VA Puget Sound, Seattle Psychology Postdoctoral Fellowship Program

The Fellowship program provides advanced training in clinical psychology, with nine focus areas. Applicants can elect to receive advanced training in Substance Use Disorders, Trauma, Primary Care, Couple & Family Services, Comprehensive Dialectical Behavior Therapy, Mental Health, and Rehabilitation Psychology. (Neuropsychology as well as Behavioral Medicine/Pain Psychology are not recruiting for 2026-2027). Detailed descriptions of each focus area can be found in a subsequent section of this Brochure. Applicants may apply for more than one position. 

The structure and activities of the Fellowship program are intended to foster the development of advanced Health Service Psychology competencies important for the attainment of leadership positions in clinical care, research, and administration.

As a foundation for advanced practice in the profession, fellows should have demonstrated competence in the following by the completion of the residency year, as measured by supervisors' and self- evaluations. Many of these outcomes will build upon knowledge and skills already well developed during doctoral and internship training. All the fellowship placements will provide opportunities for further development of these 'cross cutting' competencies, though placements might emphasize some competencies more than others. Additionally, other program components (including didactics, supervision, and clinical research) will provide added challenge and the opportunity for integration. When viewed in context of the entire sequence of training that begins with the first year of doctoral education, the fellowship year provides in-depth experience that promotes the development of these advanced competencies. 

1. Research 

Fellows are expected to:

• Demonstrate the substantially independent ability to critically evaluate and disseminate research or other scholarly activities (e.g., case conference, presentation, publications) at the local (including the host institution), regional, or national level.
• Demonstrates the integration of foundational and current research knowledge relevant to the focus of the fellow’s practice area.
• Demonstrates knowledge of common research methodologies used in the study of the practice area and the implications of the use of these methodologies.

• Demonstrates the ability to formulate and test empirical questions informed by clinical problems encountered, clinical services provided, and the clinic setting within which the fellow works.

   

2. Ethical and legal standards 

Fellows are expected to 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 oneself in an ethical manner in all professional activities. 

3. Individual and cultural diversity

Effectiveness in health service psychology requires that trainees develop the ability to conduct all professional activities with sensitivity to human diversity, including the ability to deliver high quality services to an increasingly diverse population. Therefore, trainees must demonstrate knowledge, awareness, sensitivity, and skill when working with diverse individuals and communities who embody a variety of cultural and personal background and characteristics. 

In service of this goal, fellows are expected to demonstrate: 

• 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 (e.g., research, services, and other professional activities). This includes the ability to apply a framework for working effectively with areas of individual and cultural diversity not previously encountered over the course of their careers. Also included is the ability to work effectively with individuals whose group membership, demographic characteristics, or worldviews create conflict with their own.
• The ability to independently apply their knowledge and approach in working effectively with the range of diverse individuals and groups encountered during internship. 

4. Professional values and attitudes

Fellows are expected to: 

• Behave in ways that reflect the values and attitudes of psychology, including 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 more independence as they progress across levels of training. 

5. Communication and interpersonal skills

The program views communication and interpersonal skills as foundational to education, training, and practice in health service psychology. These skills are essential for effective service delivery and professional interaction. Fellows are expected to: 

• Develop and maintain effective relationships with a wide range of individuals, including colleagues, communities, organizations, supervisors, supervisees, and those receiving professional services.
• Produce and comprehend oral, nonverbal, and written communications that are informative and well-integrated; demonstrate a thorough grasp of professional language and concepts.
• Demonstrate effective interpersonal skills and the ability to manage difficult communication well. 

6. Assessment

Fellows are expected to: 

• Demonstrate current knowledge of diagnostic classification systems, and 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).
• 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 orally and in written documents the findings and implications of the assessment in an accurate and effective manner sensitive to a range of audiences. 

7. Intervention

Fellows are expected to demonstrate the ability to: 

• 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 characteristics, 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. 

8. Consultation and interprofessional skills

Consultation and interprofessional skills are reflected in the intentional collaboration of professionals in health service psychology with other individuals or groups to address a problem, seek or share knowledge, or promote effectiveness in professional activities. Fellows are expected to: 

• Demonstrate knowledge and respect for the roles and perspectives of other professions.
• Demonstrate knowledge of consultation models and practices.
• Apply this knowledge in direct or simulated consultation with individuals and their families, other health care professionals, interprofessional groups, or systems related to health and behavior. 

The advanced competencies described above are developed as a consequence of supervised experience in a variety of settings, augmented by didactics, readings, and professional mentoring over the duration of the training year. Because professional learning is maximized when experiences are graded, sequential and cumulative, the postdoctoral program requires that each fellow devise an individualized learning contract with the help of a primary mentor, outlining the proposed learning experiences that will help them attain advanced skill and knowledge in each of the required competency areas. Composing this learning contract requires fellows to conduct a self-assessment of their prior skill level in each area. 

Mentors are responsible for identifying those training experiences that will help the fellow develop advanced abilities in each area, while considering the fellow’s prior level of experience and demonstrated competence. Further, mentors assist the fellow in devising a learning plan that is graded and sequential, such that they are likely to succeed in new areas and can profit from accumulated experiences by building new skills based on prior accomplishments. In this regard, it is expected that many fellows will have relatively strong skills in areas that are a focus of graduate and internship training (e.g., assessment and intervention) but will have relatively weaker skills in domains in which they may not have received intensive training (e.g., program administration). 

Whatever the case might be for a fellow, the process of devising the learning contract ensures that the training plan for each fellow considers their prior level of skill and individually tailors a graded learning experience that is designed to maximize their education. The fellowship provides a wealth of potential learning experiences; realistically, no single fellow can take advantage of all of them during the fellowship period. Consequently, mentors and fellows put considerable thought into devising a tailored plan that maximizes the individual growth of each fellow, considering their different histories and different career paths. 

We strongly believe that high quality supervision is the bedrock of professional training. Fellows receive at least two hours per week of individual, face-to-face, regularly scheduled supervision for the entire training period. All supervision is conducted by licensed psychologists with expertise in the activities being supervised. Fellows receive supervision from at least two psychologists during the training year, one of whom serves as the primary mentor or supervisor. In addition, fellows participate in at least two additional hours per week of other structured learning activities, including group supervision, didactics, direct observation, co-treatment and/or formal coursework. Given the interdisciplinary nature of all training settings, consultation by providers of other disciplines is readily available and easily accessible. Additionally, outside consultants are sometimes employed to provide additional, expert supervision in an area that is not readily available within the Fellowship program.

Formal postdoctoral training at the Seattle VA was initiated in 1991, when the Addiction Treatment Center (ATC) was chosen as one of two VA sites to offer Fellowship training in the interdisciplinary team approach to substance abuse treatment. Postdoctoral training in this area has been continuous since that time. In 1994 the ATC was named a Center of Excellence in Substance Abuse Treatment and Education (CESATE) and the addictions fellowship program was expanded.   In 2001, the Mental Illness Research, Education and Clinical Center (MIRECC) received funding for support of postdoctoral training in PTSD, with the first appointment beginning in August 2001, thereby formally inaugurating an integrated Fellowship program at VA Puget Sound. 

The Psychology Postdoctoral Program at the Seattle VA prepares fellows for advanced competence in clinical psychology, with focus in a chosen content area. 

The MIRECC Fellowship is intended as a two-year program (with a potential for a third year), emphasizing clinical research and clinical experience in PTSD. This position provides 75% protected research time. The Neuropsychology and Rehabilitation fellowships are two years in length and provide up to 20% protected research time, depending on qualifications and career goals of the fellow. Remaining fellowship positions are one year in length and clinical in focus, with up to 20% protected time for clinical research, quality improvement research, program development, and/or program evaluation, depending on qualifications and career goals. 

Regardless of the focus area chosen, fellows attain advanced skills and knowledge in a core of professional domains, including ethics and professional standards, research strategies, teaching and supervision methods, cultural diversity and individual differences, assessment and intervention, professional development, and interprofessional consultation.

Fellows receive at least two hours per week of individual, face-to-face, regularly scheduled supervision, conducted by licensed psychologists with expertise in the areas being supervised, and receive additional supervision as needed to ensure competent and safe patient care.  Fellows receive supervision from at least two psychologists during each training year.  In addition, fellows participate in at least two additional hours per week of other structured learning activities, which may include group supervision, patient care rounds, case review, didactics, seminars, co-therapy and/or formal coursework. Supervision provided should be relevant to the professional services conducted by the fellow, including supervision of direct patient care, research, administration, teaching, and consultation. Supervisors co-sign all progress notes, treatment plans, assessment reports, correspondence, and any other entries into the medical record, thereby verifying their knowledge of, and concurrence with, the fellow’s assessment and treatment plan. When the supervisor is away from the Medical Center, they arrange for appropriate alternative supervision, such that a fellow has ready and reliable access to on-site supervision and consultation. 

Vertical supervision

In some clinic settings, fellows can develop supervision skills by participating in vertical supervision and consultation. Vertical supervision and consultation opportunities are designed to address the specific training needs identified in each fellow’s training plan, targeting the development of competence in specific supervision skills.

Fellows can expect on-going and specific feedback from their supervisors. In addition, written evaluations are completed at the mid-point and end of each Fellowship year. Evaluations focus on the learning goals identified by each fellow in their individualized learning contract, as well as the foundational and functional competencies required of a professional psychologist. Evaluations are discussed between the fellow and the supervisor and may be modified by their consensus before being finalized. Fellowship faculty meet regularly to discuss fellows' progress for the purpose of identifying additional supports and resources that may assist fellows' in attaining their training goals. In addition, fellows are asked to critique themselves in accordance with their own goals and to provide both verbal and written evaluation of placements and supervisors.

The training derived through direct clinical experience and research activities is augmented by programmatic didactics. In addition, each emphasis area offers its own core curriculum (described later), designed to promote expertise in the area of focus. 

Fellows may also participate in a vast array of additional educational offerings available in the Medical Center. A robust intellectual environment is maintained through the efforts of many VA national Centers that have been sited at this facility. As a component of their educational mandate, these Centers frequently provide continuing education relevant to psychologists. In addition, the Mental Health Service and most Medicine specialty services sponsor numerous educational offerings of interest to psychologists, including case conferences, journal clubs, lectures, and research forums. 

Our close affiliation with the nearby University of Washington provides easy access to numerous additional offerings, including Psychiatry and Behavioral Sciences Grand Rounds, Psychiatry department and Psychology department colloquia, as well as specialized offerings from the UW School of Social Work, UW School of Nursing, and UW Alcohol and Drug Abuse Institute. Taken together, these resources provide a rich academic environment of exchange and debate—albeit within a clinical care setting—suitable to support the best in professional development. 

Overview

In recognition of the burden of disease and mortality associated with substance use disorders, the Veterans Health Administration designated enhancement funds in the early 1990s to establish the Centers of Excellence in Substance Addiction Treatment and Education (CESATE). The CESATE programs serve as national resources, with a mission of improving the quality, clinical outcomes, and cost-effectiveness of health care for Veterans with substance use disorders. In 1993, the Seattle CESATE was the first of two national CESATE programs to receive funding. Since its inception, the goals of the Seattle CESATE have been to 1) develop, implement, evaluate, and disseminate best clinical practices and educational initiatives along the continuum of care for substance use disorders, 2) provide education and training in treatment of substance use disorders, 3) provide consultation and technical assistance to program managers, medical center leadership and VA Central Office on issues relevant to quality care of Veterans with substance use disorders, and 4) conduct clinical, health services, and educational research to improve the health of Veterans with substance use disorders. Additionally, we remain alert to national trends in substance misuse (e.g., the opioid epidemic), related consequences (e.g., intentional and unintentional overdose) and gaps in healthcare services (e.g., improving access to care), as well as new treatments and VA priorities (e.g., measurement-based care). 

In the service of the first two CESATE program goals, the interprofessional training approach was chosen. Through a combination of intensive clinical training within the VA Puget Sound Addiction Treatment Center(ATC) and interprofessional didactic experiences, fellows from up to three clinical disciplines develop advanced skills in working therapeutically with Veterans with substance use disorders, become more familiar with the unique contributions that their professional disciplines make to treatment, and become better able to integrate these professional contributions in an interprofessional treatment process. Fellowship positions are typically one year in length and available for disciplines including Psychology, Social Work, and Chaplaincy.

Goals of the CESATE Interprofessional Fellowship

Our primary goal is to provide fellows an excellent interprofessional training experience in the assessment and treatment of substance use disorders, which prepares fellows to assume clinical, academic, and/or administrative leadership positions in substance use disorder treatment within the Department of Veterans Affairs, academic medical centers, and in the community. The objectives of the Interprofessional Fellowship program are common across disciplines, providing fellows with learning experiences deemed essential for all professionals working in addictive behaviors. The curriculum provides a range of structured clinical and didactic activities that allow individualized training, using individualized learning plans, to meet specialized, discipline-specific goals and interests of the fellows. A secondary goal is to increase knowledge and advance skills in program development, program evaluation, and clinical and health services research relevant to Veterans with substance use disorders.  

Psychologists receiving postdoctoral training can expect to develop advanced levels of knowledge and skills in assessment and intervention, research strategies, and administration. Moreover, they can expect continued professional development, including advancement of professional identity, increased confidence in assuming an advanced level of professional responsibility, and advanced knowledge and skills in ethics, professional and legal standards, and in culturally competent practice. In addition to these advanced skills in professional psychology, postdoctoral fellows can also expect to develop these specific areas of expertise: 

• Knowledge of theoretical models regarding the etiology of substance use disorders, and their relationship to different therapeutic interventions.
• Advanced skills in the assessment and diagnosis of substance use and related disorders.
• Advanced skills in individual and group therapy with those with substance user disorders
• Knowledge of medications, medication practices, and medication effects with Veterans with substance use disorders.
• Knowledge, comfort, and skill in the treatment of Veterans with co-occurring mental health disorder
• Knowledge, comfort, and skill in the treatment of Veterans receiving opioid use disorder medications (buprenorphine or methadone).
• Knowledge regarding the clinical aspects of HIV infection and AIDS among those with substance use disorders.
• Knowledge of the scientific literature on the etiology, diagnosis, and treatment of substance use disorders.
• Knowledge of program innovation, design, management, and/or evaluation in substance use disorder treatment.

Research & Academic Experiences 

In addition to intensive clinical training, fellows will initiate and complete a quality improvement (QI) and/or a research project, individually developed with supervision and consultation from the Fellowship Director as well as CESATE and Addiction Treatment Center psychology faculty. Fellows can spend up to 20% of their time in supervised QI and/or research activities with CESATE or Addiction Treatment Center faculty. Quality improvement projects vary greatly but typically involve evaluation of new or existing services or the development and/or implementation and evaluation of new treatment services within the ATC.  Research activities can include development of new independent projects, participation in new or ongoing research projects in CESATE and the ATC, and collection of new data and/or analysis of existing data relevant to substance use treatment with a goal of publication.  

Fellows also attend a nine-month seminar conducted by the Director of the CESATE Interprofessional Fellowship. The seminar includes academic readings and covers topics of diagnosis, etiology, epidemiology, natural history, change, treatment models, treatment outcome, relapse, individual differences and cultural factors, and special populations. This seminar is attended by CESATE Interprofessional Fellows, University of Washington addiction psychiatry fellows, as well as University of Washington, Swedish and East Pierce Family Medicine addiction medicine fellows. Fellows are expected to be active participants, and to periodically lead the seminar as a means of developing skills in teaching. Additional didactic experiences are available through the VA Puget Sound Psychology Service. 

Interprofessional Fellowship Training Settings 

Addiction Treatment Center

Clinical training during the fellowship year takes place within the VA Puget Sound Addiction Treatment Center. Addiction treatment across VA Puget Sound is delivered through a variety of outpatient clinical care programs that are integrated to provide comprehensive treatment for individuals with substance use disorders. Patients compose a heterogeneous population of (mostly male) Veterans who exhibit a wide range of substance use, psychiatric and medical problems. A large proportion of our Veterans experience concurrent psychiatric disorders.

The Addiction Treatment Center offers long-term rehabilitation services and maintains a commitment to the continuity of care for Veterans with substance use disorders. Services provided include triage, assessment and referral, and individualized outpatient care programs (ranging from daily to annually) based on need.  Available treatments include education, skills and interpersonal learning groups; opiate agonist medications, treatment for co-occurring mental health disorders, abstinence reinforcing contingency management, monitored Antabuse and monitored naltrexone. Specialized services for women are also available in a gender-sensitive environment. Over thirty clinical staff members provide this care. The composition of the staff -- which includes Psychiatry, Psychology, Social Work, Nursing, Chaplaincy, and Pharmacy, -- reflects the Addiction Treatment Center's commitment to interprofessional treatment. Several staff are also involved with research projects conducted within the Addiction Treatment Center. 

A biopsychosocial model of addictive behavior provides the rationale for the Addiction Treatment Center's interprofessional team approach. This is an integrative model that accommodates a longitudinal-developmental framework. As such, it encourages staff to consider physiological, psychological, and socio-cultural factors from each of these domains in the assessment, case conceptualization, treatment planning, and therapy processes. This approach also contributes to greater individualization of the treatment process since different patients will require differing levels of attention to each of these domains. Members from many disciplines contribute their unique perspectives on, and treatment of, aspects of the patients' problems, as well as an integrated interdisciplinary treatment plan.

This interprofessional team approach is used in all programs of the Addiction Treatment Center. Treatment modalities consist of a blend of psycho-educational, skills-training approaches and more traditional interpersonal group therapy.  Evidence-based behavioral interventions include but are not limited to Motivational Interviewing and Motivational Enhancement Therapy, Cognitive Behavior Therapy for Substance Use Disorders, and Contingency Management. Educational, vocational, and recreational therapies are also important parts of treatment. The goal of treatment is to facilitate Veterans’ recovery from substance use disorders as measured by improvements in agency, clinical outcomes, engagement in meaningful activities, secure housing, employment, and quality of life. To achieve these outcomes, the patient is assisted in reviewing problematic patterns of behavior and emotions, developing realistic personal goals for treatment and continuing care, and learning more effective methods of coping with interpersonal and emotional problems that contribute to relapse. Medications -- including methadone, buprenorphine, naltrexone, disulfiram, acamprosate, topiramate, and psychotropics -- are often an integral part of the treatment plan. 

Considerable emphasis is placed on continuity of care in the recovery process. In addition to substance use disorders, other needs and goals identified during assessment and collaborative development of individualized treatment plans are addressed during an episode of care. Consistent with VA Clinical Practice Guidelines, the Addiction Treatment Center addresses co-occurring psychiatric conditions in concurrent treatment whenever possible. Case management is routinely used to assist Veterans with housing, medical care and vocational linkages as attending to these issues is critical to recovery and broader health outcomes. 

Members of the interprofessional treatment teams contribute to the treatment process in multiple ways. They are involved in the initial screening and evaluation of potential patients, participate in the intake assessments of Veterans entering treatment, are involved in case conceptualization through participation in interprofessional treatment planning meetings, serve as individual care coordinators and therapists, co-lead therapy groups, monitor progress toward the attainment of the treatment goals established for each patient, work collaboratively with clients to develop discharge and disposition plans, and serve as co-therapists in the aftercare program, thereby assuring continuity in care across these phases of treatment. 

The Addiction Treatment Center at VA Puget Sound is also affiliated with the University of Washington School of Medicine and plays an important role in the educational programs of both VA Puget Sound and the University. It serves as a clinical training site for medical students, psychiatry residents, individuals working on graduate degrees in nursing and social work, psychology practicum students and pre-doctoral psychology interns in the Seattle VA internship program. The Addiction Treatment Center was also one of the original training sites for VA-sponsored Postdoctoral Medical Fellowships in Substance Abuse Treatment. Trainees from those disciplines represented on our interprofessional treatment team are provided training and supervised clinical experience by professional staff within their discipline. In addition, the Addiction Treatment Center hosts numerous research projects evaluating treatment methods, treatment outcome, and examining biological and psychosocial factors associated with addictive behaviors. While clinical training is the primary focus of the Interprofessional Fellowship in Substance Addiction Treatment, research involvement is readily available.  

The following services describe the many programs in which addiction treatment is provided. Fellows in Psychology can receive primary training in those settings staffed with a supervising psychologist and which offer opportunities for advanced clinical practice. Clinical expertise and faculty are drawn from the entire Addiction Treatment Center, however, and additional assignments in other settings can be arranged to participate in time-limited or specialized projects. Psychologists may request clinical placements within the following Teams:

ACCESS           Assessment, Consultation, Connection, Engagement and Stabilization Services

1. Assessment, Engagement and Consultation Service (AEC)
   1. Substance Use Disorders Intensive Outpatient Program (SUD- IOP)

OTP                  Opioid Treatment Program. Federally certified program providing methadone within a contingency management-based program. 

CORE   Co-occurring Recovery program. Full range of psychiatric severity, treatment for co-occurring disorders, and women-specific programming

The Assessment, Consultation, Connection, Engagement and Stabilization Services (ACCESS) is an interprofessional team consisting of psychology, social work, nursing, and psychiatry staff that operates the Assessment, Engagement and Consultation services (AEC) and the Substance Use Disorders Intensive Outpatient Program (SUD-IOP).  AEC provides the first contact a Veteran has with the Addiction Treatment Center, including screening, comprehensive assessment, and treatment recommendations to all Veterans seeking substance use treatment. AEC “Orientation Group” meets twice a week and individually evaluates 20-60 patients per month, with ample opportunities to work with Veterans who are diverse in gender identity; sexual orientation; racial, ethnic, and cultural identity; service branch and era; psychosocial needs; substance use and mental health concerns. Diagnosis, disposition, and recommendations are made through interprofessional team dialogue. 

