ALLIANT INTERNATIONAL UNIVERSITY--CSPP
10455 POMERADO ROAD DALEY HALL, 213
SAN DIEGO, CA 92131
T (858) 635-4743, F (858) 635-4585
AGENCY INFORMATION AND TRAINING PLAN
2015/16 ACADEMIC YEAR
Agency Name
Center for BioBehavioral Therapies
G2 Practicum
X
Internship
(Anxiety and Stress Disorders Clinic)
Only
Contact Person
Richard Gevirtz, Ph.D.
Title
Director
Supervising Psychologist
Richard Gevirtz, Ph.D.
Address
10455 Pomerado Road, M15 Room 12, San Diego, CA 92131
Secondary Locations
Phone Number
(858) 635-4842
Fax Number
858-435-4482
Email Address
rgevirtz@alliant.edu
I. NATURE OF AGENCY
Public
Private
Profit
Non-profit
X
Other (e.g.,
church
supported)
General description of the agency, including its purpose, function, and specific programs
Outpatient program targeted primarily at the treatment of stress-related disorders, e.g. headache, irritable
bowel, hypertension, etc. and anxiety disorders. This program is included within the framework of CSPP’s
clinic.
Is the agency accredited or approved by any local, state, or national accrediting organization?
No
X
Yes (specify)
II. POPULATION SERVED
Age (percentages)
children
30%
adolescents
40%
adults
30%
seniors
Diagnosis (rank order proportion of clientele)
adjustment
90%
character/behavior
psychosis
alcoholism
disorder/neurosis
disorder
substance abuse
affective disorder
other (specify)
10%
Ethnic-Racial Mix (approximate percentages)
Caucasian
70%
African2%
Latino
5%
Asian
5%
Other
Stress
American
(specify)
and
anxiety
Sources of Referral (approximate percentages)
self
15%
court
school
physician
50%
other
35% other
(specify)
health care
professional
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III. DIRECT SERVICES
Indicate approximate number of hours per week students would spend in each activity listed below:
Number of Hours Per Week
Activity
G2 Practicum
G3 Practicum
Internship
Intake Assessment
3
Crisis Intervention
Individual Therapy (short-term)
11
Individual Therapy (long-term)
Group Therapy
Couples Therapy
Family Therapy
Play Therapy
Milieu Therapy
Diagnostic Testing
Forensic Assessment
Peer Supervision
Consultation
2
Other (specify)
If your agency offers both Practicum and Internship positions, please describe how the two will differ from each
other
IV. INDIRECT SERVICES
Describe, as fully as possible, all indirect services offered (e.g., consultation, public education, etc.)
Consultation with other health care professional.
V. THEORETICAL ORIENTATION
Cognitive behavioral. Applied psychophysiology.
VI. TRAINING AND SUPERVISION
Supervisor is on site at least 1/2 of the time each supervisee is at the agency?
Yes X
No
Supervisor is licensed at least 3 years? Yes
X
No
How Long?
30 years
License Number of primary supervisor
PSY7204
Licensed psychologist on staff at least 20 hrs/per week?
Yes
X
No
What is the orientation program for new
Summer in-services and shadowing
trainees?
What are the overall training goals of the agency? For what is the student being trained?
Assessment and treatment of psychophysiological and anxiety disorders, competency with computerized
biofeedback treatment.
What training does the agency offer in providing culturally sensitive services?
In service training for health issues related to cultural differences. Part of supervision
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Training methods (indicate frequency and length per week):
Number of Hours Per Week
G2 Practicum
G3 Practicum
Internship
Activity
Individual Supervision
- Licensed Ph.D.
- Other
Group Supervision
Peer supervision
Team Meetings
Case Conferences
Co-therapy with Staff
Observation/Discussion with Staff
Seminars, Workshops, etc.
Videotaping of sessions
Comments
1
1
1
1
1
What training do you offer in general safety procedures?
Electronic safety
Specific procedures for your agency, e.g. violent patients?
n/a
VII. ADMINISTRATION
Staff and Trainees
How many clinical staff are on site?
full-time
What disciplines are represented?
MD
PHD 1
LCSW
part-time
RN
MFT
1
Other
Monthly meeting with gastroenterologist at Kaiser Permanente
How many trainees does the agency usually have at one time?
Full-Time
Half-Time
Is there always staff coverage during the time the trainees are there?
Yes
x
No
If no, give specifics
Required and Preferred Days
Are there any required days the students
Yes
No
x
If yes, what
must be at the agency?
days
and specific times
From
To
What is scheduled during these required times?
Group supervision
Are there preferred days/times the agency wants students to be there?
No
X
Yes
If yes, which?
Afternoons and evenings
Are trainees expected to work
Evenings
Yes (as
Weekends
necessary)
Are trainees on-call when they are not at the agency?
Yes
X
No
Starting and Ending Dates
Training begins
Mid-may
And ends
End of June
Vacation
How many weeks of vacation will the trainee be given during the training period? Negotiable
Does vacation time coincide with CSPP/AIU semester breaks?
Yes
X
No
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Stipend
Is there a stipend? No
X
Yes
G2 Practicum
G3 Practicum
Are taxes and social security deducted?
Is there a mileage allowance?
No
No
if yes, indicate amount below
G4/5 – Internship
Yes
Yes
VIII.
FACILITY
Students have access to
own office
share permanently
rotate as available
if they rotate, is there a clearly posted
schedule?
administrative support
computers
disability access
X
IX. EQUIPMENT
Play Therapy:
If the agency sees children, is there adequate Yes
play therapy equipment?
Assessment Materials
If testing is done, are there adequate test
Yes
materials?
What recording equipment is available to students?
Audio
X
Video
N/A
No
N/A
X
None
X
No
Computerized
Biofeedback
Systems
orientation for
new trainees
X. APPLICATION PROCEDURE
Please indicate the number of openings by year level
G2 Practicum
3
G3 Practicum
Material to be submitted for application
Vita
No
Yes
x
copy machines
No
Do you have written manuals for the following
general policies
safety
& procedures
Is there an application deadline?
X
0
G4/5 Internship
Yes
0
If yes,
when?
Additional Comments
Are there any special requirements students will have to complete prior to beginning at the site (e.g.
fingerprinting/background check, TB test, medical examination, etc.)?
For Kaiser they need to fill out health info
Are students required to pay for such things?
Yes
No
x
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Are AIU students competing with students from other schools?
If agency has trainees from other schools, which schools are they?
Yes
No
X
AIU has the following emphasis areas. Please indicate whether or not you are interested in students with the
following emphasis areas (please feel free to choose as many or as few as deemed appropriate)
Cultural
Family/Child
Health
X
Organizational/
Behavior
Forensic
Psychodynamic
Sports
In addition to the completed Training Site Information form, please submit the primary supervisor's
vita, a complete staff list and any other descriptive agency information (i.e., brochures, etc.) Failure to
do so may delay the processing of your application.
Completed by
Supervisor/Director
R. Gevirtz
"
Date
Date
11/24/14
"
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