1 CURRICULUM VITAE Name: Scott Ortiz Burkhart, Psy.D. Work Address: 3334 Capital Medical Blvd. Suite #400 Tallahassee, FL Work Work Phone #: (850) x2528 Date Updated: January, 2014 Current Employment: 2013-Present Tallahassee Orthopedic Clinic (TOC), Tallahassee, FL TOC Regional Concussion Program Position: Clinical Director/Licensed Neuropsychologist Responsibilities: Provide concussion education, treatment, and management to professional, amateur, and student-athletes throughout the Tallahassee area and southeast region. Baseline assessment and training Present Florida State University, Tallahassee, FL Sports Medicine and Athletics Department Position: Team Neuropsychologist Responsibilities: On-field and clinical assessment, treatment, and management for concussion injuries. Education for studentathletes, sports medicine staff, and coaches regarding concussion injuries within the context of collegiate athletics. Consultation with sports-medicine providers and team physicians regarding best practices for assessment, treatment, and management of concussion injuries sustained within the context of collegiate athletics.
2 Education: George Fox University, Newberg, OR, Clinical Psychology School of Behavioral Health and Sciences Degrees Completed: M.A. Counseling, Completed 2008, Psy.D. Clinical Psychology, Completed Academic Advisors: Wayne V. Adams, Ph.D., ABPP/CL, Mary Peterson, Ph.D., & William Buhrow, Psy.D., Doctoral Dissertation: Using Short-Term Memory Measures to Assess Long-Term Memory in Early-Stage Alzheimer s Disease. Dissertation Chair: Wayne V. Adams, Ph.D., ABPP/CL George Fox University, Newberg, OR, Psychology Undergraduate Department of Psychology Degrees Completed: B.S. Psychology, Completed 2004 Academic Advisors: Chris Koch, Ph.D., Sarah Hopkins, Psy.D., & Sue O Donnell, Ph.D. Clinical Experience: University of Pittsburgh Medical Center, Pittsburgh PA UPMC Sports Concussion Program Department of Orthopedic Surgery and Sports Medicine Position: Neuropsychology Fellow Experience: Pediatric Sports Neuropsychology, Adult Sports Neuropsychology, mtbi, Concussion, Forensic Neuropsychology. Primary Supervisor: Michael W. Collins Ph.D. Other Supervisors: Jamie Pardini, Ph.D., Vanessa Fazio, Ph.D., Eric W. Johnson, Psy.D., Nathan Kegel, Ph.D., Jonathan French, Psy.D., & Erin Reynolds, Psy.D.
3 Tewksbury Hospital, Tewksbury MA Department of Public Health Position: Clinical Psychology Intern Experience: Adult Neuropsychology (Traumatic Brain Injury, Huntington s Disease [HD], & Organic Brain Injury); Health Psychology/Primary Care (Co-morbid Medical/Psychological Diagnoses including; HIV, COPD, Eating Disorders, Anxiety Disorders, Trauma/PTSD, Severe Mental Illness & Geropsychology); Substance Abuse (Co-morbid Substance Abuse/Psychological Disorders). Groups: Cognitive Rehabilitation, Substance Abuse, HD Support Supervisors: Tanya Pospisil, Ph.D., Paul A. Spiers, Ph.D., Harvey Pinsky, Ph.D., & Bette Ippolito Ph.D Childpeace Montessori School, Portland, OR Position: Academic Assessment Consultant Experience: Psychological Assessment (K-12 student evaluations including; ADHD, Learning Disabilities, & Behavioral Disorders). Supervisor: Lane DeWan, Psy.D Providence Medical Clinic, Sherwood, OR Position: Interdisciplinary Behavioral Health Practicum Student Experience: Primary Care Individual Therapy (Adult and Child diagnoses including; Anxiety & Depression Disorders, Trauma/PTSD, Substance Abuse, Chronic Pain, COPD, Obesity, Diabetes Management, ADHD, & Child Behavioral Disorders) Individual Assessment (ADHD, & Learning Disabilities). Motivational Interviewing theoretical approach to treatment. Groups: Pediatric Healthy Eating Supervisor: Mary Peterson, Ph.D.