The Substance Use Disorders Intensive Outpatient Program (SUD-IOP) is a three-week program designed to provide structured support to assist Veterans in reaching their individualized goals. The program approach is informed by both Recovery and Harm Reduction principles. SUD-IOP operates on Mondays, Wednesdays, and Fridays; veterans participate in three psychotherapy groups each day and meet 1:1 as needed with their care coordinator. Veterans also have the option to include additional groups from CORE programming. on program days. Group topics include interpersonal-learning psychotherapy, relapse prevention education, ACT principles, harm-reduction principles, and mindfulness-based approaches. The interprofessional SUD-IOP team meets once a week for rounds and consultation. Consultation is also provided during the weekly ACCESS team meeting. each program day. Given SUD-IOP serves all Veterans in the Addiction Treatment Center, the patient population is diverse and includes both female and male Veterans with a range of substance use disorders and co-occurring mental health presentations; common co-occurring diagnoses are PTSD, depression, anxiety, and SMI. The goal of SUD-IOP is to: assist in establishing initial stability (including support via outpatient detoxification as indicated); assess and initiate care for co-occurring medical and mental health disorders; provide brief individual psychotherapy; support psychosocial stability; assist in developing treatment goals; provide norming to group psychotherapy process; provide initial alcohol and drug psychoeducation; and promote engagement in continuing care. A valuable feature of SUD-IOP is that the time-limited nature of the program allows fellows to follow a number of patients through a full iteration of IOP, allowing the opportunity to witness relatively rapid behavior change, mood improvement, and progress on goals.

In addition to operating AEC and SUD-IOP, the ACCESS team also serves a number of clinic-wide functions including managing inpatient and outpatient consults, coordinating medically managed withdrawal services, promoting engagement in care, offering low-barrier access to care, and telehealth services. 

OTP is licensed by the federal government to provide medication treatment of opioid use disorder (i.e., methadone, buprenorphine, or injectable naltrexone) for Veterans with opioid use disorders and operates its own on-site medication dispensary. Veterans present to the clinic dispensary for observed dosing and participate in a behavioral contingency management system based on treatment progress, including the results of urine toxicology.  The interdisciplinary staff of OTP provide psychoeducation, care coordination, health maintenance interventions, overdose education and naloxone distribution, psychotropic medication management, and both group and individual psychotherapy services. OTP is the only clinic licensed to provide methadone for opioid use disorder; thus, it serves Veterans of any gender with a full range of co-occurring psychiatric issues and severities.

OTP staff facilitate a CBT-SUD group as well as process-oriented psychotherapy groups. Many OTP staff are also involved in staffing a cross-clinic medication clinic for veterans prescribed office-based buprenorphine.  Individual psychotherapy and/or long-term interventions are provided as clinically indicated. 

CORE (Co-occurring Recovery) Program offers a broad range of evidence-based interventions and recovery resources to Veterans who want to change their relationship with one or more substances, including Veterans who are seeking to address substance use, mental health and psychosocial concerns. Veterans referred to the CORE program may be new to treatment, returning to care, or stepping down from more intensive care (e.g., SUD IOP). Treatment is Veteran-centered and informed by biopsychosocial, Recovery and Harm Reduction models. Most Veterans receiving care have one or more co-occurring mental health diagnoses, and CORE provides services to individuals with varying degrees of symptom severity. In addition, CORE serves the needs of many legally referred Veterans (~20% of referrals) as ATC is approved by the state to provide legally mandated treatment.

CORE program supports a variety of evidence-based treatments to match Veterans’ substance-related treatment goals (e.g., abstinence, moderated use, harm reduction) and preferred intensity of care, including skills groups (e.g., CBT for SUD, MBRP, DBT crisis skills, ACT), process groups, spirituality and grief support groups, individual time-limited evidenced-based therapies (e.g., MI, MET, PE, CPT, COPE, contingency management), case management, legal reporting, medication for substance use disorders, psychiatric medication management, and crisis intervention. Extended hours (Tuesday evenings), drop-in groups and telehealth appointments are available to reduce barriers to care. Weekly interprofessional team meetings include representation from chaplaincy, psychiatry, social work, and psychology. Trainees interested in CORE placement may take advantage of opportunities to acquire/increase skills in comprehensive biopsychosocial assessment and substance use disorder diagnosis, case conceptualization and care coordination, group facilitation and individual EBPs. In addition, trainees may choose to include or emphasize focused programming as follows:

Women’s Programming within CORE provides services to women-identifying Veterans with substance use and co-occurring disorders within both women-only and mixed-gender frameworks. Women-identifying veterans are welcome in all general CORE programming. In addition, women Veterans entering ATC are offered gender-sensitive care, including initial evaluation by a female staff member, assignment to a female care coordinator, and treatment in women-only groups and/or with a female psychiatrist if preferred. In addition to other CORE services, women’s programming includes:

• Skills group incorporating DBT skills, CBT for SUD, & relapse prevention
• Psychotherapy process group for harm reduction & continuing care
• Referral to additional women-only groups across mental health service

Co-occurring disorders emphasis within CORE (moderate to severe co-occurring disorders treatment) emphasizes treating Veterans with both substance use disorders and significant mental health disorders of moderate to severe acuity, including PTSD, bipolar disorder, schizophrenia and other psychotic disorders and significant cognitive difficulties. Programming for this emphasis supports fellows compassionately helping Veterans learn how to cope with their substance use and mental health concerns. In addition to other CORE services, co-occurring disorders programming may include

• Skills and process groups specific to Veterans with co-occurring disorders
• Group incorporating DBT skills to cope with emotional crises and reduce harmful behaviors.
• Individual EBPs focused on treating co-occurring disorders (e.g., COPE, CPT, PE, CBT for depression, coping with auditory hallucinations, etc.)

Contingency management for stimulant or cannabis abstinence is an evidence-based, brief treatment that selectively reinforces urine toxicology screens that are negative for the target substance. Trainees can choose a full-year detail in this program for 2-3 hours per week.

Selecting clinical placements

Fellows are expected to complete a primary placement (50% time) with one supervisor and treatment team during the Fellowship year.  Additional time is filled with smaller and more time-limited placements on additional teams (often described as secondary placements or details). Every effort will be made to place Fellows with supervisors and treatment teams of their choosing. However, there are not enough teams and supervisors to allow every Fellow unrestricted choice. Fellows are often selected with placements in mind for the coming year. During the orientation period (the first week of the Fellowship) Fellows make requests for primary and other clinical placements. 

Center of Excellence in Substance Addiction Treatment and Education (CESATE)

As noted above, the CESATE is a national VA resource dedicated to 1) developing, implementing, evaluating, and disseminating best clinical practices and educational initiatives along the continuum of care for substance use disorders, 2) providing education and training in treatment of substance use disorders, 3) providing consultation and technical assistance to program managers, medical center leadership and VA Central Office on issues relevant to quality care of Veterans with substance use disorders , and 4) conducting clinical, health services, and educational research to improve the health of Veterans with substance use disorders.  CESATE investigators have academic faculty appointments at the University of Washington and are also investigators in the Mental Illness Research, Education and Clinical Center (MIRECC) and the Health Services Research & Development (HSR&D) Seattle Center of Innovation for Veteran-Centered and Value-Driven Care. CESATE is actively engaged in research projects funded by the NIH, DoD and VA and provides a research environment focused on clinical research, health services research and quality improvement projects. We welcome the opportunity to partner with psychology Fellows in the context of research placements within our Center. With mentorship from CESATE faculty, fellows are encouraged to collaborate on ongoing research and/or initiate independent research or QI projects. Our research efforts fall largely into the following categories: 

1. Intervention development and evaluation (e.g., randomized controlled trials)
2. Dissemination and implementation research
3. National program evaluation
4. Use of “Big Data” to understand national trends and care utilization. 

Ongoing and recently completed projects involving CESATE faculty include:

Clinical research

• Characterizing cannabis use in Veterans with PSTD
• Evaluation of the effect of Prazosin and Naltrexone on alcohol craving in Veterans with alcohol use disorders with and without co-occurring PTSD
• Clinical trial comparing relapse prevention and Cognitive Processing Therapy for comorbid PTSD and alcohol use disorders.
• Multisite hybrid 1 effectiveness-implementation trial to evaluate the combination of medication treatment for alcohol use disorder (MAUD) and a mobile app for unhealthy alcohol use on improvements in drinking-related and mental health outcomes, relative to patients receiving MAUD only.
• Evaluation of a harm-reduction group for women Veterans with substance use disorders.
• Cross-sectional survey project aiming to describe diverse women Veterans with chart diagnoses of SUD and of SUD in remission and to learn about their treatment preferences and reactions to a web-based intervention for Veterans with PTSD symptoms who engage in hazardous drinking.
• Longitudinal examination of LGBT+ and heterosexual Veterans treatment utilization, mental health concerns, and health risk behaviors

Health services research

• Evaluating the impact of medical and recreational marijuana laws on cannabis, opiate, pain, and clinical services utilization outcomes
• Provision of gender-tailored care for women Veterans with substance use disorder.
• Mixed-methods evaluation of the national VA implementation of the stepped care for opioid use disorder train-the-trainer (SCOUTT) initiative to increase access to mediation treatment of opioid use disorder in primary care, mental health, pain and women’s health clinics.
• Evaluating the impact of unhealthy alcohol use on COVID-related outcomes, including the likelihood of vaccination, the risk for COVID-19 infection, and among those infected with COVID-19, the risk for poor prognosis (e.g., hospitalization and death).
• Evaluation of treatment receipt patterns among women and men Veterans with substance use disorder to include care received in specialty addiction settings, general mental health and PTSD clinics, and primary care and PCMHI settings; emphasis on women-only group programming.
• Examination of tobacco cessation services among patients receiving care for substance use disorders

• Assessment of the variation in medication of opioid use disorder (MOUD) and medication of alcohol use disorder (MAUD) receipt and retention among patients with an opioid use disorder or an alcohol use disorder

   

Technology-based enhancements for implementation of evidence-based practices 

• Development of a national VA mobile application for treatment of substance use conditions.

Educational Efforts 

• Creation of a congressionally requested comprehensive educational website covering the spectrum of involvement with alcohol and drugs that is geared towards Veterans, their loved ones, and the general public

Datasets from many of the above studies provide opportunities to conduct secondary analyses under the guidance of CESATE faculty. Typically, fellows can work closely with mentors to conceptualize study design and analytic approaches and prepare manuscripts for publications in peer-reviewed journals. During this process, fellows will learn about the primary aims, regulatory issues, VA data sources and methods of the original studies, which further promote knowledge and skills in clinical, health services and implementation research.   

The PTSD Fellowship provides advanced training in clinical psychology, with an emphasis on the scientific investigation of PTSD with and without additional co-occurring mental health conditions and substance use disorders as they manifest for Veterans. Our primary aim is to provide fellows with advanced training in clinical research methods -- informed by their own clinical experience with complex patients and supervised by experts in the field -- that leads to their becoming independent investigators. Fellows are expected to generate publishable research during their training, under close mentorship, that will position them to obtain grant funding in pursuit of a research career. Because the fellow is expected to devote 75% of their time to academic and scientific activities, in addition to 25% of their time in clinical service, the Fellowship is renewable for a second year so that fellows can accumulate the necessary clinical hours for professional licensure, while still having sufficient time to initiate and complete independent research projects. 

The PTSD Fellowship is supported by specialized funding for advanced training in Psychology and Psychiatry through the Mental Illness Research, Education and Clinical Center (MIRECC). Established in 1997, the MIRECC is a regional resource throughout the Northwest VA Network that provides innovative academic research, education, and clinical demonstration projects in the areas of PTSD and co-morbid conditions. 

Fellows can expect to join a vital and creative clinical research environment that currently involves approximately 10 psychologists and psychiatrists who are actively engaged in funded research investigations. Fellows are mentored to develop their own independent research project(s). Additionally, they also may join the research teams of senior investigators engaged in ongoing projects as a means of gaining research experience and academic products. Currently, ongoing research projects include:

• Clinical Research. MIRECC investigators are currently conducting both interventional and observational (cross-sectional and longitudinal) research. Current projects include (1) the development and evaluation through a VA HSR&D Merit award of a behavioral weight management program for Veterans with PTSD called MOVE!+UP, (2) establishment of a partnership with Black Veterans, many of whom have PTSD, to enhance how weight management care in VA can better serve Black Veterans, (3)      a VA HSR&D Merit award that involves a multi-site randomized clinical trial of DBT + DBT PE vs. PE + suicide risk management for Veterans with PTSD at elevated acute risk for suicide, (4) interventional and observational studies that examine suicide prevention among Veterans, many of whom have PTSD, who contact the Veterans Crisis Line, receive a high risk flag, or receive care on an inpatient mental health unit, (5) a VA RR&D Merit award involving a randomized trial that is evaluating Prolonged Exposure (PE) vs. PE with PE Coach among Veterans with co-morbid PTSD and neurobehavioral symptoms, (6) a longitudinal observational study of mental health and health risk behaviors among LGBTQ+ and cisgender, heterosexual Veterans with opportunities to compare those who did and did not screen positive for PTSD on various well-being indicators, and (7) quantitative and qualitative research with women Veterans with substance use disorders and co-occurring other mental health conditions, including PTSD, to inform VHA’s provision of care to these patients, both in traditional clinic-based settings and in the development of a web-based CBT intervention for Veterans with alcohol/drug use concerns.
• MIRECC investigators also have many interventional and observational data sets available that may be used for secondary data analyses.
• Recent/Ongoing MIRECC Postdoctoral Research Activities. MIRECC postdoctoral fellows have recently conducted (or are currently conducting) research in the following areas: (1) health disparities affecting vulnerable populations, including women Veterans and sexual and gender minority Veterans, (2) associations between PTSD with various trauma exposures, substance use disorders, physical health conditions, and treatment utilization among Veterans, (3) the influence of barriers to care on receiving mental health treatment, (4) psychosocial correlates of substance use disorders among Veterans compared to non-Veterans using population-based data, and (5) open trials evaluating existing behavioral interventions for novel groups of Veterans.  
• Health services research. Fellows would also have the option of receiving mentoring and guidance from adjunctive faculty (e.g., faculty doing health services research through the Seattle-Denver Health Services Research Center of Innovation (HSR-COIN) should they have an interest in “big data” and/or implementation and dissemination science.
  • MIRECC investigators have initiated a growing research program in health services studies focusing on PTSD. For example, the prevalence and correlates of violence among veterans with PTSD has been investigated and MIRECC investigators have received funding to study the role of health risk behaviors in predicting health care costs in veterans with chronic PTSD and/or depression. Recently, MIRECC investigators have demonstrated that veterans with PTSD who have chronic health conditions such as diabetes have deficient health habits and require specialized intervention.
  • Research into the neurobiology and psychophysiology of PTSD. Several physician members of the PTSD research program are investigating neuroendocrine abnormalities of sympathetic nervous system functioning and HPA axis activity in veterans with PTSD. Another component of this team is conducting psychophysiological studies of aberrations in the architecture of sleep and dreaming in veterans with PTSD, and pharmacological treatments that may block disruptions of sleep and dreaming.
  • Research on the rehabilitation psychology of PTSD and Polytrauma. The Polytrauma Program provides rehabilitation care services to military personnel returning with physical injuries from the wars in Afghanistan and Iraq. The Polytrauma Program treats physical, cognitive, and psychological impairment associated with such medical trauma. Commonly these military personnel return with PTSD and traumatic brain injury (TBI). Rehabilitation psychologist members of the Rehabilitation Care Service line are involved in neuropsychological research on co-occurring TBI, PTSD and other psychological disorders as well as post-traumatic growth.

Generally, fellows would have the opportunity to work with a mentor to learn about the design and conduct of clinical trials using one or more of the above examples. Fellows are often, though not always, interested in careers involving clinical trials and as such can benefit from exposure to those that are ongoing here while working out how they might go about designing and conducting smaller scale open or randomized trials to provide preliminary data for their own VA Career Development Awards (CDA) or NIH K or another type of larger funded study in the future. 

Goals of PTSD fellowship training

Our primary goal is to provide fellows an excellent training experience in the science and clinical treatment of trauma-related disorders – one that will prepare them for eventual leadership roles in clinical services, research, and education – particularly in VA academic healthcare settings and other types of academic settings. The postdoctoral program provides learning experiences deemed essential for advanced training in professional psychology. The curriculum provides a range of structured clinical and didactic activities that allow individualized training, using individualized learning contracts, to meet more specialized goals and interests of the Fellow. 

Psychology MIRECC fellows can expect to develop advanced levels of knowledge and skills in assessment and intervention, research strategies, teaching, and administration. Moreover, they can expect continued professional development, including further consolidation of professional identity, professional networking, increased confidence in assuming an advanced level of professional responsibility, and advanced knowledge and skills in ethics, professional and legal standards, and in culturally competent practice. In addition to attaining these advanced skills in professional psychology, postdoctoral fellows in PTSD will also participate in additional experiences designed to develop specific competencies in trauma treatment, and advanced skills in scientific, educational, and administrative practice.

Research opportunities

The PTSD fellowship provides many opportunities to develop advanced knowledge and skills in clinical research and strategies of scientific investigation.

Overview of research experiences. To provide a solid foundation for a successful research career, a tailored research curriculum is designed to develop the fellows' knowledge in the area of their chosen research topic. Formal didactics and individualized mentoring address each of the following essential components for developing a successful career as a scientist-practitioner psychologist: 

• Identification of an interest area and appropriate research questions that will serve as the focus for the fellow’s independent research program.
• Selection, design, and initiation of a programmatic series of experiments that will significantly advance knowledge of this area of interest
• Obtaining resources to carry out the planned research program.
• Establishing a presence in the scientific community through communicating one’s work and developing a network of colleagues and potential collaborators with similar research interests.

These essential components are accomplished by 1) undertaking a mentored research project, 2) attending formal didactics and courses both through the national MIRECC program and local offerings, 3) participating in research seminars and journal clubs, 4) presenting research findings at a national scientific meeting, and 5) writing a pilot research grant and/or junior faculty training award grant. A mentoring committee composed of content experts in each fellow’s topics of interest will provide oversight of the fellow’s primary research project, educational experience, and career development.

Mentored research project. At the time of recruitment, each fellow’s interests are ascertained and matched with a primary faculty mentor. At the start of the postdoctoral year, fellows are immediately invited to join in ongoing research studies. Concurrently, they work with their mentors and mentoring committee to develop their own research project. Under the guidance of the research mentor, fellows formulate testable and meaningful hypotheses relevant to the veteran with mental illness; design a research project to test these hypotheses; prepare a statistical analysis plan and create a database; understand and respond to the ethical, cultural, and legal issues involved in clinical research, and in institutional review board applications (for human or animal use); prepare VA Research and Development applications (including approvals for biohazards, radiation, etc.); determine research staffing and materiel requirements; recruit, screen, and evaluate potential subjects (as appropriate); perform the research experiments; enter data into the database; perform statistical analyses; and present research findings as oral presentations and written reports for publication. 

Formal research-oriented didactics and courses. In preparing for careers in clinical research, fellows may participate in coursework at the nearby University of Washington (tuition is waived for Fellows in our University-affiliated program). Fellows can take a variety of relevant courses, depending on their interests, background, and training needs (for example, courses in statistics or research methodology). Fellows may also attend three workshops sponsored by the School of Medicine: “Biomedical Research Integrity Lecture Series (course in the responsible conduct of research),” “Walking through an NIH Grant,” and “Forming Partnerships with Industry.” Moreover, fellows participate in a nationwide VA web based MIRECC fellowship curriculum, designed to augment and enhance their clinical and research experiences. This curriculum consists of four hours of didactic training each month, delivered virtually by national experts that allows interaction with fellows across multiple sites. This curriculum includes an orientation to health care systems; research methodology; statistics; development, management, and finance of mental health services; ethical, legal and cultural issues in mental health programming; and mental health databases and information management.

Research seminars and journal clubs. Fellows and faculty participate in a monthly Trauma and Recovery Forum that alternates journal article discussions with research focused presentations. The Forum provides an interdisciplinary setting in which fellows can present their research plans, progress, and findings for feedback, brainstorming and advice in a supportive environment. Participants in this ongoing Forum consist of basic science and clinical research faculty, as well as postdoctoral and pre-doctoral trainees in psychology and fellows and residents in psychiatry. This unique Forum provides for stimulating cross-fertilization of ideas among the participants and an optimal opportunity for all participants to learn and practice the vocabularies and thought processes of clinical and basic science. The combined research presentation and journal article components provide a means for keeping abreast of important basic and clinical developments in mental health and related disciplines.

Fellows may take advantage of many other didactic activities as time constraints and interest allow, including additional lab meetings, seminars, lecture series, research conferences, journal clubs, and rounds. A wide array of such opportunities is available at the Seattle VA and nearby University of Washington, depending on the Fellow's specific research interests. These include such offerings as the UW Psychiatry Grand Rounds, Gerontology Grand Rounds, Women's Health Care Rounds, Behavioral Neuroscience Seminar, and Ethics Forum. Overall, this curriculum provides fellows with a strong foundation in the principles and applications of investigative approaches in professional psychology.

Presentation of research findings.  An important objective of the MIRECC Fellowship is to foster the trainees’ ability to effectively communicate the results of his/her work through peer-reviewed publications and presentations at scientific meetings. Fellows can expect to receive individual mentoring in manuscript preparation, as well as editorial assistance and review. In addition, fellows can attend courses in technical writing and writing strategies specific to topics or types of journals. Ensuring that each fellow can obtain an adequate publication record during the Fellowship is an important consideration for each faculty mentor. Toward this end, fellows are expected to present their research at regional and national scientific meetings, as well as at several local venues attended by staff and trainees. Such presentations are invaluable in helping fellows to develop a presence for themselves in the scientific community and to develop a network of colleagues who work on topics related to their own. Funds to support travel to a scientific meeting are available. 

Grant writing. Fellows receive didactic and mentored training in grant writing. Didactic instruction is provided for beginning researchers. Experiential training first involves having fellows assist with the preparation of mentors' grants and subsequently applying for their own pilot grant to support an independent study. It is expected that fellows will submit a pilot grant application by the end of their first year, which serves as a transition to independent investigator status. In addition to training regarding VA, NIH, foundation grants, and other granting agencies, fellows receive training in developing appropriate collaborative relationships with industry. The benefits and pitfalls of such relationships are nicely summarized in the UW-sponsored workshop entitled “Forming Partnerships with Industry” that Fellows may attend. In addition, members of the training faculty have experience in developing such relationships. During the second year of the postdoctoral program, fellows are expected to prepare and submit a VA or NIH K-award junior faculty career development grant application. This application is the final component in a structured scientist-practitioner training program, facilitating the transition from fellow to junior faculty status, and is designed to ensure a successful career in professional psychology.

