Crosse Area Family YMCA. The space is wheelchair accessible. Convenient parking is available to the fellow. It is located at 1140 Main Street, La Crosse, WI 54601 (1.5 miles from Gundersen Health System's main campus). The clinic space consists of exam rooms and consultation offices. There is a general waiting area and a Patient Liaison present to check-in patients. The provider rooms their own patients and sees patients in one of the exam or consultation offices. Offices have computers with electronic medical record (Epic) access, telephone, and "panic alarm" buttons for security and crisis situations. All office supplies are provided by the HLC. A common workspace is used by multidisciplinary team members and has several computers with Epic access, telephones, and printers. Also available is an exercise space with equipment for patients to utilize during exercise and physical therapy programming, a large kitchen demonstration space, and group meeting rooms. The rotation supervisor (Dr. Koball) provides varying levels of clinical supervision as the fellow progresses through the training year including direct (present during visit), on-site (not present during visit but located in the building), or off-site supervision (at main Gundersen Hospital Building 1.5 miles away) and is immediately available during clinic hours by telephone and direct page. The psychology fellow spends ½ to 1 full day per week at the HLC. The Director of Training has a private office on the Gundersen Health System campus (off-site) and does not provide supervision for this rotation. Rotations in this space include: #1 The Dig DEEP (Diet and Exercise to Ease Pain) program, where the fellow sees patients with comorbid chronic pain and obesity for intake psychological evaluations and time-limited therapy visits to address pain and weight management. The fellow also runs quarterly group coaching classes for patients who participate in group exercise programming with a physical therapist through the Dig DEEP program (max of 12 patients per group). The Dig DEEP clinic is staffed with a physical medicine and rehabilitation physician, a weight management physician, a dietitian, and a physical therapist; these providers are always on site while the fellow sees patients at the HLC.