4 Providence Medical Center, Newberg, OR Emergency Medicine Department Position: Interdisciplinary Behavioral Health Consultant Experience: Emergency Room Risk Assessment Consultant (Risk Assessments including; Severe Mental Illness, Substance Abuse, Suicidal Behavior, Homicidal Behavior, Trauma, & Chronic Pain). Supervisors: Mary Peterson, Ph.D., Joel Gregor, Psy.D., William Buhrow, Psy.D., & Sarah Hopkins, Psy.D Roseburg Veterans Affairs Hospital, Eugene, OR Department of Psychology Position: Psychology Practicum Student Experience: Individual Therapy (Adult diagnoses including; Trauma/PTSD, Anxiety & Depression Disorders, HIV, Substance Abuse, Physical Disabilities, & Couples Counseling) Individual Assessment (Neuropsychological assessment including; TBI, Dementia, Competency, & Disability). Groups: PTSD Support, PTSD Psycho-education, Caregiver Support, Substance Abuse Support) Supervisor: Rex Turner, Ph.D Clark County Juvenile Court, Vancouver, WA Mental Health and Psychological Services Department Position: Psychology Practicum Student Experience: Individual Therapy (Childhood diagnoses including; Anxiety & Depression disorders, Trauma/PTSD, Childhood Behavioral disorders, & Sexual Abuse) Individual Assessment (Forensic, Learning Disabilities, Behavioral disorders, & ADHD). Pediatric and Adolescent Treatment. Groups: DBT, Substance Abuse Supervisors: Shirley Shen, Ph.D. & Christine Krause, Psy.D.
5 Academic Appointments: George Fox University, Newberg, OR School of Behavioral Health and Sciences Course: Projective Assessment Position: Teaching Assistant Experience: Lecture preparation, grading/scoring, guest lecturing, & general classroom assistance. Course Supervisor: Nancy Thurston, Ph.D. Leadership Appointments: Providence Newberg Hospital, Newberg, OR School of Behavioral Health and Sciences Position: Student Consultation Coordinator Experience: Training, Education, Scheduling, Accountability of Team Members, & Conflict Resolution. Student management of interdisciplinary mental health team providing consultation services to a local Emergency Department. Supervisor: Mary Peterson, Ph.D George Fox University, Newberg, OR School of Behavioral Health and Sciences Position: Student Orientation Leader Experience: Orient and acclimate new students to graduate program, Scheduling, & Event planning. Management and leadership of a student orientation team consisting of graduate students, graduate department staff and administration, and graduate faculty. Supervisor: Wayne V. Adams, Ph.D., ABPP/CL
6 Professional Societies: 2013-Present 2011-Present 2011-Present 2007-Present 2006-Present Florida Psychological Association Sports Neuropsychology Society International Neuropsychology Society National Academy of Neuropsychology American Psychological Association Awards and Honors: 2003 Richter Undergraduate Research Award 2002 Richter Undergraduate Research Award Previous Employment Related to Professional Work: Silverton Hospital, Silverton, OR Position: Psychological Consultant Experience: Seminars and workshops to hospital departments on topics including; team building, trust, goal-setting, suicide postvention, and conflict resolution Chehalem Youth and Family Services, Newberg, OR Position: Case Manager Experience: Manage discharge, daily activities, academic performance, family relationships, & treatment of 3 adolescent females residing in a residential treatment setting Newberg High School, Newberg, OR Student Services Department Position: Behavioral Educational Assistant Experience: Classroom assistance for behavioral special education with adolescents placed on IEP and 504 accommodations for behavioral issues.
7 Community Service Related to Professional Work: Silverton Hospital, Silverton, OR Position: Psychology Consultant Experience: Consultation on mental health issues with an emphasis on nurse education and department team building Performance Training Center, Beaverton, OR Position: Volunteer Sports Psychology Consultant Experience: Development of psychological measures and interventions, observation techniques, and multiple site visits to develop protocols to measure psychological response related to athletic performance. Contact: Mark McLaughlin, Founder/Development Coach Bridlemile Soccer Club, Portland, OR Position: Volunteer Sports Psychology Consultant Experience: Individual and team psychological monitoring of youth athletes related to individual performance, goal setting, and group dynamics. Contact: Scott Thompson, Director of Operations & Coaching Local Teaching: Undergraduate Psychology Students 2013-Present Florida State University, Tallahassee, FL Guest Lecturer on Sports-Concussion. 30+ Athletic Training and Sports Medicine students, 4-8 hours per semester Simmons College, Boston, MA. Guest Lecturer on Risk Assessment undergraduate students 6-8 hours per semester.