Additional educational opportunities

The PTSD Fellowship provides many opportunities to develop advanced and cutting-edge skills in teaching and education.

MIRECC Hub Site Didactics. The MIRECC coordinating center develops and facilitates the dissemination of the national fellowship curriculum. This series is designed to create a virtual classroom connecting our 28 advanced fellowship sites. As a VA Advanced Fellowship, these didactics emphasize Veteran mental health. Goals are to prepare Fellows for academic clinical research and leadership careers in mental health. The didactic series fosters a professional environment that is positive, respectful, and supportive of cultural and individual differences, and values the wide range of diversity and intersectionality represented by our Faculty and Fellows. As such, embedded in the content is individual and cultural diversity as it pertains to both the Veterans we serve, and the professional development needs of our Fellows. Leading experts present on all aspects of career development from grant and manuscript preparation to the role of mentorship. Another emphasis is on the most recent advances in conducting specific components of clinical research in mental health, from genetics to designing the best interventions. Further, there is also a strong emphasis on state-of-the-art methodological approaches to mental health research and practice. Fellows provide anonymous feedback via VA Redcap survey after each VTEL. This brief survey is used to revise and curate the content. Input and suggestions from Fellows are always welcome.

Teaching opportunities. Fellows can expect to develop their teaching, supervision, and administrative skills in health care education. They will have the opportunity to attend seminars taught by senior faculty, co-lead these seminars, and eventually conduct seminars under observation, as their level of expertise permits. Fellows receive instruction in teaching methods, evaluation of learning, medical informatics, cutting edge academic applications of the personal computer to enhance educational presentations, and the design of web-based courses. Fellows lecture to medical students, psychiatry residents, and psychology interns, as well as allied health professionals. Fellowship faculty attends these lectures to provide fellows with feedback and instruction on teaching skills. Fellows are also active participants in all MIRECC education efforts, including a twice-monthly video-teleconference series. Fellows present lectures in this series annually. Fellows may have the opportunity to engage in lateral supervision wherein they provide research supervision/mentoring to psychology interns and are in turn supervised on these activities by their faculty mentor. Likewise, in their clinical settings, fellows can provide adjunctive supervision for psychology interns and psychiatry residents, under the instruction and supervision of a senior psychologist.

Healthcare informatics. With guidance from local health services researchers, fellows can learn, work with, and conduct research with an advanced clinical computing system that includes our computer-based medical record (CPRS). VA Puget Sound was the third test site nationally for CPRS and continues to be one of the leading sites for this comprehensive system, which is used in inpatient and outpatient settings at both the Seattle and American Lake divisions. It is also used remotely in outreach clinics and in the two veterans’ homes in western Washington. Our computer-based medical record is used as the foundation for an extensive collection of decision support features, providing a powerful tool for implementing practice guidelines. Fellows are welcome to attend operational and support meetings, assist with tailoring CPRS and decision support features to the domain of mental health, and to conduct research using the enormous collection of clinical data that are gathered from these heavily used clinical computing applications. 

Telehealth. VA Puget Sound offers several opportunities for involvement with telemedicine programs. Our site is committed to expanding telemedicine applications and has active committees supporting these programs. Fellows can participate in devising innovative applications for this powerful technology. 

Clinical opportunities

The MIRECC PTSD Fellowship provides many opportunities to develop advanced competencies in assessment, intervention, consultation, program development, outcome evaluation, and clinical research.

Overview. PTSD patient care services at VA Puget Sound offers an integrated set of residential and outpatient clinical care programs that provide comprehensive treatment for Veterans with military-related trauma disorders. This includes veterans with PTSD symptoms related to any war zone theater of operations, as well as veterans with symptoms resulting from exposure to non-combat traumas during military service, including Military Sexual Trauma or MST. The PTSD services at VA Puget Sound are a regional resource in the Northwest, both as a tertiary treatment site for patients with complex disorders, and as a resource for education and consultation. 

The following settings describe the many programs in which PTSD services are provided. Fellows in Psychology can receive primary training only in those settings staffed with a supervising psychologist, and which provide opportunities for advanced clinical training in a quarter-time placement. Clinical expertise and faculty are drawn from all the PTSD programs, however, and additional assignments in other settings can be arranged to participate in time-limited or specialized projects. 

PTSD Outpatient Clinic (POC). The PTSD Outpatient Clinic (POC) provides outpatient treatment of patients who can profit from brief intervention, as well as patients who require long-term care for chronic psychiatric disabilities.  In addition to a primary diagnosis of PTSD, patients enrolled in this clinic represent a wide range of concurrent Axis I and Axis II disorders.  While most of the patients treated in the clinic have PTSD related to combat, there are also specialized groups for other military-related PTSD.  Services offered by the clinic include individually and group-delivered empirically based psychotherapies, interpersonal psychotherapy groups; dual disorder groups for PTSD patients who are primarily treated within the Addiction Treatment Center; case management groups for the chronically impaired patient; time-limited, topic-focused groups; individual and marital therapy and medication clinic.  Interns can receive focused supervision in evidence-based psychotherapies, including exposure therapy and behavioral activation. The POC primarily serves Vietnam era veterans, though special services are also available for Afghan, Iraq and Gulf War vets, Korean War vets, WWII vets, and former POWs.

The POC clinic staff consists of psychologists, psychiatrists, a social worker, a nurse, an addictions therapist, and a mental health technician. The PTSD Outpatient Clinic provides fellows with an opportunity to participate in all the functions of the psychologist, including individual, marital and group psychotherapy, psychological assessment, case management, team consultation and treatment planning.  

Within the POC there is the opportunity to provide treatment to women veterans with PTSD. These veterans experienced various types of trauma, including duty-related trauma, during their military service, though the majority experienced MST.  Approximately half of these patients also experienced childhood sexual and/or physical abuse, and many sustained traumas post-military.  The majority meets diagnostic criteria for PTSD, and many have Major Depression, while a minority meets diagnostic criteria for such difficulties as bipolar disorder, schizoaffective disorder, eating disorders, other anxiety disorders (e.g., obsessive compulsive disorder, panic disorder) and substance use disorders (SUDs).  A substantial minority also has Axis II disorders or meets criteria for Disorders of Extreme Stress Not Otherwise Specified.  The majority have significant physical health problems that often include chronic pain and mobility difficulties.

Postdoctoral fellows function as primary mental health providers who coordinate the care for a small panel of patients. Additionally, they can provide individual and group psychotherapy, and work closely with experienced co-therapists in delivering evidenced-based treatments using state-of-the-art approaches. The professional duties of the psychology fellow -- including assessment, therapy, consultation/liaison, crisis intervention, interprofessional collaboration, and clinic administration -- are supervised by the Team Leader or other appropriate psychology faculty. In addition, consultation from providers of other disciplines is easily obtained.

The Primary Care Clinic (PCC) is a fast-paced outpatient primary care medical setting. PCMHI team members and fellows work in an interprofessional environment, providing functional assessment, triage, and brief treatment for patients with a wide range of behavioral and mental health concerns and medical issues; consultation, education, and support are also provided to primary care providers. The overall goals of the PCMHI training experience are to promote fellows’ ability to rapidly assess a wide variety of clinical presentations, adapt evidence-based interventions to promote improvement in patient functioning, and advance skills working as integral team members in an interprofessional setting.  The Seattle PCMHI team currently consists of a clinical social worker, five psychologists, two psychiatrists, two nurse care managers, and additional trainees (psychiatry residents). The team frequently collaborates with other PCMHI teams across VA Puget Sound, i.e. American Lake and community-based outpatient clinics (CBOCs). Psychology fellows work as active members of the team and work toward increasing autonomy throughout the fellowship.   

Primary care patients present with a broad range of concerns, including assistance managing physical or medical concerns, trauma- and stress-related disorders, depression, anxiety, substance abuse, and relationship concerns.  In addition to working with patients, treatment interventions may also include working with family members. Since patients' presenting problems encompass a wide range of concerns, fellows will strengthen their diagnostic skills and learn to develop appropriate brief treatments that promote functional improvement (e.g., returning to work or managing diabetes). Fellows can also utilize a range of brief evidence-based treatment interventions (e.g., brief therapy for PTSD, motivational enhancement to improve diabetes management, behavioral activation for depression, cognitive behavioral therapy for insomnia, stress management, mindfulness and acceptance-based interventions for behavioral health, and communication skills).  

The majority of Veterans served by PCC are male, but are otherwise diverse in race, ethnicity, age, sexual orientation, disability status, socioeconomic level, immigration status, religious and spiritual identities, and housing status. The PCC’s Homeless Patient Aligned Care Team shares a hallway with PCMHI, providing ample opportunity to treat Veterans who are homeless. PCMHI psychologists are committed to providing interns training in culturally competent care for diverse Veterans. 

A core responsibility of the fellowship is staffing the “Starr Mental Health” clinic, which is a rapid access service that provides brief assessment and triage to patients who are typically referred following an appointment with their primary care provider.  Although this service was historically a same-day, walk-in clinic, treatment delivery has expanded to include the options for same day triage visits via video telehealth or telephone.  While providing services in the Starr Mental Health clinic, fellows will learn to manage patients’ varying levels of need and acuity and provide brief assessment and treatment planning, as well as conduct risk assessments and safety plans for patients who are at increased risk of harm to themselves or others. Fellows will have the opportunity to develop interprofessional consultation skills and co-manage patients with complex medical conditions with professionals across disciplines.  These experiences will increase familiarity with chronic disease conditions (e.g., diabetes, hypertension, and obstructive sleep apnea), psychotropic medications, and biological influences on patients’ overall functioning and psychological well-being.   

A variety of training experiences designed to enhance skills in interprofessional communication and collaboration are offered through the Center of Education in Interprofessional Collaboration (COEIPC) , another core facet of the fellowship. As part of their COEIPC responsibilities, psychology fellows will each spend a half day per week staffing the precepting room, where trainees from medicine, pharmacy, and nursing receive supervision between patient visits. This experience involves ad hoc opportunities for fellows to offer consultations to trainees and their preceptors when behavioral health issues arise during a primary care visit.  

As part of this experience, fellows are also able to see patients for brief visits after receiving a warm handoff from their provider, e.g., to introduce mental health services or conduct a brief triage and treatment planning session. Fellows may also conduct shared medical appointments with providers and offer in-room health coaching. Additional aspects of COEIPC include ongoing collaborative care conferences (where cases are discussed from an interdisciplinary framework), QI/research meetings, and pre-clinic conferences, which are brief didactic presentations by the medical staff to trainees that cover a breadth of topics relevant to primary care.  

Fellows will have flexibility in organizing their time and priorities. There are many activities in which fellows can involve themselves, including promoting the whole health of veterans through brief individual and group therapy that is conducted either in person or via telehealth. Primary care fellows are encouraged to experience and explore different ways of functioning as a psychologist in a medical setting, expand their understanding of and competence with interventions targeting the behavioral aspects of medical illness, and develop toward fully competent practitioners of integrated care. Fellows are encouraged to develop a clinical service in PCMHI, such as a group treatment, according to their interests and the clinic needs.  Developing autonomy and independence as a clinician, consultant and in initiating new programming is an aim of fellowship training in PCMHI.     

Andy Paves, PhD, and Miji Um, PhD are psychologists in the Primary Care Clinic. 

Primary Care Mental Health Integration (PCMHI) – Women's Health Clinic   

The Women's Health Clinic (WHC) is a part of the Primary Care Mental Health Integration Program, and a training site of the Center of Education in Interprofessional Collaboration (COEIPC). WHC is an outpatient primary and specialty (Ob/Gyn) care setting that addresses the healthcare needs of women and transgender/gender diverse Veterans.  This clinic currently serves approximately 2,500 women Veterans. The clinic is staffed by an interprofessional team that includes permanent staff and trainees from across disciplines (e.g., internal medicine, nurse practitioner, social work, pharmacy, gynecology, nursing and psychology/psychiatry). 

The WHC embraces an integrative approach to health care in which the role of behavioral and psychological health care is valued.  This is reflected in the co-located, collaborative care model of primary care-mental health service in WHC.  Behavioral/mental health practitioners have been integrated in WHC since the 1990s.  The relatively small scale of the WHC promotes a high degree of collaboration between interprofessional team members who work together to address veterans’ physical and psychological well-being.   

The WHC offers fellows the opportunity to work within a primary care setting devoted to meeting the needs of women veterans and the gender-specific concerns they present. The veterans referred for behavioral/mental health consultation are referred for a wide range of concerns. These include mood, anxiety and trauma-related disorders, chronic pain and somatization syndromes, relationship and/or sexual problems, gender transition issues, strained patient-provider relations, and non-adherence with health care recommendations.  Veterans are also referred for adjustment to serious health problems, psychosocial losses/stressors, and age-related decline.  Reproductive mental health has become a more prominent issue within the WHC as our younger Veteran population has grown and reproductive health services including infertility services, abortion care, maternity care are included in the benefits for eligible Veterans.  The Seattle WHC has been on the leading edge of perinatal and reproductive mental health program development. 

Women veterans have distinct complexities that require gender specific consideration and treatment approaches.  Multiple trauma exposures, including childhood abuse, military sexual trauma and combat trauma, is highly prevalent in the histories of women veterans, and these histories are associated with significant physical health impairments as well as psychological sequelae.  Women veterans present with concerns related to reproductive health, hormonal change over the lifespan, and stresses associated with their key roles in parenting and family relationships. Compared to male veterans, women veterans are more racially and ethnically diverse and join the military from lower socioeconomic backgrounds. There is also a higher percentage of women veterans who identify as lesbian, compared to the civilian women population.   

The WHC psychologists and fellow provide assessment, consultation, and interventions, including individual and group therapies. Because of the emphasis on brief care, fellows learn to focus on essential elements of evidence-informed interventions to foster change.  Fellows in the WHC are also trained to embrace technology to assist in meeting the needs of women veterans, offering individual and group mental and behavioral health services through clinical videoconferencing, telephone care and by promoting the use of internet-based and mobile technology to support mental health goals.  Fellows are also involved in providing consultation to the primary care providers and clinic staff on issues of effective patient management. This consultation takes place in a variety of venues, including participation in ad hoc collaborative care conferences.  This forum is used to consult with primary care and other providers involved with patient care to promote the team’s ability to provide effective medical care while considering the complex psychological factors that impact women veterans’ medical and psychological well-being.  Team huddles that include PCMHI psychologists and other primary care team members occur daily.  

A variety of group therapy experiences are available through a Women’s Health Clinic rotation.  The Maternal Health Group is an interprofessional group program for pregnant and postpartum women and provides an opportunity to work side by side with clinic staff of various disciplines.   In addition, monthly groups for transgender veterans and for cancer survivors are offered as well as a quarterly single session workshop on menopause.  

Fellows are encouraged to develop a specialized group or other clinical service according to their interests and needs of the clinic. Developing autonomy and independence as a clinician, consultant and in developing programming is an aim of fellowship training in the WHC. 

Desta Gebregiorgis, PhD and Mary Jean Mariano, PhD are psychologists in Women’s Health Clinic. 

Overview of the Fellowship Training Year 

The primary care fellows will work with supervisors of their choosing to customize a training year that will complement and extend their individual abilities with placements selected from the primary care clinics.  Although the fellowship is primarily a clinical fellowship, fellows are encouraged to develop an additional project that furthers professional development. Some project ideas from past fellows include developing and starting a group to address an unmet clinical need, implementing programmatic changes to increase efficiency within the clinic, or participating in QI projects. The primary care fellows will also organize a didactic series of monthly topics aimed at rounding out their training goals. Additionally, fellows will have the opportunity to attend various weekly educational opportunities including local and regional presentations. Monthly national conference calls and presentations on PCMHI topics are also available for further learning and exposure to leading professionals in this area. 

The two-year Postdoctoral Fellowship in Clinical Neuropsychology at the Seattle VA is designed to provide comprehensive training that will result in advanced professional practice and competency in Neuropsychology. Training in clinical neuropsychology and brain-behavior relationships takes place through didactic and experiential training in neuropsychological assessment, consultation/liaison, scientific practice and research, didactics/teaching/supervision, and demonstration of knowledge of ethics and diversity. Opportunities for training in cognitive rehabilitation intervention may also be available, depending on supervisor and clinic-schedule availability. The Fellowship maintains a core curriculum, but there is some flexibility in the breakdown of time depending on the goals of the Fellow. Most time is spent in clinical activities, with research accounting for up to 20% of the Fellow’s time. Approximately 10% of time is spent on didactics and 5% is spent on administrative duties. The rigor of this specialty-accredited Fellowship is consistent with APA Division 40/Houston Conference Guidelines in providing the foundation for trainees to pursue board certification in Clinical Neuropsychology. 

Clinical Experiences                  Core clinical experiences for this Fellowship are based in the Mental Health (MH) Neuropsychology Service (Drs. Bailey and Zahniser) and the Geriatric Research Education and Clinical Center (GRECC) Neuropsychology Clinic (Dr. Trittschuh). Our clinics serve a patient population that is diverse in several ways, and particularly with respect to age, SES, and disability status. Cases tend to be complex, often featuring a range of comorbid and interacting medical, neurologic, psychiatric, and/or substance use-related factors. We collectively embrace cross-cultural neuropsychology practices. We are committed to the provision of care that embraces diversity, advocacy, and humility. Although our specialty neuropsychology clinics are housed in MH and GRECC, both services receive consults from throughout the medical center, with most common referral sources including Neurology, Mental Health, and Primary Care. Neuropsychology training is focused primarily on comprehensive outpatient neuropsychological assessment. A particular emphasis is placed on expanding trainees’ skills in clinical interviewing, differential diagnosis and conceptualization of complex cases, and written and verbal communication to patients and other providers. The first year of the Fellowship consists of rotations in each of the primary Neuropsychology clinics, including MH Neuropsychology (co-supervised by Drs. Bailey & Zahniser) and GRECC Neuropsychology (with Dr. Trittschuh), each for a minimum of 4 months (often with some overlap). In the second year, Fellows will take on increased clinical independence and administrative responsibility in continuing to provide neuropsychological evaluations for Veterans seen in these clinics and can also select one or more adjunctive clinical minor(s) individualized to the interests and training needs of the Fellow. Depending on staff availability, possible clinical minors may include: a rotation in a neurology clinic (e.g., seizure or movement disorder clinics), a rotation in a Rehabilitation Psychology setting (e.g., polytrauma outpatient clinic, acute inpatient rehabilitation unit, and/or the spinal cord injury unit), a rotation in Geropsychology (e.g., Community Living Center, the VA’s nursing home facility) and/or training in cognitive rehabilitation. Some clinical minors would run concurrently with a reduced time schedule in either MH Neuropsychology or GRECC Neuropsychology, while others would be intensive, with 2-3 months full-time in that rotation. Opportunities may exist for tiered supervision of Psychology Interns, depending on availability and training goals.

The core Neuropsychology clinics/rotations are described below:

• MH Neuropsychology:
  • MH Neuropsychology is a generalist consult service that receives hospital-wide referrals. We see adult patients of all ages, with our evaluations revealing a wide range of diagnoses including neurodegenerative conditions (e.g., Alzheimer’s disease), neurocognitive disorders due to medical/neurologic factors (e.g., vascular dementia, seizure disorders, MS, TBI, cancer), neurodevelopmental conditions (e.g., ADHD, learning disorders), substance-use related cognitive impairment, and primary psychiatric disorders, among others. The age of veterans referred for neuropsychological evaluations can range from early 20s to 90s.
  • Many of these Veterans have complex mental health histories and are concurrently treated by other providers in Outpatient Mental Health, allowing Fellows to gain experience collaborating with our MH colleagues on mutual cases. Emphasis is placed on translating clinical findings in written/verbal formats to aid in improved veteran centered care.
  • We provide pre-surgical neuropsychological evaluations in consultation with our Neurology colleagues as part of candidacy determinations for neurosurgical interventions (e.g., DBS implantation, focused ultrasound) for Parkinson’s disease and other neurological disorders.

• GRECC Neuropsychology:
  • Provides in-depth training in the assessment and diagnosis of a range of neurodegenerative disorders. Examples of cases seen include, but are not limited to, Alzheimer’s disease, vascular dementia, MCI, HIV dementia, progressive supranuclear palsy, frontotemporal dementia, familial idiopathic basal ganglia calcification syndrome, Parkinson’s disease (pre/post DBS), Parkinson’s disease dementia, and Lewy body dementia.
  • Like MH Neuropsychology, we also provide pre-surgical neuropsychological evaluations as part of candidacy determinations for neurosurgical interventions (e.g., DBS implantation) for Parkinson’s disease and other neurological disorders in older Veterans.
  • Teleneuropsychology (using clinical video technology) is a regular part of our clinical service to older Veterans who live remotely and/or for whom traveling to the Seattle VA is burdensome. We conduct these clinic-to-clinic evaluations from the Seattle VA to Community Based Outpatient Clinics (CBOCs) with telehealth clinical technicians to assist at those patient sites. GRECC Neuropsychology also uses CVT for conducting feedback, virtual groups, and rarely, brief cognitive testing, to Veterans at home.
  • Provides “E-consult” consultation and liaison services to provide expert case review, impression development, and treatment recommendations.
  • Fellows will participate and present as part of the monthly GRECC Interprofessional didactic series which features collaborative presentations from trainees in Ophthalmology, Pharmacy, Social Work, Chaplaincy, Audiology, Occupational Therapy, Physical Therapy, Speech Therapy, Geropsychology, and Neuropsychology.
  • Participate in the monthly Clinico-Pathological Correlations conference and potentially observe brain cuttings/histopathology at UW Harborview.
  • Lead or co-lead psychoeducational groups focused on topics including cognitive skills and development of healthy brain aging habits, if interested/available at time of rotation.

Didactics                          In addition to the core clinical activities, this Fellowship includes educational components aimed at developing advanced and comprehensive knowledge regarding brain-behavior relationships, neuropsychological and psychodiagnostic test interpretation, cultural and diversity-related considerations in neuropsychology, and in psychiatric and neurologic disorders and syndromes. Didactics are designed to be complementary to each other and to the clinical experiences gained on fellowship. Specific core offerings also include the following:

1. VA Puget Sound Neuropsychology Didactics (many components offered jointly with American Lake VA)
   1. Neuropsychology Seminar (monthly)
   2. Neuropsychology Case Consultation meeting (twice monthly)
   3. Board Certification Preparation meetings (bi-monthly; including group and individual fact-finding exercises)
   4. Professional Development meetings

Fellows will also complete all components of a full mock ABCN exam during the course of their Fellowship, including a sample written exam, practice sample submission, fact-finding, practice sample defense, and ethics/professional development examination.

In addition to the core didactic offerings described above, Fellows have opportunities to benefit from numerous other educational programs offered here at VAPS, locally through the University of Washington (UW), more broadly at the national VA level, and through other connections in the Neuropsychology community. These include:

1. VAPS Rehabilitation Psychology didactics (weekly)
2. VAPS GRECC Interprofessional Seminar (monthly)
3. UW-Alzheimer’s Disease Research Center’s Clinicopathological Correlation Conference (CPC; monthly). This is a program that is jointly run by faculty in the GRECC, Adult Changes in Thought (ACT) study, Seattle Longitudinal Study (SLS), and University of Washington ADRC. It offers a rare chance to conceptualize cases from start to finish: first clinical symptoms to neuropathological diagnosis, often with pre- and post-mortem imaging and genetics information. Paired with this experience are the opportunity for observation of brain cutting/histopathology at UW Harborview while on GRECC rotation, depending on availability.
4. VA National Cultural and Diversity Neuropsychology (CDN) Network Seminar (quarterly)
5. VA-ECHO Healthcare Equity Seminar (monthly)
6. Know Neuropsychology Didactic series (numerous didactics available via YouTube, plus new seminars available periodically)
7. Navigating Neuropsychology podcast (archived episodes available via web, plus new episodes available periodically)

Other optional didactics, journal clubs, and writing clinics are plentiful at VAPSHCS, Harborview Medical Center, and the University of Washington. These include, but are not limited to, Psychiatry and Neurology grand rounds, Gerontology grand rounds, in addition to MIRECC and GRECC regular didactic series.

Trainees will work with the Neuropsychology faculty to identify which of these supplementary didactic offerings are of greatest interest and how these can be incorporated into their specific training plan.

Research/Scholarly Activity                   Research and/or program development/quality improvement is also a core part of the postdoctoral training experience, and Fellows are typically provided with 20% research time, dependent on experience, achievement, and career goals. By the end of fellowship, Fellows are required to have at least one tangible product that demonstrates their engagement in research/program development/quality improvement activities, congruent with the percentage of time that was dedicated to research during the fellowship. Examples include poster presentation/accepted abstract, submission of a manuscript for publication, submission of a grant proposal, or development/adaptation of a treatment manual to a new patient population. This product must be related to work completed during fellowship in conjunction with the Fellow’s Seattle VA research supervisor. For Fellows looking to submit a VA Career Development Award or other grant during their fellowship, our Neuropsychology staff work with them to develop their training in grantsmanship and help them identify appropriate mentorship for this process.

Seattle VA neuropsychologists are all engaged in research to varying degrees. An ongoing project shared among all our Neuropsychology staff is an effort to attain IRB approval to develop a robust database of veterans we have served in our clinics, with the ultimate goal of using these data to produce clinically relevant and translatable research products. 

Our staff also have varied individual interests. For example, Dr. Trittschuh typically leads VA/VISN-supported Clinical Demonstration projects for the GRECC. These have focused on both the development of educational programs/materials and clinical offerings to encourage healthy brain aging for older Veterans, as well as those directed toward the development of memory skills among those with PTSD. Another aim is to connect GRECC specialty neuropsychological services with Veterans who have trouble accessing centralized care, whether it is due to distance, transportation issues, and/or disability. Dr. Trittschuh is a co-investigator and/or collaborator on several NIH-funded research projects. Opportunities exist for Fellow involvement in these projects and for new project development within the scope of Dr. Trittschuh’s expertise. Examples of current projects include: GWAS associated with differing cognitive phenotypes within late-onset Alzheimer's disease, cognitive data harmonization studies, and a study of MCI and dementia incidence within a longitudinal study of an elderly community-dwelling cohort (ACT study). 

Dr. Bailey’s previous clinical and research interests include extending the scope of neuropsychological practice through normative data collection in the Latino/Hispanic population, performance validity assessment, and cross disciplinary (e.g., neuropsychology and neuroradiology) integration to improve the accuracy of localizing lesions and lateralizing language functioning in patients with epilepsy. Currently, Dr. Bailey is more focused on the intersection of neurodiversity and protective cognitive/personality factors. 

Dr. Zahniser’s primary clinical and research interests include dementia and neurodegenerative disease, positive neuropsychology, integrating neuropsychology into interdisciplinary medical settings, and neuropsychology feedback. Current foci for quality improvement and program development projects include (1) streamlining neuropsychological practice to meet the needs of the interdisciplinary VA medical center setting and (2) incorporating new approaches to enhance patient outcomes following neuropsychology feedback.

Training Goals                Our goal is to provide comprehensive training in clinical neuropsychology and brain-behavior relationships during the Fellowship through both didactic and experiential training. The major training areas are outlined below. 

1. Neuropsychological assessment: Fellows will receive training in all aspects of neuropsychological assessment, including test selection, test administration and scoring, report writing, and provision of feedback/education. Supervision is collegial, follows a developmental model, and offers tiered supervision when possible. Given that we all come from various training/cultural backgrounds, Fellows will be observed and offered with ample opportunities to get to know a supervisor’s approach at the onset of supervisory relationship. Fellows should expect an increasing degree of professional autonomy as their training progresses, and this will be paced to match their growing skills. Integration of culturally competent practice is expected for all cases, allowing for repeated exposure to developing culturally competent neuropsychological skillsets.

2. Consultation/liaison with family members and healthcare professionals: Fellows will be able to consistently demonstrate the ability to effectively work with diverse populations and provide appropriate intervention in response to a range of presenting problems and treatment concerns. Fellows will also demonstrate skill in applying and/or adapting evidence-based interventions with a specialized population and be able to provide clinical leadership when working with junior providers. Fellows should demonstrate effective consultation skills with other professionals, particularly those in other disciplines, by providing expert counsel regarding difficult clinical matters.

3. Cognitive interventions: As available and depending on interest, Fellows may have opportunities to participate in both individual- and group-based cognitive interventions and psychoeducation. Interventions offered at the Seattle VA are based on empirical literature and have been adapted to the needs of our Veterans. The Fellow will be expected to become proficient with this literature.

4. Scientific thinking and research skills: Psychology training at the Seattle VA is based on the scientist-practitioner model and a high value is placed on providing evidence-based care. Fellows should consistently demonstrate the ability to base clinical decisions on the scientific literature, and to generate evidence-based principles to guide practice in areas that lack an empirical literature. The supervisors will promote the Fellows' learning by sharing knowledge, readings, and resources regarding the empirical basis of their practice. In turn, Fellows are expected to be familiar with the empirical literature related to their patient care duties, and to incorporate this knowledge base in their daily practice. 

5. Individual and cultural diversity: Fellows will receive training and supervision to increase awareness of aspects of individual and cultural diversity and how these factors can impact patients’ presentation, assessment practices, selection of norms, and implications for treatment. Fellows will be asked to consistently integrate culture, socioeconomic status, linguistic, disability, gender, and other characteristics of diversity in case conceptualization. Fellows will also engage in self-reflection to promote growth and awareness of their own responses and culturally diverse identities (supported through DEI didactic offerings available to all trainees and MH staff at VAPSHCS).

6. Education, teaching, and supervision skills: Fellows should demonstrate the ability to give presentations in a formal didactic setting, to teach skills to medical students, residents, psychology interns, and allied health trainees in medical center training settings, and to educate and support other professionals in medical center settings.

Supervision                     The advanced competencies described above will be developed over the course of the Fellowship through a combination of supervised clinical experiences and didactics, as well as professional mentoring over the duration of the training. The Fellow will devise an individualized learning plan with the help of their supervisors, outlining the proposed learning experiences that will help the Fellow attain advanced skill and knowledge in each of the required competency areas (assessment, intervention, consultation, education, individual and cultural diversity, and research/scholarly activity). The development of this learning plan requires each fellow to conduct a self-assessment of their prior skill level in each area. Supervisors are responsible for identifying those training experiences that will help the Fellow develop advanced abilities in each area, while considering the Fellow’s prior level of experience and demonstrated competence. Fellows will receive a minimum of two hours per week of individual, face-to-face, regularly scheduled supervision for the entire training period. In addition, Neuropsychology staff gladly use our professional networks to identify opportunities for additional, informal mentorship for fellows depending on their goals, interests, and identities.

The Rehabilitation Psychology fellowship is a two-year position focused on the development of advanced competencies on behalf of individuals with disabilities and chronic health conditions in order to maximize health and welfare, independence and choice, functional abilities, and social role participation across the lifespan. 

Rehabilitation Psychology fellows will primarily train in the Rehabilitation Care Service and the Spinal Cord Injury Service, although additional training experiences in other service lines are frequently integrated to support fellows’ specific training needs and goals. Specific training opportunities are described below. 

Rehabilitation Care Service                                  

The Rehabilitation Care Service (RCS) line is an energetic and collegial service that provides a full spectrum of inpatient and outpatient care to Veterans with a wide variety of medical conditions, neurological/degenerative disorders, traumatic injuries, and acquired disabilities. Some of the primary populations cared for within Rehabilitation Care Services include people with multiple sclerosis (MS), traumatic brain injury (TBI), stroke (CVA) and amputation. Psychologists and fellows are appreciated members of interprofessional teams, providing an array of neuropsychological and diagnostic assessment, group and individual psychotherapy, and team training and consultation.  Research and clinical work are frequently blended in RCS, and several of the training faculty members are involved with significant research activities. The Rehabilitation Care Service (RCS) is home to two national Centers of Excellence within the VA system -- the Multiple Sclerosis Center of Excellence and the VA RR&D Center for Limb Loss and Mobility.  Several clinical trials are being conducted within RCS, and fellows may have opportunities to participate in these trials as interventionists and/or participate in a research detail related to these projects.

RCS includes multiple possible training experiences.  Supervisors will help fellows select which combination of the following experiences will help them best meet their training goals: 

1. Inpatient/Acute Rehabilitation: Inpatient Rehabilitation is offered to Veterans with recent/acute conditions on a 12-bed inpatient acute unit. Inpatient clinical services typically include providing assessments and brief intervention for adjustment to illness and disability, depression, and anxiety, as well as brief cognitive assessment. The inpatient unit provides an excellent opportunity to provide psychological and neuropsychological consultation to a diverse interprofessional team that includes physicians, nurse specialists, social workers, and speech and language pathologists as well as physical, occupational, and recreational therapists. Inpatient training experiences are supervised by Aaron Turner, PhD, ABPP-RP and Megan Miller, PhD.
2. Center for Polytrauma Care: RCS is home to a Polytrauma Network Site - the Puget Sound Center for Polytrauma Care.  This interprofessional rehabilitation team is dedicated to caring for Veterans with multiple injuries. Most commonly, Rehabilitation Psychology fellows will provide assessment and treatment to veterans of the Iraq/Afghanistan War who have multiple co-occurring conditions including TBI, PTSD, chronic pain, sleep problems, and cognitive impairments.  The Center for Polytrauma Care also sees veterans from Alaska, Idaho, Oregon, and Washington in its role as a regional polytrauma rehabilitation resource. The Center for Polytrauma Care also provides lifetime follow-up for Veterans from all eras who have moderate to severe TBI. The training emphasized in Polytrauma includes assessment, psychoeducation, and triage; evaluations often include comprehensive neuropsychological assessment, and brief treatment. Empirically supported therapies offered in Polytrauma include cognitive rehabilitation, limited treatment for PTSD (typically for Veterans with significant cognitive impairment/TBI), hypnosis for chronic pain, and On-TRACC (a hybrid self-management/cognitive rehabilitation intervention that is being offered in 2025-26 as part of a clinical trial).  The supervisor for Polytrauma training is Rhonda Williams, Ph.D., ABPP-RP.
3. Outpatient Rehabilitation: RCS Psychologists are part of multiple specialty interprofessional medical outpatient clinics and provide consultation to patients and medical staff. Outpatient services are provided via several large specialty outpatient clinics, focusing on conditions such as MS, ALS, Stroke, TBI, and limb loss.  Recently, RCS psychologists have helped develop and become integrated into our post-COVID-19 clinic, which provides interprofessional care to Veterans with chronic symptoms following COVID-19 illness. Outpatient rehabilitation teams typically include physiatrists, speech language pathologists, social workers, as well as vocational, physical and occupational therapists. Outpatient clinical services generally include comprehensive assessments (which may include formal neuropsychological evaluations) and rehabilitation psychology interventions (offered in both individual and group formats). Regarding assessment opportunities, this rotation allows trainees to hone assessment skills ranging from brief cognitive screening to full neuropsychological batteries.   Assessments conducted on this rotation are integrated with treatment and include providing feedback to veterans, families, and clinical teams is an important role for the psychologists on this service. As for intervention opportunities, outpatient therapy is available and is usually offered in a brief therapy model though may be available for longer-term interventions as indicated. Sessions may be conducted in person and/or using telehealth technology to meet with veterans in their home. Psychologists in RCS provide empirically supported treatments to veterans with acquired injuries to address comorbid psychological disorders (e.g., PTSD, depression), pain problems, and sleep problems. Last, several structured (e.g., Cognitive Rehabilitation, Cognitive Behavioral Therapy for Insomnia), skills-based (Mindfulness Mediation and Self-Hypnosis for Chronic pain) and support groups (e.g., Amputee, MS, ALS support groups) are offered on a recurrent basis. Fellows are welcome to participate in any of these assessment or treatment activities and these often provide opportunities for vertical supervision when an intern is also training in RCS. Primary supervisors in outpatient RCS are Madeline Werhane, Ph.D. and Megan Miller, Ph.D. 

Inpatient and Outpatient Spinal Cord Injury  

The Spinal Cord Injury Service (SCIS) is a regional hub facility, consisting of a 38-bed inpatient unit for veterans with spinal cord injuries, as well as an outpatient clinic serving over 800 active patients in 5 states. Seattle is also the home of a large data management system and research department devoted to improving care for veterans with SCI. An interprofessional treatment team works to meet the comprehensive medical and mental health needs of outpatients and inpatients. The psychologists on this service are highly valued members of the treatment team and provide psychological and neuropsychological assessment, psychotherapy, and program development.  Both staff psychologists are board certified in rehabilitation psychology and hold leadership positions in the Academy of Rehabilitation Psychology and APA Division 22 (Rehabilitation Psychology).

Issues that often face SCI patients include vocational changes, cognitive deficits secondary to traumatic brain injury, difficulties in coping with chronic illnesses/disabilities/stress, sexual dysfunction, grief reactions, family/relationship problems, chronic pain, and substance abuse. Fellows rotating on this service develop skills in working closely with an interprofessional team, clarifying and responding to referral questions, formulating appropriate assessment batteries, presenting treatment recommendations, and providing psychotherapy in the rehabilitation setting.  Neuropsychological services may range from brief cognitive screening to comprehensive neuropsychological assessment. Empirically supported interventions typically involve provision of brief therapy, opportunities occur for longer-term, manualized treatments that are adapted to accommodate disability. Sessions may be conducted in person and/or using telehealth. This work setting is very dynamic, and a psychology fellow takes a leadership role in helping veterans with both recent and remote spinal cord injuries get the most from their medical care. 

Supervising Psychologists in the SCIS include Randi Lincoln, PhD, ABPP-RP, and Jan Tackett, PhD, ABPP-RP. 

Educational Opportunities

Fellows are expected to attend the weekly Rehab Psychology Didactic series, which includes curriculum that is designed to cover all core competencies necessary for ABPP Certification in Rehabilitation Psychology. Weekly didactics include a combination of formal lectures, group supervision/case consultation, trainee presentations, and journal article reviews. Fellows are also encouraged to attend other didactic series of interest. Additionally, there are myriad formal educational opportunities available within SCIS, RCS, and the greater hospital, and fellows are encouraged to attend any of interest. Participation in national meetings related to rehabilitation psychology and disability is encouraged.

Specific skills taught in the Rehabilitation Fellowship 

Core Knowledge of Rehabilitation Psychology. Training is provided over the course of the two-year fellowship that reflects the core competencies, values, and approach of Rehabilitation Psychology. This training is provided via individual and group supervision, directed self-study, and didactics. Fellows will be encouraged to participate in relevant national societies/organizations during their fellowship period. Preparation for board certification in Rehabilitation Psychology is a central goal of this fellowship, including individual mentoring as well as practice written and oral boards. 

Rehabilitation/Neuropsychological assessment. Assessment is a core competency in Rehabilitation Psychology, and includes comprehensive assessment of cognitive, neuropsychological, neurobehavioral, and psychosocial function. All rotations that comprise the Rehabilitation Psychology Fellowship provide opportunities to hone assessment skills. Training is available at all levels, including test administration and scoring, evaluation planning (i.e., selection of appropriate tests given a particular referral question), report writing, providing feedback/education to Veterans, families, and other providers, and planning and implementing treatment recommendations. We have an extensive repertoire of state-of-the-art neuropsychological tests and support from an RCS-dedicated full-time psychometrist. Attention is paid to training fellows in adapting neuropsychological tests/assessment for those with physical, sensory, or neurobehavioral disabilities.

Rehabilitation Interventions. Fellows will have an opportunity to develop advanced intervention skills using both individual and group-based interventions, delivered in person and via telehealth. Interventions frequently include evidence-based treatments for mental health disorders (e.g., Cognitive Processing Therapy or Prolonged Exposure for PTSD, Behavioral Activation for Depression, Universal Protocol for comorbid Anxiety/Depressive disorders) as well as for health conditions (e.g., CBT, hypnosis or mindfulness-based cognitive therapy for chronic pain, Motivational Enhancement for substance use). Attention is paid to adapting empirically validated treatments to make them accessible and useful for Veterans with cognitive impairment; sensory or physical disabilities, such as blindness and quadriplegia; and to accommodate Veterans who have difficulty engaging due to psychosocial or neurobehavioral factors.  

In addition to treating mental health disorders, Rehabilitation Psychologists provide interventions that are specific to optimizing function and independence among individuals managing functional impairments, such as positive psychology interventions, advocacy, education, self-management, sexual health interventions, family therapy and couples’ therapy. 

Seattle VA also provides cognitive rehabilitation and offers training opportunities that integrate the evidence base and clinical practice guidelines regarding treatment of specific cognitive deficits in clinical practice. These strategies are integrated into the treatment milieu for inpatient programs and comprise the structure of outpatient psychology-based treatments.

Interprofessional team participation. Fellows will have extensive opportunities to participate on interprofessional treatment teams, serving a variety of roles ranging from brief consultation to daily collaborative care. Some examples include established inpatient and outpatient interprofessional teams and intra-facility teams assembled as clinically indicated on a person-by-person basis. 

Clinical research. While this fellowship is predominantly clinical in nature, up to 20% of a fellow’s time can be spent in research. Research involvement can range from active participation in a project to a deliberate study of a literature and practice integrating this knowledge into clinical practice. Several of the identified supervisors have active funded research programs, providing a rich environment of qualified and available mentors. Myriad training opportunities are available to meet fellows’ programmatic training goals, including supervised grant writing, participation in mentors’ grant-writing activities, participation in all aspects of funded/ongoing research activities (e.g., study design, administration, data analyses, authoring/co-authoring manuscripts, and disseminating findings at national meetings). A fellow’s program of research can be oriented around a topic of their choosing, around activities selected to address particular skill or training needs, or a combination of these factors. We have resources to provide research training that matches the learning needs of the fellow regardless of their prior experience. Additional collaborative opportunities exist with other psychologists, physicians, and health scientists in Mental Health, the MIRECC, the GRECC, VA Rehabilitation R& D, VA Health Services R& D, and the University of Washington School of Medicine. It is routine for projects to include investigators from several of these programs. 

Systemic interventions. Fellows will hone their sensitivity to issues most relevant to recently deactivated military personnel, so that they become adept in: a) methods to decrease stigmatization through partnering with relevant organizations (e.g., VBA, Department of Labor, state and local vocational rehabilitation programs and services); b) methods to improve access to care and outreach (e.g., familiarity with telemedicine technology and resources); and c) knowledge of organizational systems, their operation, and their management.

Overview          This fellowship aims to increase opportunities for the training of psychologists within integrated medicine settings, with a particular focus on comprehensive pain management. Addressing the psychosocial and behavioral health needs of medical patient populations promotes successful disease management, as well as improved overall wellness, functioning, and quality of life. 

The Pain Clinic is an interprofessional outpatient pain-management program for veterans with complex chronic pain. Psychologists work closely with Pain Clinic medical providers (physicians, medical students/residents/fellows, nurse practitioners, physician’s assistants, pharmacists, acupuncturists, physical therapists, massage therapists, and yoga therapists) to deliver a variety of services, including individual and group treatments, evaluation, consultation, and coordination of care for complex patients. Pain psychologists also serve on a variety of hospital, regional, and national VA/Department of Defense pain committees, and are active in program development, quality improvement, research, and pain education at all levels of VA.

Patients are referred from primary care, medical, surgical, psychiatric, and substance use disorder services. Pain psychologists provide co-disciplinary (alongside a medical provider) comprehensive pain care with patients referred for interventions and provide consultation and treatment for a wide spectrum of problems related to chronic pain, such as functional impairment, medication misuse, maladaptive illness behavior, management of other chronic conditions, and non-adherence to medical recommendations. In addition, psychologists in the Pain Clinic facilitate referrals to specialty mental health and SUD treatment clinics and can provide bridge care to help Veterans prepare for an episode of treatment. 

Our treatment approach is based on the biopsychosocial model and a “collaborative self-management” approach to care, which emphasizes establishing a strong working relationship with patients to help them improve long-term function and quality of life. This model is being widely adopted as a foundation of pain education in the VA and provides the theory behind clinical approaches unique to our program, including the use of a co-disciplinary model of care. Additionally, a pilot program originally developed at VA Puget Sound has influenced VA’s national model of telehealth care delivery for specialty pain services.

Fellows have the opportunity to conduct interprofessional evaluations and follow-up visits with medical providers who see patients simultaneously with psychologists. Our wide range of patients allows fellows with interests in special populations to customize their caseloads and experiences based upon specific aspects of diversity (e.g., age, disability, gender, race, ethnicity, rurality, service era, sexual orientation, spirituality). Fellows will gain a working knowledge of various pain syndromes and both psychological and medical treatments for chronic pain. In addition to providing individual psychotherapy, they also may choose to co-facilitate a variety of groups and classes via telehealth. Fellows also are encouraged to collaborate in ongoing research, quality-improvement, and program-development projects, or to propose their own ideas.

Though working with Veterans with chronic pain is a major focus of this fellowship, there is flexibility to work in other behavioral-medical settings, depending on the Fellow’s training goals and supervisor availability.  

Fellowship Structure and Settings

Fellows have the opportunity to work in multiple medical settings and with multiple interprofessional teams. The required elements across the training year include: 

• Pain Clinic: approximately 50% weekly
  • Fellow provides co-disciplinary clinical services, in collaboration with medical staff, within the Pain Clinic.
  • Fellow provides individual or group psychotherapy services to Veterans enrolled in the Pain Clinic, as well as psychoeducation about complex chronic pain management to veterans newly enrolled in the clinic.
  • Fellow may participate in the Mental Health Integration into Pain Clinics (MHI-P) team, a new VA initiative designed to reduce barriers to mental health treatment for patients seen in Pain Clinic. The MHI-P team provides same-day triage, brief focused appointments to Veterans without engagement in other mental health care, and risk assessment/safety planning and consultation to medical team members.
  • Fellows may also participate in the Functional Restoration Program (FRP), our intensive outpatient program for those with complex chronic pain, significant functional limitations, and willingness to engage in multiple weekly sessions. This involves virtual and in-person group sessions for physical therapy, self-massage training, sound meditation, pain neuroscience education, and pain psychology, as well as co-disciplinary progress review meetings.
  • Fellows will also provide consultation to other Pain Clinic providers on behavioral health questions including motivational enhancement, management of difficult behavior, and risk assessment/suicide prevention.  
  • Fellows can choose to participate in various pain-related committees, such as the Pain Committee or the Employee Wellness and Engagement Committee.
  • Fellows can participate in existing quality improvement projects within the Pain Clinic or propose new projects that can be completed within the training year. Examples of recent quality improvement projects include integrating measurement-based care into clinical practice and evaluating the impact of mindfulness on pain outcomes.
  • In addition, opportunities may be available to participate in pain-focused research (e.g., evidence-based psychotherapies for chronic pain and opioid safety). Please see staff biographical sketches at the end of this brochure for more information about individual areas of research.
• Other Behavioral Medicine Settings: up to 40% weekly
  • Depending on their training goals, Fellows can choose to work within the following clinical settings (see descriptions of these training experiences elsewhere in the VA Puget Sound Health Care System-Seattle Division psychology internship or fellowship brochures):
    • Behavioral Sleep Medicine
    • Transplant Psychology (Marrow Transplant Unit)
    • Primary Care–Mental Health Integration
    • Home-Based Primary Care
    • Spinal Cord Injury
    • Inpatient Rehabilitation
    • Neuropsychology  
    •  
• Didactics and supervision: approximately 10% weekly

This structure offers significant flexibility in the Fellow’s schedule for tailoring to their unique goals, especially during the latter part of the year. Options include:

• Research, Program Development and Evaluation, and Administration:
  • Research duties may be negotiated and can include working on new and/or existing projects with collaborators at VA Puget Sound Health Care System – Seattle Division.
  • Program development and evaluation may include a quality improvement project designed to enhance clinical care/processes.
  • Numerous administrative projects are available on an ongoing basis.
  • For Fellows with a record of academic productivity, 20% protected time can be reserved for clinical research or Quality Improvement research related to Behavioral Medicine, in lieu of clinical work in other Behavioral Medicine clinical settings.
• Provision of training:
  • Opportunities often exist in providing vertical supervision of junior trainees.
  • There are frequently opportunities to provide trainings in areas germane to pain management and behavioral medicine within the Psychology service (e.g., giving talks at the monthly Psychology meeting, Behavioral Medicine Seminar, and/or the intern didactic series).
  • The Fellow can provide interprofessional training to medical staff via presentations for the SCAN ECHO programs (a learning, teaching, and consultation platform that bring together VA providers from different areas of the country) and within the clinics in which they are embedded.  

Clinical Responsibilities in Primary Settings 

Clinical care is provided within the biopsychosocial model and uses empirically supported assessment and intervention strategies. 

Intervention. Within Pain Clinic, the Fellow will offer shared, co-disciplinary appointments with medical providers to orient patients to the biopsychosocial model and promote active self-management of their chronic pain. The Fellow can provide group, individual, or couple modalities of psychotherapy, using treatment approaches that include cognitive–behavioral therapy, motivational interviewing, acceptance/mindfulness-based therapy, and other evidence-based therapies for chronic pain (e.g., pain reprocessing therapy, self-hypnosis for chronic pain). In addition to pain-specific treatment, the fellow will likely provide care focusing on other behavioral health-related issues. Most patients also receive medical treatments such as physical therapy, opioid and non-opioid pain medications, or whole-person health approaches, so the fellow can expect to work closely with providers in other disciplines to promote functional gains. Patients are encouraged to take advantage of technological advances through modalities that include mobile applications and telehealth. 

In other clinical settings, fellows typically provide brief, focused psychotherapy interventions (e.g., 4-12 sessions) to address presenting concerns; however, they may also offer single psychoeducation sessions when appropriate and/or see long-term psychotherapy patients. Common areas of clinical intervention include adjustment to diagnosis and/or disability, reduction of risky behaviors (e.g., substance use), stress management, and coping skills development. Fellows also typically address traditional health psychology concerns, including insomnia, weight management, substance use reduction, etc. Individuals with complex medical conditions also experience elevated rates of primary psychiatric diagnoses that may be a focus of treatment. Psychotherapy approaches typically include Cognitive-Behavioral Therapy, Acceptance and Commitment Therapy, Dialectical Behavior Therapy skills training, Motivational Interviewing, Harm Reduction, and Relapse Prevention. Depending on the clinical setting, these would likely be offered in individual, group, or couple psychotherapy modalities.

Assessment. The Fellow provides multiple types of assessment. In the Pain Clinic, the Fellow will conduct comprehensive co-disciplinary biopsychosocial assessments of new patients and pain psychology intakes for patients who are eager to engage in pain psychology care. The Fellow may have the opportunity to conduct mental health evaluations for pain-procedure candidates (e.g., neuromodulation evaluation). Within other behavioral medicine settings, these include cognitive screening and evaluation, personality and psychopathology assessment, and comprehensive mental health evaluations for transplant candidates. 

Consultation-Liaison. The Fellow will develop competence in both providing and seeking clinical consultation services, as well as being a productive member of multiple interprofessional teams. Medical providers regularly consult with the Fellow and refer Veterans with a wide range of presenting mental health and/or behavioral health concerns. The Fellow also frequently acts as a liaison between the medical provider and the Veteran to enhance clinical care.

Additional opportunities and responsibilities during elective experiences vary based on the Fellow’s interests and choices. 

Scholarly Activities

Fellows typically complete a project during the training year as a legacy for the patients, staff, and/or system. The Fellow will select and plan this project with one (or both) of the primary supervisors, though it may be conducted independently or in collaboration with supervisor(s), other trainees, or staff. The project may have a research focus (e.g., manuscript for publication, poster presented locally or nationally), a program development/evaluation emphasis (e.g., program utilization analysis; improvements to increase access/reduce treatment barriers; conducting a needs assessment and then creating a new clinical offering to meet patient, family, or provider needs), or an educational objective (e.g., trainings presented to interns, psychologists, and/or medical staff). Many other types of projects are also possible and should reflect the Fellow's interests. 

As mentioned above, research, program development/evaluation, and administrative projects can become a focus of this fellowship year. Previous Fellows have completed many different types of projects (e.g., developing evidence-based psychotherapy groups for medical patients, implementing rapid HIV testing in substance disorder treatment settings, developing a contingency management program for Hepatitis C patients on active treatment). 

Supervision, Professional Development, and Education

Supervision is provided by licensed and privileged psychologists at VA Puget Sound Health Care System – Seattle Division. Specific supervisors vary somewhat depending on the choices the Fellow makes regarding their flex time; however, the supervisors for the core experiences include:

• Kelly Chinh, PhD
• Lisa Glynn, PhD
• Ryan Henderson, PhD
• Andrea Katz, PhD
• Laura Tuck, PsyD 

Professional development and mentorship are central components of this fellowship, with supervisors providing guidance as needed and desired by the Fellow. As mentioned above, the Pain Clinic at VA Puget Sound – Seattle collaborates closely with primary and pain specialty care clinics at the local (e.g., American Lake), regional (VISN 20), and national (VA Central Office “PMOP”) levels. Given this wide interprofessional network, there are many opportunities for collegial contact and professional growth. Past graduates of this fellowship have gone on to take clinical positions in VA (areas of behavioral medicine, mental health, substance use disorders, chronic pain), as well as in public-health research and academia. 

Didactic experiences are rich and varied. The Fellow may attend one of two weekly “ECHO” chronic-pain didactics, the twice-yearly Pain Mini Residency program, the Behavioral Medicine Seminar Series, and other behavioral medicine offerings across participating specialties. Other didactic experiences are tailored to the Fellow’s interests and professional goals, but may include Rehabilitation Psychology, Neuropsychology, Primary Care–Mental Health Integration, or Mental Health/Substance Use Disorder seminars. The Fellow may also attend local Grand Rounds presentations, didactics, and seminars at the University of Washington. 

Overview         This fellowship offers advanced training in couple therapy in a VA setting. Its primary goal is to provide training in the provision of clinical services to Veteran couples, as well as training in the development and evaluation of family services throughout the medical center and VA system. Given that family services is an important emerging area in the VA health care system, there is ample opportunity for clinical and programmatic innovation during the fellowship year. The fellowship will provide training for clinical and administrative careers serving as leaders and pioneers in advocating for, developing, and providing relationship- and family-focused care in the VA healthcare system and beyond.

The Fellowship Training Year          This fellowship is 12 months in duration, typically beginning in mid- August. Fellows are expected to devote at least 80% of their time to the provision of direct clinical care, with up to 20% time spent on scholarly activities, such as mentored research, program evaluation/quality improvement projects, and program development. The fellowship is completed primarily within the Couple & Family Program (CFP) of the VA Puget Sound Health Care System, Seattle Division, though fellows will be encouraged to broaden their clinical competence through supplemental clinical activities in adjacent outpatient clinics.

The fellow will be a member of the Couple & Family Program (CFP), which is situated within the Mental Health Clinic (MHC). Its primary supervisor and track lead is Geoff Corner, PhD , who serves as CFP Director. The fellow will function as a full member of two teams, CFP and either MHC or a clinic associated with another staff member providing clinical supervision (e.g., the PTSD Outpatient Clinic if the fellow is hoping to seek out training opportunities focused on targeted PTSD treatment). This will include attendance at two team meetings and any other huddles or consultation meetings scheduled throughout the meeting. Fellows can also participate in other clinical, research, and administrative duties, and they will collaborate with team members of varying professional backgrounds (e.g., social workers, psychologists, psychiatrists, psychiatry residents, nurses, trainees).

Couple Therapy Services         This fellowship track will primarily provide advanced clinical training in couple therapy utilizing Integrative Behavioral Couple Therapy (IBCT). Fellows will focus on the provision of IBCT as a core clinical activity throughout the training year. They can supplement this with additional couple and family therapy experiences based on their interests and the expertise they bring into the fellowship. For example, those with strong interests in family systems may develop an individualized learning plan that includes connections with other VA services or clinics in which there may be high demand for family- or relationship-focused care, including the PTSD Outpatient Clinic, the Mental Health Clinic, Spinal Cord Injury, Rehabilitation Care, Primary Care, and Women’s Health. Opportunities to develop relevant family services in these settings or generally within Outpatient Mental Health may be available. Fellows may also elect to receive training in the “Relationship Tune-up,” which is an evidence-based, brief (5 session) dyadic intervention focused on bolstering communication and other relationship skills.

Couple- and Family-Focused Group Therapy Services          Fellows are encouraged to facilitate or co-facilitate psychotherapy groups throughout the fellowship year. Couple- and family-oriented groups that are currently offered through outpatient mental health include the PTSD 101 Workshop for Family and Friends (a monthly, single-session psychoeducational group focused on providing information and support to friends and family members of Veterans with PTSD) and the Restoring Bonds: Relationship Skills Class (an 8-week group for couples to learn new skills to communicate more effectively, resolve conflict, and facilitate connection and closeness). Additionally, a portion of the fellowship can be focused on program development of new couple- and family-based services. Fellows are encouraged to develop their own groups and services based on personal interest and the needs of Veteran families and couples.

Individual Psychotherapy         Fellows may elect to spend 100% of their clinical time providing couple therapy or other family-focused services. Alternatively, they can choose to pursue other clinical interests up to a 50% split as determined by their individualized learning plan(i.e., 50% couple/family work and 50% individual/group therapy with other emphases). As part of this time, fellows may elect to work with a number of Veterans with diverse backgrounds, a variety of presenting problems, and/or seeking any specific treatments (e.g., LGBTQ+ Veterans, working with grief, CPT/PE). They are also welcome to pursue opportunities to facilitate or co-facilitate other outpatient mental health groups as part of their fellowship based on their other interests and expertise. Specific groups offerings available at a given time vary significantly and can be discussed with the fellow’s supervisor.

Assessment         Fellows are trained in the IBCT assessment process, which integrates information gathered via several clinical interviews and self-report measures. This assessment is conducted over several sessions at the beginning of any course of IBCT. It includes a joint assessment session, individual assessment sessions with each partner, and a joint feedback session. During feedback, fellows share a formulation of the etiology and maintenance of relationship distress developed collaboratively with the couple throughout the other assessment sessions. This becomes the guiding framework for treatment. In addition, fellows will complete CFP intakes, which provide an opportunity to work with, assess, and engage in treatment planning with various couples referred to CFP throughout the hospital. These intakes end with treatment planning, triaging of various relational and mental health needs, and making necessary referrals for care. Lastly, fellows who spend a portion of their time working in another outpatient mental health clinic (e.g., MHC, POC) have the option to complete  intakes for specialty mental health services, which involve accurate detection and diagnosis of mental health conditions, treatment planning, and preliminary psychodiagnostic report writing. 

Telehealth         Fellows are encouraged to conduct a portion of their clinical work using video telehealth appointments. These involve treating couples or individual clients through videoconferencing. The COVID-19 epidemic propelled this treatment modality into VA Medical Centers and Community Based Outpatient Clinics (VA satellite clinics in rural areas). Currently, the growth of this technology enables practitioners to reach underserved populations and individuals who have difficulty accessing mental health services for various reasons (e.g., mental or physical illnesses, transportation difficulties, distance to VA, childcare issues). Fellows are encouraged to see patients for IBCT via video telehealth. As the VA continues to return to in-person, hospital-based care, a hybrid model of clinical care will likely be the standard for the foreseeable future. Fellows will have the opportunity to develop competency and flexibility to deliver both in-person and video telehealth couple and family care. 

Consultation         Fellows will have the opportunity to consult with other mental health and medical providers throughout the hospital regarding couple- and family-related issues. As the offerings in CFP grow, fellows may also play an essential role in the marketing of CFP to other VA services and departments. This can take the form of formal in-service presentations at other clinic or departmental meetings, informally attending such meetings to increase the visibility of CFP, and/or creating and distributing materials throughout the hospital. Fellows will also play a critical role in providing consultation to help current or future referring providers understand when couple therapy is indicated and can be helpful, when another kind of care would be more appropriate instead (e.g., therapy or discernment counseling through community care), and when other forms of support are necessary to prepare the Veteran or couple to engage in and receive benefit from couple therapy (e.g., individual therapy, an intervention focused on IPV).

Administration         There are several opportunities for administrative work and training, including coordinating and running administrative meetings, program development, and program evaluation and quality improvement projects. Duties of current fellows include assisting with coordinating and running weekly CFP team meetings, reviewing and tracking referrals to CFP received from providers throughout the hospital, and organizing and implementing the National Couples and Family Psychology Didactic Series (see Academic & Educational Opportunities below for additional details). Lastly, CFP is always looking for ways to extend its reach throughout the hospital while increasing access to care for Veterans who would benefit from the kind of treatments offered through the clinic. An administration-minded fellow is welcome and encouraged to participate in activities aimed at developing, refining, and/or streamlining processes through which Veterans are referred, screened, or otherwise connect with care through CFP.

Research         Fellows are encouraged to utilize protected research time for activities consistent with their training and professional needs and goals. This may include program development, quality improvement and program evaluation projects, and the preparation of manuscripts utilizing existing data. 

Academic & Educational Opportunities           Fellows are encouraged to participate in scholarly activities throughout the medical center, including monthly VA Advanced Family Services teleconferences. Another critical component of this fellowship track is organizing and facilitating the National Couples and Family Psychology Didactic Series for any and all psychology fellows receiving training in couple and family services at VAs all over the country. This didactic series is a monthly seminar series dedicated to the presentation and discussion of research and clinical topics in couples and family clinical care. It is a unique opportunity to influence nationwide fellowship training in the area of couple and family health, as well as a chance to network with other VA professionals providing relationship-focused care. Lastly, fellows are encouraged to participate in other seminars, didactic series, and journal/research clubs offered throughout the hospital. Examples include the IPV/MST Lunch and Learn, PTSD Journal Club, PTSD Research Forum, Primary Care Didactics, Telemental Health Journal Club, and Spinal Cord Injury/Rehabilitation Didactics. 

Supervision         Fellows will work with Dr. Corner, who serves as CFP Fellowship Track Lead and primary supervisor for the year. However, we encourage fellows to take advantage of the areas of expertise of our diverse staff and receive secondary supervision on experiences that are of interest. Supervision may include review of audio-recorded sessions.

The Outpatient Mental Health (OMH) Fellowship provides advanced training in clinical psychology services delivered across multiple outpatient mental health settings. The fellowship focuses on training in evidence-based treatment approaches for various mental health disorders with an opportunity to specialize in the treatment of serious mental illness, acute psychiatric presentations, and/or general outpatient mental health. The OMH fellow will be embedded within one or two of the following large interprofessional teams: The Mental Health Clinic (MHC), PTSD Outpatient Clinic (POC), Acute Inpatient Psychiatry unit (7West), Intensive Outpatient Program (IOP), and Psychosocial Rehabilitation and Recovery Center (PRRC). Fellows will develop a variety of skills critical to operating as a psychologist in VA, including intervention, cross-discipline treatment planning and consultation, program development and evaluation, administration, quality improvement, clinical research, and as available, vertical supervision.

The OMH Fellowship is designed to accommodate trainees with a range of prior experiences in working with Veterans with general co-occurring mental health concerns, PTSD, serious mental illness (SMI), and/or acute psychiatric presentations. The fellowship has flexibility to be adapted according to the fellow’s level of interest in gaining breadth and/or depth in treating Veterans with co-occurring disorders. For example, fellows interested in a full immersion experience may spend the entire year working in multiple related clinics (e.g., IOP + 7West or MHC + POC). Alternatively, fellows may choose to spend most of their time in one clinic with a smaller footprint in a supplementary setting (e.g., POC + 7West) for a more diversified training experience. 

Available Clinic Placements: Throughout the year the OMH fellow will be able to select one or two clinics listed below for part-time, full-year placements. Other arrangements (e.g., two 6 month “rotations”) may be negotiated on a case-by-case basis. 

1. The Mental Health Clinic (MHC) offers outpatient mental health care for Veterans with a broad range of presenting problems and utilizes a variety of evidence-based treatment approaches. Veterans seen in MHC present with a range of clinical challenges, including mood and anxiety disorders, serious mental illness, psychotic spectrum disorders, insomnia, PTSD (typically non-military traumas, such as sexual assaults, childhood abuse, motor vehicle accidents, etc.), personality disorders, somatic disorders, and substance use disorders. MHC Veterans thus provide fellows with an opportunity to obtain strong generalized training. The fellow may choose to work with Veterans with specific clinical presentations that suit their training goals.
2. The PTSD Outpatient Clinic (POC) provides care to veterans of all gender identities and all service eras seeking treatment for military-related PTSD. In addition to a primary diagnosis of PTSD, veterans enrolled in this clinic also present with co-occurring disorders, most often mood, anxiety, and substance use disorders.
3. The Acute Inpatient Psychiatry unit (7West) is a 25-bed, locked unit serving Veterans of all genders and war eras who need short-term stabilization before transferring to a less restrictive level of care. Two of these beds are reserved for planned medical withdrawal management from the Addiction Treatment Center (ATC). Many of the veterans admitted to the unit are considered voluntary admissions, however at any given time there may be veterans held for involuntary treatment. The average length of stay ranges from 6-10 days. Treatment includes recovery-oriented groups, milieu, and/or individual therapy, medication management, and daily treatment team meetings. Veterans admitted to 7West may have a wide range of difficulties including depression, psychosis, PTSD, substance use, homelessness, suicidal ideation, homicidal ideation, grave disability, mania, and dementia.
4. The Intensive Outpatient Program (IOP) delivers mental health care to veterans in need of intensive services for stabilization. The IOP serves veterans in a less restrictive environment by offering a level of care between traditional outpatient mental health programs and the acute inpatient psychiatry unit. Treatment goals are established collaboratively with the Veteran and often focus on symptom stabilization, crisis management, and psychosocial rehabilitation. The IOP is a four-week program that provides assessment, evidence-based individual and group therapy, medication management, and case management services. Veterans in the IOP present with a wide range of difficulties including depression, PTSD, suicidal ideation, interpersonal stressors, psychosis, and mania. Many of the veterans in the program have recently discharged from the acute inpatient psychiatry unit or have presented for psychiatric emergency services within the last 24 hours.
5. The Psychosocial Rehabilitation and Recovery Center (PRRC) delivers outpatient mental health care to veterans in need of additional support to build and maintain wellness. The rehabilitative services offered are based on the Recovery Model and include assessment, individual and group psychotherapy, crisis assessment and intervention, case management, community integration, and vocational rehabilitation services. Veterans in the PRRC present with a wide range of difficulties including depression, PTSD, anxiety, psychosis, mood disorders, emotion liability, and baseline and acute suicidality. Given the nonlinear nature of mental health recovery, Recovery Coaches provide flexible and collaborative care, often modifying treatment plans to meet the specific needs of veterans in response to changes in symptom severity and psychosocial stressors. The goal of this program is to empower veterans to take the lead in their lives by building meaningful and fulfilling experiences outside of mental health treatment. PRRC primarily functions as a group-based program, offering 15-20 groups per week. Additional training opportunities include individual psychotherapy, diagnostic evaluation, case management, treatment planning, consultation, and program evaluation/development (e.g., implementation of a new group offering).

The MHC team consists of social workers, psychiatrists, nurses, a peer support specialist, and various trainees (e.g., a psychology fellow, psychiatry residents, social work and psychology interns). The MHC psychology staff is one of the largest groups of psychologists practicing at the Seattle VA, and they possess a corresponding wealth and diversity of expertise. Supervisory psychologists available in MHC include Drs. Charlotte Brill, David Call, Mark Engstrom, and Alvaro Garcia.

The POC is an interprofessional team comprised of psychologists, social workers, psychiatrists, nurses, and a peer support specialist. The clinic offers a variety of time-limited and evidence-based individual and group psychotherapy options to address PTSD and related mental health concerns (see below regarding specific interventions) that stem from the experience of combat, military sexual trauma, physical assault, training accidents, disaster recovery, and any other trauma that occurred during the course of military service. Supervisory psychologists available in POC include Drs. Tory Durham (OMH Fellowship Track Lead), Jane Luterek, and David Pressman. 

7West is a fast paced, interprofessional training environment that includes exposure to a variety of disciplines, including psychiatry, social work, nursing, and occupational therapy. The fellow may choose to participate in a wide variety of activities. This could include leading and/or co-leading a variety of skills-focused groups, brief individual therapy, diagnostic evaluation and clarification, suicide safety planning, and assisting with outpatient care coordination efforts. In addition, there are many opportunities for program development and evaluation while completing a rotation on 7West. The supervisory psychologist on 7West is James Madole, PhD.

The IOP team is interprofessional, consisting of psychology, psychiatry, and social work. Psychology interns are involved in all aspects of care and have many opportunities, including individual and group psychotherapy, diagnostic evaluation, crisis intervention, case management, team consultation, treatment planning, and program development and evaluation. The IOP team holds a monthly diversity journal club in which topics related to diversity issues and how they relate to clinical practice in IOP are discussed in team meetings. Supervisory psychologists in IOP include Drs. Kelly Allred and Samantha Yard.

The PRRC team is interprofessional, consisting of psychology, social work, psychiatry, and addiction therapy. Treatment is informed by goals established collaboratively between patients and their primary PRRC provider (i.e., Recovery Coach). The supervisory psychologist in PRRC is Dr. Jason Chauv. 

Across clinics, the fellow can expect to gain clinical expertise in any of the following areas:

Individual Evidence-Based Psychotherapies such as Cognitive Behavioral Therapy (including CBT for depression, anxiety, psychosis, insomnia, ADHD, chronic pain, health anxiety, and/or suicidality), Acceptance and Commitment Therapy (ACT), Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP), Exposure Therapy for anxiety disorders, Exposure and Response Prevention for OCD (ERP), Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), Concurrent Treatment of PTSD and SUDs using PE (COPE), Dialectical Behavior Therapy (DBT), Brief Cognitive Behavioral Therapy for Suicide, and Motivational Interviewing (MI). 

Group-based interventions such as CBT skills, ACT skills, Behavioral Family Therapy (BFT), DBT skills, CPT, CBT for Insomnia, Unified Protocol for Emotional Disorders, Transdiagnostic Anxiety Exposure, Motivational Interviewing, SUD Skills groups, ACT for anger, CBT for Bipolar Disorder, Mindfulness, Increasing Positive Emotions, Race-Based Stress and Resilience, Coping with Grief, and Crisis Management Skills. 

Fellows are also encouraged to create and deliver their own group-based interventions should that be a fit for their fellowship training goals. Unique offerings within PRRC also include Ending Self-Stigma, Community Connection, Healthy Relationships, and Self-Esteem based groups.

Psychodiagnostic interviewing and treatment planning for new Veterans presenting to the clinic. The fellow will staff one Triage and Rapid Evaluation Clinic (TREC) per week. Given the diverse range of Veteran patients that present to outpatient mental health, the fellow can expect to sharpen diagnostic and treatment planning skills. Following intake assessment, the fellow will act as treatment coordinator to gain critical experience in treatment planning with more independence than at the internship level.

The advanced psychodiagnostic assessment clinic is an opportunity for Veterans and providers to gain diagnostic clarity and inform treatment planning through results from an integrated report based on objective personality indices. Veterans are referred from many clinics in outpatient mental health; participating in this clinic is an opportunity for a fellow to gain additional competency in efficient assessment report writing and thoughtful provision of feedback to Veterans (and sometimes Veterans' families) with complex co-morbid presentations.

Continuity of Care. The OMH Fellowship offers an unusual opportunity to engage in Veteran care across varying levels of symptom acuity. A Veteran’s treatment plan may include engagement in one or more of the Mental Health Intensive Services clinics, depending on his or her needs and treatment goals. For example, a Veteran may initiate care on 7West for acute stabilization, discharge to the IOP for continued stabilization, and then transition to the PRRC for ongoing care. Interns may elect to support an individual Veteran across these varying levels of treatment intensity, perhaps over a longer period than one rotation as part of a continuing detail.

Clinical opportunities with older Veterans including completion of TREC intakes with older adults in collaboration with other geriatric mental health providers, including potential participation in this team's interprofessional team meetings; individual psychotherapy with older adults (e.g., CBT, IPT, ACT); and development and facilitation of group interventions specifically for older adult populations.

Provision of care through telemental health is a regular part of services provided in the outpatient mental health clinic, and fellows can expect to continue gaining proficiency in therapy delivered via this modality.

Overview of the Fellowship Training Year    

The fellow will work closely with mentors to design an individualized training plan that both plays to their strengths and helps address ongoing training needs to prepare for an exciting career in psychology. The fellowship is designed to enhance the fellow's expertise in treating co-occurring disorders while also helping propel the fellow into a career trajectory of their choosing. One of the strengths of this fellowship is the flexibility to develop a dynamic and personalized training plan that covers a multitude of domains (e.g., clinical expertise, quality improvement, teaching and training opportunities) that are important to the fellow. The fellow will also participate in weekly interprofessional team meetings, our weekly intake clinic, and collaborate and consult with various disciplines on the team. There are numerous opportunities to participate in journal clubs, research forums, and didactics that focus on a range of topics relevant to mental health. The fellow may also choose to present didactics in various settings over the course of the year. Historically, fellows have collaborated to organize and facilitate a mental health didactic series for outpatient mental health providers.

Supervision  Fellows are strongly encouraged to work with several different psychologists as their primary supervisors over the course of the training year. For example, the fellow may select two different supervisors to work with for individual supervision at a given time with the opportunity to change primary supervisors over the course of the training year as they navigate meeting their various training goals. Additionally, the fellow will receive supervision from psychologists in other contexts and settings, such as co-leading groups or conducting research/quality improvement projects. 

Research, Program Development, and Quality Improvement Projects (optional)  The fellow is strongly encouraged to design and implement a fellowship project. Fellows may request up to 20% time for this project. Typically, this involves joining an existing research project. Alternatively, the fellow can choose to participate in a quality improvement project, either as an independently designed project or an existing one. Examples of these projects include research studies; psychotherapy group development, implementation, and outcome assessment; assessment instrument development; service delivery assessment and innovations; submission of review papers and/or chapters; needs assessments for special populations with proposed service changes to better address the needs of the target population; and by designing and implementing trainings in an area of expertise the fellow brings to the service.

Overview

This fellowship offers advanced training in Dialectical Behavior Therapy (DBT) within an outpatient VA setting. The primary goal is to provide training in the provision of DBT to high-risk and complex Veterans with borderline personality disorder (BPD) traits. The fellow is expected to have prior training and experience delivering DBT and can expect to advance their skills in both DBT and the DBT Prolonged Exposure (DBT PE) protocol for PTSD during the fellowship year. Additionally, the fellow will have the opportunity to work in the general outpatient mental health clinic to obtain experience with a broader range of patients. In both contexts, the fellow will work closely with an interprofessional team and may be able to participate in activities such as program development, program evaluation/quality improvement, and vertical supervision. The fellowship will provide training for clinical and administrative careers specializing in DBT and the treatment of high-risk, dysregulated, and complex patients more broadly.       

Services Offered in the DBT Program

The DBT Program is a specialized program that includes two treatment tracks. Veterans seen in both tracks of the DBT program are referred from other mental health programs, medical clinics, and inpatient units throughout the facility. The DBT team is interprofessional, consisting of psychologists, social workers, and a psychiatrist, and includes clinicians from multiple outpatient mental health services (Mental Health Clinic, PTSD Outpatient Clinic, and the Intensive Outpatient Program).  

1. Comprehensive DBT Program

The Comprehensive DBT program was established at the Seattle VA in January 2019 to provide compassionate and evidence-based treatment to Veterans with complex and severe mental disorders who are at high risk for suicide and self-injurious behavior. The program provides one year of comprehensive treatment consisting of all four modes of DBT, including individual therapy (1-2.5 hours/week), group skills training (2 hours/week), between-session phone coaching (as needed during business hours), and therapist consultation team (90 minutes/week). The program treats about 20 Veterans at a time who: (1) have exhibited repeated behavioral dysregulation in the past year in at least two areas that are potentially self-damaging (e.g., suicidal and self-injurious behavior, substance misuse, physical aggression, spending, reckless driving, binge eating), (2) meet criteria for borderline personality disorder (BPD) or have significant BPD traits, and (3) have not significantly improved despite high use of other mental health services. In addition, Veterans treated in this program typically have multiple comorbid disorders (e.g., PTSD, substance use disorders, depression, and eating disorders) and severe functional impairment (e.g., chronic unemployment, limited social support, housing and financial insecurity).   

2. DBT Skills Group Program 

The DBT Skills Group Program includes six groups that each enroll 10 Veterans at a time. Veterans participate in DBT skills group for six months during which they participate in each of the DBT skills modules (mindfulness, emotion regulation, distress tolerance, and interpersonal effectiveness). The program is open to any Veteran who may benefit from learning DBT skills. As a result, participants exhibit a wide range of mental health difficulties. 

The Fellowship Training Year 

This fellowship is 12 months in duration, beginning in mid-August. The fellow is expected to devote at least 60% of their time to the provision of direct clinical service, including at least 40% time delivering DBT and 20% time providing clinical services in the Mental Health Clinic. In addition, 20% of the fellow’s time will be spent on academic and scholarly activities, such as research, program evaluation/quality improvement projects, and program development.

Clinical Service: The program provides the fellow with the opportunity to engage in all aspects of delivering comprehensive DBT as well as other clinical services relevant to the fellow’s training goals.

1. Comprehensive DBT Program (at least 40% time)

• DBT screening assessments: The fellow will conduct clinical assessments for Veterans referred to the comprehensive DBT program to determine their eligibility. The assessment includes a structured diagnostic interview for BPD as well as standardized measures assessing suicide attempts, non-suicidal self-injury, other forms of behavioral dysregulation, and service use.
• DBT individual therapy: Each Veteran in the comprehensive DBT program receives one year of weekly DBT individual therapy (1 hr/wk). Veterans with PTSD may also elect to receive DBT PE as part of their individual therapy (1.5 hrs/wk) once they achieve sufficient control over higher priority targets. The fellow will have the opportunity to be the primary DBT therapist for ~5 patients.
• DBT skills group: The fellow will co-lead and/or lead 2 DBT skills groups (4 hrs/wk) that will include Veterans from both tracks of the DBT program.
• DBT phone coaching: The fellow will provide skills coaching via phone to their individual therapy patients during business hours (~1 hr/wk). At times, fellows may also provide phone coaching back-up for other providers on the team.
• DBT consultation team: The fellow will attend the therapist consultation team meeting (1.5 hrs/wk) during which they will have the opportunity to receive and provide consultation. The fellow will also gain experience serving as the meeting team leader (leading mindfulness, setting an agenda, and managing time) and observer (attending to whether team members are adhering to DBT consultation agreements and principles) during the fellowship year.

2. Mental Health Clinic (at least 20% time)

The fellow will also engage in clinical services in the outpatient Mental Health Clinic (MHC) that are consistent with their broader training goals. This may include individual and group therapy with Veterans with a diverse range of clinical presentations. For more information about the clinical services provided in MHC, please see the description of the Mood and Anxiety Fellowship.

Supervision: The fellow will receive two hours of weekly individual supervision. In the DBT program, the fellow will receive supervision from Drs. Melanie Harned or Samantha Yard throughout the training year. In MHC, the fellow will select a supervisor that is a good match for their training goals. Additionally, the fellow will receive supervision from other providers in forums such as co-leading groups or conducting research. 

Research, program development, and quality improvement projects: The fellow is strongly encouraged to design and implement a fellowship project. Fellows may request up to 20% time for this project; the amount of time should accurately reflect the nature of the project and its work requirements. The fellow may choose to participate in research in the form of an independent project or join an existing research project. Alternatively, the fellow could choose to participate in a quality improvement project, again either an independently designed project or an existing one. Examples of projects include research projects; service delivery assessment and innovations; submission of review papers and/or chapters; needs assessments for special populations with proposed service changes to better address the needs of the target population; designing and implementing trainings in an area of expertise. 

Administration: There are several opportunities for administrative work and training, including running DBT consultation meetings, tracking and placing referrals to DBT with appropriate groups and individual providers, and organizing DBT trainings for VA trainees and providers. 

Academic & Educational Opportunities: Fellows will attend the monthly fellowship didactic on professional issues. Fellows are encouraged to participate in other seminars, didactics, and journal/research clubs throughout the Medical Center. Examples include the PTSD Journal Club, PTSD Research Forum, Primary Care Didactics, Mental Health Intensive Services Didactics, and Grand Rounds offered through the Department of Psychiatry and Behavioral Sciences of the University of Washington School of Medicine. A fellow may choose to curate a mental health didactic series as well and provide at least one didactic over the course of the year.

Training Requirements

The ideal candidate will already have received intensive training in DBT (40 hours of workshop training or equivalent) and have prior experience delivering all modes of comprehensive DBT under the supervision of an experienced DBT provider. Interested applicants who do not have this experience may also apply and we will work to assist the fellow in finding appropriate training if needed. The fellow will also be required to read the DBT treatment manual (Linehan, 1993) as well as the DBT skills training manual (Linehan, 2015) prior to starting the fellowship. Interested applicants are welcome to consult with the Training Director and one or more of the DBT program supervisors to determine if this fellowship may be a good fit for their training and professional goals.

Require disclosure of sensitive or personal information.

Eligibility for application and selection

Applicants must meet the eligibility qualifications for psychology training within the Department of Veterans Affairs, which are described at https://www.psychologytraining.va.gov/eligibility.asp.  These requirements include, but are not limited to, the following. Applicants must be U.S. citizens.  The Federal Government requires that male applicants to VA positions who were born after 12/31/59 must sign a Pre-appointment Certification Statement for Selective Service Registration before they are employed.  It is not necessary to submit this form with the application, but if you are selected for this training experience and fit the above criteria, you will have to sign it. All trainees will have to complete a Certification of Citizenship in the United States prior to beginning the training year.  We are unable to consider applications from anyone who is not currently a U.S. citizen. 

The VA conducts drug-screening exams on randomly selected personnel as well as new employees.  Trainees are not required to be tested prior to beginning work, but once on site they are subject to random selection in the same manner as other staff. Acceptance of trainees is contingent upon the results of a federal background check and a health status verification (see https://www.va.gov/OAA/TQCVL.asp). Failure to meet these qualifications, or failure to pass a federally mandated background check for employment, could nullify an offer to an applicant.

As an equal opportunity training program, our program welcomes and strongly encourages applications from all qualified candidates, regardless of gender, racial, ethnic, sexual orientation, disability, or other minority status. The program adheres to VA Equal Opportunity policies which can be requested. 

Health Professions Trainees (HPTs) are appointed as temporary employees of the Department of Veterans Affairs. As such, HPTs are subject to laws, policies, and guidelines posted for VA staff members.  There are infrequent times in which this guidance can change during a training year that may create new requirements or responsibilities for HPTs.  If employment requirements change during the course of a training year, HPTs will be notified of the change and impact as soon as possible and options provided. The Training Director will provide you with the information you need to understand the requirement and reasons for the requirement in timely manner.”

VA Drug-Free Workplace Program Guide for Veterans Health Administration (VHA) Health Professions Trainees (HPTs)

In 1986, President Reagan signed Executive Order 12564, Drug-Free Federal Workplace, setting a goal to prevent Federal employee use of illegal drugs, whether on or off duty. In accordance with the Executive Order, VA established a Drug-Free Workplace Program, and aims to create an environment that is safe, healthful, productive, and secure.

As you might already know: 

1. All VHA HPTs are exempt from pre-employment drug-testing.
2. Most VHA HPTs are in testing designated positions (TDPs) and subject to random drug testing.
3. All VA employees appointed to a Testing Designated Position (including HPTs) must sign a    Random Drug Testing Notification and Acknowledgement Memo.
4. All HPTs in Testing Designated Positions are subject to the following types of drug testing:
   • Random
   • Reasonable suspicion
   • Injury, illness, unsafe or unhealthful practice; and
   • Follow-up after completion of a counseling or rehabilitation program for illegal drug use through the VA Employee Assistance Program (EAP).

Here are a few additional points:

1. VHA HPTs may receive counseling and rehabilitation assistance through the VA EAP. Contact the local VHA HR office for more information about EAP.
2. VHA HPTs will be given the opportunity to justify a positive test result by submitting supplemental medical documentation to a Medical Review Officer (MRO) when a confirmed positive test could have resulted from legally prescribed medication.
3. Prior to being notified of a drug test, VHA HPTs may avoid disciplinary action by voluntarily identifying themselves to EAP as a user of illegal drugs. Disciplinary action will not be initiated if the HPT fully complies with counseling, rehabilitation and after-care recommended by EAP, and thereafter refrains from using illegal drugs. Note: Self-identification must happen prior to being notified of a drug test. This option is no longer viable once an HPT has been selected for a drug test. However, be aware that VA will initiate termination of VA appointment and/or dismissal from VA rotation against any trainee who:
   • Is found to use illegal drugs on the basis of a verified positive drug test (even if a drug is legal in the state where training); or
   • Refuses to be drug tested.

Due Process Procedures while enrolled in the program

Grievance procedures:

1. Trainee Grievances       We believe that most problems are best resolved through face-to-face interaction between fellow and supervisor (or other faculty), as part of the on-going working relationship.  Fellows are encouraged to first discuss any problems or concerns with their direct supervisor.  In turn, supervisors are expected to be receptive to complaints, attempt to develop a solution with the fellow, and to seek appropriate consultation. If fellow-faculty discussions do not produce a satisfactory resolution of the concern, several additional steps are available to the fellow.

Informal mediation       Either party may request the Training Director to act as a mediator, or to help in selecting a mediator who is agreeable to both the fellow and the supervisor.  Such mediation may facilitate a satisfactory resolution through continued discussion. Alternatively, mediation may result in recommended changes to the learning environment, or a recommendation that the fellow change placements (or make some other alteration in his/her learning plan) to maximize their learning experience.  Fellows may also initiate a request to change placements, following the procedures described elsewhere in the Fellowship Brochure.  Changes in placements must be reviewed and approved by the Training Committee.

Formal grievances       If informal avenues of resolution are not successful, or in the event of a serious grievance, the fellow may initiate a formal grievance process by sending a written request for intervention to the Training Director. 

a. The Training Director will notify the Psychology Service Director of the grievance and call a meeting of the Training Committee to review the complaint. The fellow and faculty will be notified of the date of the review and given the opportunity to provide the Committee with any information regarding the grievance. 

b. Based upon a review of the grievance and any information provided by involved parties, the Training Committee will determine the course of action that best promotes the fellow's training experience.  This may include recommended changes within the placement itself, a change in supervisory assignment, or a change in clinical placement. 

c. The fellow will be informed in writing of the Training Committee's decision and asked to indicate whether they accept or dispute the decision.  If the fellow accepts the decision, the recommendations will be implemented.  If the fellow disagrees with the decision, they may appeal to the Director of the Psychology Service, who as an ex-officio member of the Training Committee will be familiar with the facts of the grievance review.   The Service Director will render the appeal decision, which will be communicated to all involved parties and to the Training Committee. 

d. If the grievance involves any member of the Training Committee (including the Training Director), that member will recuse himself or herself from serving on the Training Committee due to a conflict of interest.  A grievance regarding the Training Director may be submitted directly to the Director of the Psychology Service for review and resolution in consultation with the Training Committee. 

e. A grievance charging a violation of ethics or law will be submitted directly to the Chief of the Psychology Service for review and determination rather than proceeding to the Training Committee. Given the need to balance fair review of a grievance with the legal and personnel rights of an individual, this pathway better allows for the appropriate protection and safeguards of all involved parties.

f. These procedures are not intended to prevent an intern from pursuing a grievance under any other mechanisms available to VA employees, including EEO, or under the mechanisms of any relevant professional organization, including APA or APPIC. Interns are also advised that they may pursue any complaint regarding unethical or unlawful conduct on the part of psychologists licensed in Washington State by contacting the office of the Examining Board of Psychology.   

Probation and termination procedures:

2.  Insufficient competence      The fellowship program aims to facilitate the development of advanced Health Service Psychology (HSP) competencies. Conceivably, a fellow could fall short of the program’s minimal levels of achievement (MLA’s) due to a serious deficit in skill or knowledge, or due to problematic behaviors that significantly impact their professional functioning. In such cases, the training program will help fellows identify these areas and provide remedial experiences or recommended resources to improve the fellow's performance to a satisfactory degree. Conceivably, the problem identified may be of sufficient seriousness that the fellow would not successfully complete the fellowship unless that problem was remedied. 

a.         Should such a circumstance ever be a concern, the problem must be brought to the attention of the Training Director at the earliest opportunity to allow the maximum time for remedial efforts.  The Training Director, in concert with involved supervisors, will review faculty concerns with the fellow, and call a meeting of the Training Committee.  The fellow and involved faculty will be invited to attend and encouraged to provide any information relevant to the concern.

b.         A fellow identified as having a serious deficit or problem will be placed on probationary status by the Training Committee, should the Training Committee determine that the deficit or problem is serious enough that it could prevent the fellow from fulfilling the exit criteria, and thereby, not receive credit for the fellowship.

c.         The Training Committee may require the fellow to participate in particular learning experiences or may issue guidelines for the type of experiences the fellow should undertake in order to remedy competency deficits.

d.         The fellow, the fellow's supervisor(s), the area emphasis Lead, the Training Director, and the Training Committee will, in collaboration, produce a learning plan specifying the kinds of knowledge, skills, attitudes and/or behaviors that are necessary for the fellow to develop in order to remedy the identified problem.

e.         Once a fellow has been placed on probation and a remedial learning contract has been written and adopted, the fellow may move to a new clinical placement if there is consensus that a new environment will assist the fellow's remediation. The new placement will be carefully chosen by the Training Committee and the fellow to provide a setting that is conducive to working on the identified problems.  Alternatively, the fellow and supervisor may agree that it would be to the fellow's benefit to remain in the current placement.  If so, both may petition the Training Committee to maintain the current assignment.

f.          The fellow and the supervisor will report to the Training Committee on a regular basis, as specified in the contract (but not less than every two months) regarding the fellow's progress.

g.         The fellow may request that a faculty representative of their choosing be invited to attend and participate as a non-voting member in any meetings of the Training Committee that involve discussion of the fellow and his/her status in the fellowship. The intention is that said faculty member would serve as a knowledgeable advocate for the fellow regarding the policies and procedures of the program and would promote the interests and preferences of the fellow. While all faculty, and particularly the Training Director, have a responsibility to act in the best interests of the fellow, they also have additional responsibilities to the program, the profession, and the public. The presence of a faculty advocate for the fellow in such circumstances makes it more likely that a proper balance is struck between the program’s duty to provide training to the fellow and it’s responsibilities for professional gate-keeping. 

h.         The fellow may be removed from probationary status by a majority vote of the Training Committee when the fellow's progress in resolving the problem(s) specified in the contract is sufficient. Removal from probationary status indicates that the fellow's performance is at the appropriate level to receive credit for the fellowship (i.e., is meeting the program’s MLA’s).

i.          If the fellow is not making progress, or, if it becomes apparent that the fellow is unlikely to successfully fulfill the Minimal Levels of Achievement within the contracted fellowship period despite remediation, the Training Committee will so inform the fellow at the earliest opportunity, so as to allow the fellow a maximum degree of autonomy in their own decision-making.

j.          The decision for credit or no credit for a fellow on probation is made by a majority vote of the Training Committee. The Training Committee vote will be based on all available data, with attention to the fellow's fulfillment of the probationary learning plan and the program’s Minimal Levels of Achievement. 

k.         A fellow may appeal the Training Committee's decision to the Director of the Psychology Service. The Service Chief will render the appeal decision, which will be communicated to all involved parties, and to the Training Committee. Should the Service Chief be recused from deliberation due to a conflict of interest, the Associate Chief of Staff for Mental Health will render the appeal decision.

l.          These procedures are not intended to prevent a fellow from pursuing an appeal of the Training Committee decision under any other applicable mechanisms available to VA employees, including EEO. 

3.  Illegal or unethical conduct                        Illegal or unethical conduct by a fellow must be brought to the attention of the Training Director.  Any person who observes such behavior, whether faculty or trainee, has the ethical responsibility to make a report.

a.         The Training Director, the supervisor(s), and the fellow may address infractions of a minor nature.  A written record of the complaint and outcome become a permanent part of the fellow's training file.

b.         A significant infraction or a pattern of repeated minor infractions must be documented in writing and submitted to the Training Director, who will notify the fellow of the complaint.  Per the procedures described above, the Training Director will call a meeting of the Training Committee to review the concerns, after providing notification to all involved parties.  All involved parties will be encouraged to submit any relevant information that bears on the issue and invited to attend the Training Committee meeting(s).

c.         In the case of illegal or unethical behavior in the performance of patient care duties, the Training Director will inform appropriate facility leadership, and may seek additional advisement from appropriate Medical Center resources, including the offices of Human Resources, Risk Management and/or District Counsel. 

d.         Following a careful review of the case, the Training Committee may recommend no action, probation, or dismissal of the fellow. Recommendation of a probationary period shall include the due process steps of notice, hearing and appeal described in the section above pertaining to insufficient competence.  A violation of the probationary contract would necessitate the termination of the fellow's appointment at VA Puget Sound. Ethical or legal infractions of a serious nature could necessitate immediate termination, consistent with facility HR policies.

The psychology staff at the Seattle VA is committed to excellence in patient care, research and training.  Our faculty actively pursue a variety of roles available to psychologists, and work to serve the larger profession and community by participating on Medical Center and University committees, VA Central Office committees, community boards, committees of the Washington State Psychological Association, and boards and committees of national professional organizations. 

The following psychologists provide education and training within our program.  Washington State requires that internship hours that count toward the interns’ eventual licensure must be provided by psychologists with two or more years of experience post-licensure. Psychologists who have not yet attained two-years of post-licensure experience are available to provide supervision beyond the minimum two hours of individual supervision received from more senior supervisors.  In our interprofessional setting, additional consultation and case supervision is easily obtained from professionals of other disciplines with expertise to offer.

Kelly Allred, PhD is a psychologist in the Intensive Outpatient Program (IOP) and serves as the Assistant Training Director of the Psychology Training Program. She received her PhD in Clinical Psychology from the University of Pennsylvania in 2018 under the mentorship of Dianne Chambless. She completed her internship training as well as a fellowship in Primary Care at the Seattle VA. Dr. Allred’s theoretical orientation is primarily cognitive behavioral with an emphasis on mindfulness-based interventions. Her graduate research focused on racial and ethnic differences in perceived criticism and other family factors that predict clinical outcomes. She has also contributed to research at VA Puget Sound examining the relationships among discrimination, social support, and suicide risk for transgender veterans. Dr. Allred has a strong interest in promoting diversity and multicultural competence among psychologists. She serves as Chair of the Psychology Training Program Diversity Committee. 

K. Chase Bailey, Ph.D., ABPP is a neuropsychologist on the Mental Health Neuropsychology Service. He received his doctoral degree in Counseling Psychology in 2015 from the University of Oklahoma. He then completed his internship at the VA North Texas Healthcare System in Dallas, TX. He went on to complete his fellowship training in San Antonio, TX in the South Texas Veterans Health Care System. While on fellowship, he received diverse training ranging from interprofessional team care for patients with severe TBI in a Polytrauma Rehabilitation center, to outpatient clinical and capacity evaluations in a diverse patient population. Dr. Bailey is licensed in the state of Texas and earned Board Certification in Clinical Neuropsychology through the American Board of Professional Psychology. His primary clinical responsibilities include conducting outpatient neuropsychological evaluations from a diverse range of referral sources. He utilizes collaborative therapeutic assessment paired with same day feedback to afford veterans a timely and personally relevant discussion around the brain behavior relationship. His current interests include extending the scope of neuropsychological practice through cross cultural neuropsychology, and interprofessional integration to improve the accuracy of localizing lesions and lateralizing language functioning in patients with epilepsy.   

Jennifer Bambara, PhD, ABPP is a Psychologist in the Rehabilitation Care Service and is the Director of the VA Puget Sound Center for Polytrauma Care. She also serves as Clinical Program Manager for the VISN 20 Polytrauma System of Care. She completed her doctorate in Clinical Psychology at the University of Alabama at Birmingham. Her Clinical Psychology internship was completed at VA Puget Sound, Seattle, and she completed a Rehabilitation Psychology fellowship at the University of Washington in the Department of Physical Medicine and Rehabilitation. She is licensed in the state of WA and earned board certification in Rehabilitation Psychology. Clinically, she provides neuropsychological assessment as well as individual and group psychotherapy to Veterans with a variety of medical conditions and physical injuries. Within the Polytrauma Clinic, this most often involves working with individuals with a history of traumatic brain injury, PTSD, sleep disturbance, and/or chronic pain. Commonly used interventions include CBT, ACT, BA, hypnosis for pain management, mindfulness for pain management, and cognitive skills training. Dr. Bambara is also engaged in research and quality improvement projects focused on enhancing the well-being of Veterans with a history of TBI. 

Charlotte Brill, PhD is a clinical psychologist in the Mental Health Clinic. Dr. Brill completed her doctorate in clinical psychology at the University of Washington, under the mentorship of Dr. Bill George. She completed clinical internship at the Durham VA and a postdoctoral fellowship focusing on PTSD recovery and Comprehensive DBT at the Seattle VA. Dr. Brill is strongly committed to trauma recovery and her primary clinical interest is in PTSD treatment, particularly among sexual assault survivors. She particularly enjoys PE and CPT and is VA certified in CPT after completing the CPT rollout during clinical internship. Dr. Brill is also part of the Comprehensive DBT Program. She also serves as the Psychiatry Resident Psychotherapy Training Coordinator. Dr. Brill is licensed in Washington State.

David Call, PhD is a clinical psychologist in the Mental Health Clinic. Dr. Call received his doctoral degree from Northern Illinois University under the mentorship of Dr. Holly Orcutt. He completed his internship training at Central Arkansas Veterans Healthcare System with an emphasis on serious mental illness, Veteran homelessness, and the treatment and assessment of PTSD in both residential and outpatient settings.  He completed postdoctoral training (PTSD/TBI Track) at the VA San Diego Healthcare System, where he was then hired as a staff psychologist (PSTD/SUD specialist at the ASPIRE CENTER) at a residential program for newly returning Veterans who were struggling with the impact of PTSD and insufficient housing on values-consistent living. His interests include the integration and evaluation of acceptance and mindfulness-based interventions within the context of evidence-based treatments for PTSD (CPT and PE), as well as depression and anxiety (CBT); anger management (ACT-based) and emotion dysregulation are further areas of clinical focus individually and in groups. Dr. Call is VA-certified in Cognitive Processing Therapy for PTSD, has completed comprehensive training and VA certification in Acceptance and Commitment Therapy for depression (ACT-D), and is a member of the Comprehensive DBT Program at the Seattle VA. Dr. Call also has an interest in supervision and professional development, with an emphasis on skills related to case conceptualization and comprehensive psycho-diagnostic assessment. 

Jason Chauv, PsyD is the psychologist in the Psychosocial Rehabilitation and Recovery Center (PRRC). Dr. Chauv completed his doctorate in Clinical Psychology at the University of La Verne. His graduate research experiences culminated in his dissertation exploring the relationship between various cultural factors and Chinese international students’ perceptions toward mental health services. He completed his internship at Loma Linda VA Medical Center followed by a Psychosocial Rehabilitation (PSR) fellowship at Palo Alto VA Medical Center. He is licensed in Washington State. Dr. Chauv’s clinical interests include psychosis, bipolar disorder, and related serious mental illnesses (SMI). He also focuses on the alleviation of mental health stigma and the implementation of the recovery model when working with Veterans and the interprofessional team.

Geoff Corner, PhD, MPH is a clinical psychologist in the Mental Health Clinic and the Couple and Family Program. He obtained his doctoral degree in Clinical Science from the University of Southern California under the mentorship of Drs. Gayla Margolin and Darby Saxbe. He completed his clinical internship and subsequent postdoctoral training at the Seattle VA. At USC, his research focused on how couples navigate loss and important life transitions, and he carries this interest into his clinical work with both individuals and couples. His background includes an emphasis on meaning and legacy, including their roles in coping with loss and life-limiting illnesses. He uses a variety of treatment approaches for individual and relational challenges, including ACT, CBT, IBCT, PE, and CPT. He recently completed a CPT rollout training offered through VA, and he has previously attended rollouts for IBCT and IPT. He has experience working with hoarding, excoriation, phobia, and social anxiety, and he has particular interest in working with older adult couples affected by health adversity. He created and co-facilitates groups in MHC and CFP focused on coping with grief and relationship skills, and he is a DBT skills class co-facilitator. He serves as the psychotherapy referral triage coordinator in MHC, and in this role, he assists in connecting Veterans with therapy resources throughout outpatient mental health and setting up Veterans for successful engagement in an episode of care.

Anja Cotton, PsyD is a psychologist in the Opioid Treatment Program (OTP) within the Addiction Treatment Center (ATC).  She received her PsyD in Clinical Psychology from Pacific University in 2000. She completed her internship In New York at the VA Hudson Valley followed by the CESATE Postdoctoral Fellowship in substance abuse treatment at the Seattle VA.   She is licensed in the state of Washington and is a Clinical Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington.  Dr. Cotton has VA national certification to provide CPT, PE, and Strength at Home (IPV) treatments and has pursued training and experience in non-VA therapies including MDMA Assisted Therapy for PTSD and Internal Family Systems psychotherapy. She has special interest in psychedelic assisted treatment, systems improvement, quality improvement, program development, and clinician work/life balance and self-care.  

Tory Durham, PhD is a clinical psychologist serving as the PTSD-SUD Specialist for the Seattle Division of the VA Puget Sound. In this role, she facilitates integrative care groups and provides individual therapy in both the PTSD Outpatient Clinic and the Addiction Treatment Center for veterans with co-occurring PTSD and substance use disorders. She also acts as a liaison between these two clinics. Dr. Durham received her PhD in Clinical Psychology from the University of Toledo in 2017. She completed her internship training at the VA Puget Sound, American Lake Division, and a two-year postdoctoral fellowship in the Center of Excellence for Substance Abuse Treatment and Education (CESATE) at the VA Puget Sound, Seattle Division. She is currently licensed in Washington state. Dr. Durham is a national VA consultant for Cognitive Processing Therapy (CPT) and is currently VA certified in CPT and Prolonged Exposure (PE) for PTSD. She is also trained to provide Concurrent Treatment for PTSD and SUD using PE (COPE); Exposure, Relaxation, and Rescripting Therapy for Military Veterans (ERRT-M), Written Exposure Therapy (WET), and a wide range of interventions for substance use disorders. She is committed to reducing stigma in mental health care and working with underserved populations.

Mark Engstrom, PhD is a psychologist in the Mental Health Clinic and is a Clinical Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. He completed his PhD in Clinical Psychology from the University of Illinois at Chicago in 2008, his internship at the Seattle VA in 2008, and his Postdoctoral Fellowship in Rehabilitation Psychology at the University of Washington in 2009. Early professional interests included community psychology, qualitative research, adjustment to disability, and the phenomenology of hope and posttraumatic growth in marginalized populations. Currently Dr. Engstrom has interests in the delivery of evidence-based treatments for PTSD, including Prolonged Exposure (PE), Cognitive Processing Therapy (CPT), and Adaptive Disclosure. He is also interested in transdiagnostic and integrative assessment and treatment approaches for heterogeneous outpatient populations. Additionally, Dr. Engstrom is a member of the Seattle VA’s Comprehensive DBT program and co-facilitates two DBT Skills groups. Dr. Engstrom is nationally certified within VA as a provider for CPT, PE, and individual and group-based CBT. Dr. Engstrom is licensed in the state of Washington.

Lisa Glynn, PhD (she/her) is a psychologist in the Pain Clinic. She received her PhD in Clinical Psychology from the University of New Mexico in 2013, under the mentorship of Dr. Theresa Moyers. She completed her internship at VA Palo Alto in 2013, followed by her postdoctoral training at Seattle VA’s Center of Excellence in Substance Abuse Treatment and Education (CESATE) in 2014. She is licensed in Washington. Dr. Glynn serves as the Program Manager of Pain Psychology for Seattle and American Lake. Previously, she co-developed the TelePain program, which expanded from VA Puget Sound to the rest of the Northwest region in 2018 and is now being used as the model for VA TelePain nationally. Her clinical work includes providing direct service to veterans with chronic pain and opioid-safety concerns. Dr. Glynn applies a client-centered approach to evidence-based motivational, behavioral, cognitive–behavioral, and mindfulness-based interventions. She also serves as the track lead for the Seattle VA Behavioral Medicine & Pain Psychology fellowship. Dr. Glynn participates in research, program development, quality improvement, provider training, workgroups and committees, and diversity/equity/inclusion activities. She serves as Co-PI of IMPROVE, a research trial of evidence-based group psychotherapies for chronic pain. Previously, her research has focused upon the process of Motivational Interviewing (MI) and Motivational Enhancement Therapy (MET) for substance use disorders and other health behaviors. She is a member of the Motivational Interviewing Network of Trainers, and also provides training and consultation to VA clinicians as a national lead trainer and subject-matter expert for the VA National MI/MET Training Program.

Melanie Harned, PhD, ABPP is a psychologist in the Mental Health Clinic and the Coordinator of the Dialectical Behavior Therapy (DBT) program. She is an Associate Professor in the Department of Psychiatry and Behavioral Sciences and an Adjunct Associate Professor in the Department of Psychology at the University of Washington. She is licensed in Washington state. She received her PhD in Clinical Psychology from the University of Illinois at Urbana-Champaign in 2002 and completed her psychology internship at McLean Hospital/Harvard Medical School. From 2004-2018, she worked at Dr. Marsha Linehan’s research clinic at the University of Washington first as a postdoctoral fellow and subsequently as the Director of Research.  She is the developer of the DBT Prolonged Exposure (DBT PE) protocol for PTSD and has received multiple NIMH and VA grants to evaluate this treatment in high-risk and multi-diagnostic patients. She has also received multiple NIH grants to develop and evaluate technology-based methods for disseminating and implementing evidence-based treatments into clinical practice. She is a certified DBT clinician, certified PE clinician and supervisor, and is ABPP certified in Cognitive and Behavioral Psychology. She regularly provides training and consultation nationally and internationally in DBT and DBT PE.

Eric Hawkins, PhD is Director of the Center of Excellence in Substance Addiction Treatment and Education (CESATE) and an investigator in both the CESATE and the Denver-Seattle Center of Innovation for Veteran-Centered and Value-Driven Care.  He is an Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington.  He received his PhD in Clinical Psychology from Brigham Young University.  He completed his doctoral internship at the Seattle VA. His postdoctoral training includes fellowships in the Interprofessional Treatment of Substance Abuse (CESATE) and Health Services Research, both at the Seattle VA.  He is licensed in Washington State.  His primary research responsibilities and interests include evaluating and improving behavioral health and substance use outcomes of patients with substance use conditions, including improving access to pharmacotherapies for the treatment of opioid use disorder.  Current projects include, evaluating the national VA implementation of the Stepped Care for Opioid Use Disorder Train-the-Trainer (SCOUTT) initiative and conducting a multisite hybrid 1 effectiveness-implementation trial to evaluate the combination of a mobile app for heavy drinking and medications for alcohol use disorder (MAUD) on improvements in drinking-related and mental health outcomes, relative to patients receiving MAUD only. 

Ryan Henderson, PhD is a psychologist in the Pain Service.  After completing his internship at the Salt Lake City VA, he received his PhD in Counseling Psychology from the University of Utah in 2010.  Dr. Henderson then completed a postdoctoral fellowship at the Seattle VA in the Center of Excellence in Substance Abuse Treatment and Education (CESATE).  He subsequently joined the pain service in 2012 and is currently licensed in the state of Washington. His research and clinical interests are primarily focused in the areas of assessment and treatment of chronic pain and addiction.  Dr. Henderson utilizes an integrative approach to treatment drawing heavily from interpersonal, cognitive-behavioral, and motivational enhancement approaches.  Dr. Henderson has also been certified by the VA in evidence based cognitive behavioral therapy for chronic pain and provides this treatment in both individual and group treatment settings.

Katherine Hoerster, PhD, MPH is a clinical psychologist in the PTSD Outpatient Clinic, a Core Investigator at the VA Puget Sound HSR Center of Innovation for Veteran-Centered and Value-Driven Care, and an Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. She completed a 5-year Health Services Research & Development (HSR&D) career development award (CDA; 12-263) focused on addressing co-morbid PTSD and obesity. She is now building on that work as a Principal Investigator (PI) of an HSR&D Merit-funded clinical trial (IIR18-230) testing a behavioral weight management program addressing weight loss barriers for Veterans with PTSD. She is also MPI of an HSR&D Merit-funded clinical trial (IIR 21-100; MPI Gray) testing a virtual peer health coaching intervention seeking to improve health related quality of life among Veterans with multimorbidity, as well as also being MPI (MPI Breland) on a mixed methods project funded through a Memorandum of Understanding with the National Center for Health Promotion and Disease Prevention (NCP) investigating disparities in weight management outcomes for Black Veterans. Lastly, Dr. Hoerster is PI of a facility seed grant-funded pilot study to assess acceptability and feasibility of HARPP, an integrated weight management and PTSD treatment for Veterans with PTSD and obesity.

Carl Kantner, PhD is a psychologist in the Addiction Treatment Center and Program Manager for the Co-occurring Recovery (CORE) Program. He earned his MA in religious studies and PhD in clinical psychology from Boston University. Dr. Kantner received clinical training at the Brockton VA Medical Center’s homeless domiciliary, and Boston University’s Center for Anxiety & Related Disorders (CARD) and Danielsen Institute. He completed internship in the Boston Consortium in Clinical Psychology at the VA Boston Healthcare System and postdoctoral training in the Seattle Division of VA Puget Sound Healthcare System CESATE fellowship. Dr. Kantner’s interests include mindfulness-based interventions; expanding substance use and co-occurring disorder treatment; integration of religion and spirituality in psychotherapy, and the role of implicit cognitive processes in health behaviors. Dr. Kantner’s training background in evidence-based treatments includes CPT, CBT-I, Strength at Home, VA CALM, MBRP and contingency management.

Andrea Katz, PhD is a psychologist in the Pain Clinic, working with the new Mental Health Integration – Pain Clinic (MHI-P) team to improve access to mental health care to Veterans in the Pain Clinic. Dr. Katz completed her doctorate in Clinical Psychology at the University of Illinois at Chicago in 2017, under the mentorship of Dr. Stewart Shankman. She completed her clinical internship and Specialty Medicine Psychology fellowship at VA Puget Sound, Seattle Division and has been on staff in the Pain Clinic since 2018. Her clinical interests focus on the interplay between mental and physical health conditions. Dr. Katz is licensed in the state of Washington and uses a biopsychosocial framework to provide evidence-based, patient-centered care to Veterans with chronic pain and related behavioral health concerns. She is a VA-certified provider of CBT for Chronic Pain and CBT for Insomnia. She serves on the Behavioral Medicine and Pain Psychology Fellowship Selection Committee and the Pain Clinic Employee Wellness and Engagement Committee. She also has an interest in quality improvement efforts and works on two projects within the Pain Clinic. 

Elizabeth Konichek, PhD is a psychologist in the Co-Occurring Recovery (CORE) program in the Addiction Treatment Center. She earned her doctorate at Palo Alto University in California in 2018. She completed her internship training at the Sheridan, Wyoming VA and enrolled in a fellowship program with an SMI emphasis before being hired in a staff position in Albuquerque, New Mexico. Elizabeth worked in both PRRC and Inpatient Mental Health Services in Albuquerque before moving to Seattle to work her current position in the CORE program. She is licensed in both New Mexico and the state of Washington. Her clinical interests include treatment of SMI populations, treatment of co-occurring SUD and MH disorders, and reduction of stigma in mental health treatment.  

Randi Lincoln, PhD, ABPP (RP) is a psychologist in the Spinal Cord Injury Service (SCIS).  She received her PhD in Clinical and Health Psychology, with a concentration in neuropsychology, at the University of Florida in 1999.  She completed a Geriatric Research and Education Clinical Center (GRECC)/neuropsychology internship and GRECC/neuropsychology postdoctoral fellowship at the North Florida South Georgia VA Medical Center. She provides clinical care and administrative program development in the SCI/D Program, with interests in posttraumatic growth and resiliency after injury, geropsychology, disability as diversity, sexual health, adaptation of evidence-based treatment and neuropsychological assessment to the disabled population, and chronic pain management in the rehabilitation setting. She is currently involved in research related to peer support in the spinal cord injury population. She is a VA certified provider of CPT. Dr. Lincoln currently serves as the Academy of Rehabilitation Psychology Treasurer and Conference manager, is a written practice sample examiner for the American Board of Rehabilitation Psychology and is an APA Psychology Internship site visitor. She is past Chair of the VA Puget Sound Psychology Professional Standards Board and past Acting Chair of the VA Puget Sound Psychology Credentialing and Privileging Committee.  She is a Clinical Assistant Professor in the Department of Rehabilitation Medicine at the University of Washington, is board certified in Rehabilitation Psychology, and is licensed as a psychologist in Washington.

Jane Luterek, PhD is a psychologist in the PTSD Outpatient Clinic and serves as the Women’s Mental Health Lead (Champion) at VA Puget Sound Health Care System. She is a Clinical Assistant Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington and is licensed in Washington State. She received her PhD in Clinical Psychology from Temple University in 2005, under the mentorship of Dr. Richard Heimberg. She completed her internship training and served as a research fellow in the Mental Illness Research, Education, and Clinical Center (MIRECC) at the Seattle VA. She is a VA National Consultant for Prolonged Exposure and Acceptance and Commitment Therapy (ACT) and is also a VA certified provider for Cognitive Processing Therapy. She has a strong interest in promoting equitable care for women Veterans, as well as evidence-based practices (e.g., PE, CPT, ACT, DBT, BA, ERRT) and principle driven approaches that serve Veterans with PTSD and comorbid conditions.

James Madole, PhD is a clinical psychologist in the Acute Inpatient Psychiatry (7West) unit. He completed his BA in Philosophy at New York University and a post-baccalaureate certificate in Psychology at the University of California, Berkeley. He received his PhD in Clinical Psychology from the University of Texas at Austin in 2023, after completing his internship at the VA Puget Sound, Seattle Division. Dr. Madole’s primary clinical interests are in the treatment of PTSD/SUD in individuals with medical and psychiatric comorbidities, suicide prevention, and CBT for psychosis. Dr. Madole is also passionate about clinical education and the dissemination of psychotherapeutic training to interprofessional healthcare providers. He is licensed in Washington State. 

Mary Jean Mariano, PhD is a psychologist in the Primary Care Women's Health Clinic and a Clinical Associate Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington. She is licensed as a psychologist in Washington. She received her PhD in Clinical Psychology from the University of New Mexico in 1988.  She completed her internship at the Seattle VA in 1984 and remained as a Health Services Research Fellow (1984-86) and worked as a Research Scientist at the University of Washington before joining the VA staff in 1990. Dr. Mariano has wide-ranging clinical experience, with past work in programs focusing on head injury rehabilitation, chronic pain, chronic mental illness, and trauma in women veterans. Her practice has focused primarily on women for many years, and she serves as the Seattle PCMHI representative on the Puget Sound VA’s Women’s Mental Health Consultation group and has membership on the VAPSHCS Women Veterans Committee.  She has served on a national VA expert panel on Primary Care MH Integration services for women veterans and continues to work with national leaders to develop programming and training in service of addressing the unique needs of women veterans in Primary Care MH Integration.   Dr. Mariano coordinates an interprofessional workgroup on perinatal services at Puget Sound VA and is certified in VA as a Reproductive MH specialist with specialized training in Interpersonal Therapy for Reproductive Mental Health.   Dr. Mariano has special interest in biopsychosocial models of health and illness, currently conceptualized in VA under the auspices of Whole Health and integrated care, including the connection of trauma exposure to chronic pain and other physical symptoms, and in the social and health systems factors that perpetuate or mitigate illness behavior and somatoform disorders. Dr. Mariano has a special interest in the care of gender non-conforming veterans, serves as a consultant to mental health providers regarding gender diversity issues, and is a member of the Puget Sound VA LGBT Consultation Workgroup.  In addition, Dr. Mariano is enthusiastic about group and individual psychotherapy based on an integration of theoretical models and incorporating evidence-informed care that recognizes the power of relationship factors in the therapeutic process.    

Steve McCutcheon, PhD is the Director of Internship and Postdoctoral Training.  He received his PhD in Clinical Psychology from the University of Washington, under the mentorship of Dr. Marsha Linehan. He completed his internship at the Seattle VA in 1982, and subsequently remained for a two-year fellowship in Health Services Research. He is licensed to practice in Washington and holds the rank of Clinical Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine. Dr. McCutcheon’s primary interests are in professional education program development and educational policy. In recognition of his education efforts, Dr. McCutcheon has received numerous national awards, including the 2020 APA Award for Distinguished Career Contributions to Education and Training in Psychology. Dr. McCutcheon is also active in governance of national professional organizations. Most notably, he served as Chair of the APPIC Board of Directors, as Chair of CCTC (Council of Chairs of Training Councils), as Chair of the VA Psychology Training Council (VAPTC), and as Chair of the APA Commission on Accreditation (CoA). He recently completed two terms as Associate Editor of APA’s Training and Education in Professional Psychology.

Megan Miller, PhD is a psychologist in the Rehabilitation Care Services. Dr. Miller received a dual degree in Clinical and Health Psychology at the University of Pittsburgh in 2018. She completed her internship and two-year fellowship in Rehabilitation Psychology at VA Puget Sound, Seattle Division. She is a licensed psychologist in the state of Washington. Her clinical interests center on the intersection of behavioral health, cognitive assessment, and physical rehabilitation. Her clinical work focuses on the Whole Health perspective as it pertains to those coping with functional changes related to ALS, MS, stroke, Parkinson’s disease, TBI and other chronic medical problems. Her clinical approach blends several interventions (CBT, ACT, IPT) along with neuropsychological assessment to inform treatment approaches and interdisciplinary team interactions.  Dr. Miller also has interests in program development and research in sleep improvement in both inpatient and outpatient settings. 

Hallie Nuzum, PhD is a Clinical Geropsychologist in Geriatrics and Extended Care, dividing her time between the Community Living Center (CLC) and Hospice & Palliative Care (HPC) teams. She completed her PhD in Clinical Psychology at the University of Notre Dame and is licensed in Washington state. Dr. Nuzum completed her internship with an emphasis in Geropsychology at the West Los Angeles VAMC in 2019, and postdoctoral fellowship in Geropsychology at VA Palo Alto in 2020. Dr. Nuzum’s clinical interests include adapting empirically supported treatments to promote functioning and quality of life for older Veterans, particularly in the context of chronic and/or life-limiting medical illness, cognitive decline, and disability. She is VA-certified in ACT and Resources for Enhancing All Caregivers’ Health (Reach VA). She is additionally trained as a Unit-Based Ethics Conversation (UBEC) facilitator. She is involved with QI projects on CLC antipsychotic use, suicide risk assessment, behavior management, and staff education/support.

Kaitlin Ohde, PhD is a clinical health psychologist in Transplant Psychology / Bone Marrow Transplant Unit. Her primary clinical interests and expertise include behavioral medicine, resiliency, oncology, medical illness, chronic pain, and consultation.  Her previous positions include Primary Care – Mental Health Integration (PCMHI) and the Women’s Clinic at the Seattle VA, where she served as the section group psychotherapy coordinator for PCMHI and was involved in several quality improvement projects aimed at improving Veteran access to care. Dr. Ohde earned her PhD in Counseling Psychology at the University of Northern Colorado in 2020. She completed her internship at the Salt Lake City VA Health Care System (2019-2020) and a post-doctoral fellowship in behavioral medicine and specialty pain clinic at the VA Puget Sound, Seattle Division (2020-2021). She is a licensed psychologist in the state of Washington. Dr. Ohde’s treatment approach focuses on acceptance based (ACT) and cognitive behavioral approaches to promote behavior change and resilience in patients managing cancer diagnoses and chronic health conditions. She has VA national certification to provide Cognitive Processing Therapy (CPT) and Cognitive Behavioral Therapy for Chronic Pain (CBT-CP).   

Andy Paves, PhD is a psychologist in Primary Care Mental Health Integration (PCMHI). He completed his doctoral degree in Clinical Psychology from the University of Washington in 2016, under the mentorship of Dr. Mary Larimer. He completed his internship at the Southwest Consortium in Albuquerque, New Mexico (VA New Mexico Health Care System and Albuquerque Indian Health Service). Following this, he completed a postdoctoral fellowship in Integrated Care at the Honolulu VA. Prior to joining the staff at the Seattle VA, he was Psychologist in PCMHI at the Bremerton Community-based Outpatient Clinic. Dr. Paves is licensed in the state of Washington. He has had advanced training in behavioral medicine, Motivational Interviewing, Behavioral Activation, Mindfulness-based interventions, and Functional Analytic Psychotherapy (FAP). He is a VA certified provider in CBT for Insomnia (CBT-I) and Cognitive Processing Therapy and has also completed VA training and consultation in Prolonged Exposure for Primary Care, and CBT for chronic pain. He has general interests in improving access to care and providing culturally relevant, evidence-based treatment to underserved populations. He previously served on the Executive Committees for the Asian American Psychological Association (AAPA) and its Division on Filipino Americans. He also co-facilitates a bi-monthly open forum for mental health staff to discuss issues related to diversity.

David Pressman, PhD is the Team Leader of the PTSD Outpatient Clinic (POC). He received his PhD in Clinical Psychology from Columbia University-Teachers College in 2007. He completed his internship at Montefiore Medical Center in the Bronx.  Prior to arriving at the VA, Dr. Pressman worked at Madigan Army Medical Center on Joint Base Lewis-McChord. Dr. Pressman previously served at the PTSD-SUD Specialist for the Seattle Division of VA Puget Sound. He is a licensed psychologist in the State of Washington.

Greg Reger, PhD is the Deputy Associate Chief of Staff for Mental Health, at VA Puget Sound, and a Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington.  He received his PhD in Clinical Psychology from Fuller Theological Seminary in 2004 and completed his psychology internship at Walter Reed Army Medical Center. He is an Army Veteran and deployed to Iraq in support of Operation Iraqi Freedom in 2005 where he served in the 98th Combat Stress Control Detachment. Dr. Reger spent five years as a civilian with the Department of Defense leading teams in the design and evaluation of technology to support psychological health.  His research is focused on the development and evaluation of virtual reality, mobile applications, virtual standardized patients, and other innovative technologies for psychological purposes.  Dr. Reger led the VA/DoD team that designed the original PE Coach mobile application, and he is funded to conduct an RCT to evaluate the impact of the application on clinically relevant outcomes during prolonged exposure for PTSD. His team is also funded to design and evaluate a virtual standardized patient to train suicide safety planning.

Tracy Simpson, PhD is a Clinician Investigator in the Center of Excellence in Substance Abuse Treatment and Education (CESATE). She assumed directorship of the Seattle Mental Illness Research, Education and Clinical Center (MIRECC) fellowship program in the fall of 2008 and has been a member of the VA Puget Sound R&D Committee since 2013.  She received her PhD in Clinical Psychology from the University of New Mexico in 1999, under the mentorship of Dr. William Miller.  She completed her internship at the University of Washington in 1998 and completed a postdoctoral fellowship under the mentorship of Dr. Alan Marlatt at the University of Washington in 2000. She is a Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington and is licensed in the State of Washington. Dr. Simpson’s current primary responsibilities are conducting research and mentoring; additionally, she devotes half a day a week to clinical work providing treatment for women veterans through the Addiction Treatment Center’s General Team and the PTSD Outpatient Clinic. She currently has a grant from VA HSR&D (a longitudinal study of LGBT and heterosexual Veterans’ health risk behaviors and treatment receipt) and VA RR&D (an RCT evaluating MBSR, a comprehensive behavioral pain intervention, and treatment as usual for Veterans with chronic pain). She has datasets from RCTs pertaining to behavioral interventions for individuals with comorbid PTSD and an alcohol use disorder (or AUD without PTSD) and those data are available for secondary analyses. Dr. Simpson has a large survey study in progress that is collecting data from women Veterans enrolled in VHA with indicators of current substance use disorder (SUD; cohort 1) and past SUD (Cohort 2). The survey study is complemented by a qualitative “Think Aloud” component that is collecting feedback from a subset of the women Veterans along with clinicians on the VA’s VetChange web-based intervention for combat Veterans with hazardous drinking and PTSD symptoms to inform future gender-tailoring of the intervention. She is also currently interested in better understanding patterns of treatment receipt for Veterans and civilians with substance use disorders, including what patient characteristics predict who gets SUD care in what types of settings and via what sort of delivery platforms. In addition, Dr. Simpson is an active contributor to both Veteran-facing and Clinician-facing educational materials pertaining to the continuum of alcohol and drug involvement.

M. Jan Tackett, PhD, ABPP is a psychologist in the Spinal Cord Injury Service (SCIS).  He received his PhD in Counseling Psychology from the University of Denver in 1998, after completing his internship at the Seattle VA in 1997.  He provides assessment, rehabilitation, education, and counseling for inpatient and outpatients with spinal cord injuries. Dr. Tackett is a Clinical Assistant Professor in the Department of Rehabilitation Medicine at the University of Washington. His interests include co-morbid SCI/TBI, suicide prevention, clinical supervision, psychology specialization and advanced training as well as ethical decision-making. He is licensed in the State of Washington and provides ethics consultations as a member of the VA Puget Sound Ethics Consultation Service. He is currently President of the American Board of Rehabilitation Psychology and Secretary/Treasurer of the Council of Rehabilitation Psychology Postdoctoral Training Programs and serves on the Board of the Academy of Rehabilitation Psychology as well as the Council of Rehabilitation Psychology. He has received the APA Division 22 Mentoring Award. 

Emily Trittschuh, PhD is a Clinical Neuropsychologist and the Associate Director of Education and Evaluation (ADEE) with the Geriatrics Research, Education, and Clinical Center (GRECC), a Center for Excellence at the VA Puget Sound Health Care System. She is also a Professor with the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine. Dr. Trittschuh completed her PhD in Clinical Psychology at Northwestern University after her internship at Brown University. She completed a two-year T32 postdoctoral fellowship in neurobehavior and structural/functional MRI at Northwestern University. Dr. Trittschuh’s primary clinical interest is the early diagnosis of neurodegenerative disease. Her research has focused on the prevalence/incidence of Mild Cognitive Impairment and dementia in aging and she’s a co-investigator for the Adult Changes in Thought (ACT) U19 study. She also is involved with the harmonization of cognitive data across national and international studies, work which can permit GWAS studies of AD phenotypes to better understand resilience and other factors that might be related to disease genesis and potential treatments. She has led GRECC Clinical Demonstration projects focused on Healthy Brain Aging, Telehealth Neuropsychology Services, and Memory Skills training with older veterans with PTSD. Supervision and mentorship are special foci; she mentors trainees across disciplines and at different stages of career development. She is a member of numerous national, regional, and local committees, including the VA national GRECC Connect (hub site director), Chair of the GRECC national Aging and Cognition Education (ACE) workgroup, member of the VISN 20 Dementia committee, the UW/VA Academic Affairs Committee, the Society for Clinical Neuropsychology’s PIAC Ethics committee, UW Dept of Psychiatry’s Promotion committee, and was a foundation steering member and member-at-large for the Queer Neuropsychological Society (QNS). She’s a past president of the Pacific Northwest Neuropsychological Society. She is a licensed psychologist in the states of Illinois and Washington.

Aaron Turner, PhD, ABPP (RP) is Director of Rehabilitation Psychology in the Rehabilitation Care Service. He received his PhD in Clinical Psychology from the University of Washington in 2001, after completing his internship at the University of Washington Department of Psychiatry and Behavioral Sciences. He is licensed in Washington and is a Professor in the Department of Rehabilitation Medicine at the University of Washington.  Dr. Turner serves as the Associate Director of Research for the VA Multiple Sclerosis Center of Excellence, is an affiliate investigator in the Center of Excellence in Substance Abuse Treatment and Education (CESATE), and the VA Center for Limb Loss and MoBility (CLimB).  He is the Rehabilitation track lead for the fellowship program and serves as the attending psychologist of the Inpatient Rehabilitation Program.  Current and recent VA Merit Review research programs include RCTs of a group-based self-management program to improve physical and psychosocial health following limb loss (PI) and MS (Site PI), an NIH-funded RCT comparing three group-based treatments for chronic pain in veterans (hypnosis, meditation, and self-management) (Co-I), three studies examining longitudinal outcomes following amputation (co-I), and three studies examining shared decision making for amputation (co-I) and a VA Merit Review examining functional outcomes following COVID (Co-PI).  He is also the PI of a National MS Society Postdoctoral Training Grant in Rehabilitation Research.   Dr. Turner is a fellow of APA Divisions 18 and 22 and the recipient of the Early Career Practice as well as Rosenthal Early Career Research Awards from APA Division 22 (Rehabilitation Psychology), and the Outstanding Researcher Award from APA Division 18 (Psychologists in Public Service).  Additional clinical and research interests include depression, exercise, medication adherence, pain, and health behaviors in rehabilitation populations.

Rhonda Williams, PhD, ABPP (RP) is a psychologist in the Rehabilitation Care Service and Center for Polytrauma Care. Dr. Williams is a Professor in the Department of Rehabilitation Medicine at the University of Washington; she is licensed in the State of Washington. She received her PhD in Clinical Psychology from Arizona State University in 1999, after completing her internship with an emphasis in Rehabilitation Psychology at the University of Washington. She subsequently completed a postdoctoral fellowship in Rehabilitation Psychology at Harborview Medical Center in 2000. Dr. Williams earned American Board of Professional Psychology certification in 2009. She provides neuropsychological assessment and individual and group psychotherapy to veterans with a variety of medical conditions and physical injuries, especially traumatic brain injury, PTSD, and pain. Her research interests center around conducting clinical trials of behavioral interventions, such as treatments for chronic pain and cognitive rehabilitation. Dr. Williams devotes equal time to clinical and research activities. She has been a PI or CO-I on over 28 funded projects, including 14 clinical trials. Dr. Williams is currently the Co-PI on an NIH funded study of moderators of treatment response to 3 interventions for chronic pain (i.e., Hypnotic Cognitive Therapy, Mindfulness-Based Cognitive Therapy, and CBT). She is also the Site PI on a DOD study of a novel intervention to improve engagement in treatment among post-911 Veterans with concussions. This intervention, called “ON-TRACC”, combines cognitive rehabilitation and self-management skills, and is being delivered within the context of usual care in the Polytrauma program.

Samantha Yard, PhD is a Clinical Psychologist providing clinical care and supervision within the Intensive Outpatient Program and the Dialectical Behavior Therapy (DBT) Program. Dr. Yard received her BA in Psychology at Wesleyan University, and her PhD in Clinical Psychology from the University of Washington under the mentorship of Dr. Jane Simoni. Her dissertation investigated a model of health risk behavior among incarcerated women, which was supported by a 5-year NIMH NRSA fellowship. She was also the recipient of the 2014 APA Division 18 Outstanding Student Award. She completed internship and postdoctoral training at VA Puget Sound, Seattle, serving as an Advanced Fellow in PTSD within the Mental Illness Research Education and Clinical Center (MIRECC), and received the APA Division 18 Outstanding Psychology Trainee Award. Dr. Yard is licensed in Washington State and has particular expertise in empirically supported behavioral therapies including DBT, Prolonged Exposure, ACT, and Functional Analytic Psychotherapy. Her other interests include program implementation and training, and she was the recipient of the VA Puget Sound Award for Exceptional Supervision, Mentorship, and Training in 2021.

Evan Zahniser, PhD, ABPP is a neuropsychologist on the Mental Health Neuropsychology Service. He earned his doctorate in clinical psychology from Loyola University in Chicago, IL and completed his clinical internship at the West Los Angeles VA Medical Center (Geropsychology track). He went on to complete a postdoctoral fellowship in clinical neuropsychology at the VA Puget Sound Healthcare System, American Lake Division. In addition to providing generalist neuropsychological services for patients referred from across VA Puget Sound, Dr. Zahniser is a member of the Geriatric Mental Health team, an interdisciplinary group of providers offering specialty services for older adult patients in Outpatient Mental Health. Primary professional interests include cognitive aging, dementia and neurodegenerative disease, positive neuropsychology, streamlining neuropsychological practice to meet the needs of interprofessional medical settings, and enhancing patient outcomes following neuropsychology feedback. Dr. Zahniser is licensed in Washington State and board certified in clinical neuropsychology by the American Board of Professional Psychology (ABPP).