8 Local Teaching: Graduate Psychology Students George Fox University, Tigard, OR. Guest Lecturer in Research and Statistics, Various Lecture topics Master s level Counseling students, 8-10 hours per semester. Local Teaching: Invited Teaching Presentations UPMC Current Issues in Athletic Training Conference 2012 Invited Lecturer. Current Issues in Concussion UPMC Center for Sports Medicine, Pittsburgh, PA Nov Aug Providence Newberg Medical Center, Nurse Education Seminar. Invited Lecturer. Recognizing Abuse; Domestic, Child, Elder, and Horizontal Violence Providence Newberg Medical Center, Newberg, OR Silverton Hospital, Nursing Education Seminar. Invited Lecturer. Horizontal Violence in the Medical Setting Silverton Hospital, Silverton, OR. Research Publications Shunk, A.W., Coppel, D.B., Elbin, R.J., Henry, L., Burkhart, S., & Kontos, A.K. (2014). The role of the sports-psychologist in sport-related concussion; From awareness to management. [In Press]. Covassin, T., Elbin, R.J., Crutcher, B., & Burkhart, S. (2013). The management of sportsrelated concussion: considerations for male and female athletes. Transl. Stroke Research. Aug;4(4): Kontos A.P., Elbin, R.J., Fazio, V., Burkhart, S., Swindell, H., Maroon, J., & Collins, M.W. (2013). Risk of sport-related concussion among youth football players aged 8-12 years. Journal of Pediatrics. Sep;163(3): Elbin, R.J., Fazio, V., Burkhart, S., Henry, L. & Kontos, A.P. (2013). Individual and combined effects of LD and ADHD on computerized neurocognitive concussion test performance. Archives of Clinical Neuropsychology. Aug;28(5):
9 Cline, A., Henry, L., Burkhart, S., Fazio, V., Elbin, R.J. (2013).A preliminary investigation of post-concussion neurocognitive performance and symptoms in patients with and without a history of migraine. Pittsburgh Orthopaedic Journal. Burkhart, S., Elbin, R.J., Dakan, S., Wedge, J., Johnson, E., Kontos, A.P. (2013). Selfreported location of injury following concussion: does location matter? Pittsburgh Orthopaedic Journal. Kontos, A.P., Elbin, R. J., Burkhart, S., & Collins, M.W. (2012). Incidence and neurocognitive effects of concussion in youth (8-12 yrs) American football: A prospective study. Medicine & Science in Sport & Exercise; 2012; 44(5), S265. Covassin, T., Elbin, R., Crutcher, B., Burkhart,S., Kontos, A. (2012). The relationship between coping, neurocognitive performance, and concussion symptoms in high school and collegiate athletes. The Sport Psychologist. Burkhart, S., French, J., Henry, L., Collins, M.W., & Kontos, A. P. (2012). Diffuse axonal injury in an athlete following concussion: A case study. Pittsburgh Orthopedic Journal. Kontos, A.P., Burkhart, S., Elbin, R.J., Johnson, E., Collins, M.W., & Lovell, M.R. (2012). Comparison of athletes with LD and ADHD to those without on computerized neurocognitive concussion test performance. Pittsburgh Orthopedic Journal. Elbin, R.J., Burkhart, S., Fazio, V., Fanelli, L., Kegel, N., & Kontos, A.P. (2012). Prospective study of the neurocognitive effects of concussion among youth football. Pittsburgh Orthopedic Journal. Published Abstracts & Posters Covassin, T., Elbin, R., Crutcher, B., Burkhart,S., Kontos, A. The relationship between coping, neurocognitive performance, and concussion symptoms in high school and collegiate athletes. Poster presented at National Athletic Trainers Association Conference, Las Vegas, NV, June Proceedings published in Journal of Athletic Training. French JE, Henry LC, Burkhart S., Collins MW, Elbin RJ, & Kontos AP (2013, February). New Normative Data for Subtests from a Computerized Neurocognitive Concussion Test among Athletes Aged Years. Poster presented at Big Sky Athletic Training Conference, Big Sky, MT. Knox, J., Elbin, R.J., Kegel, N., French, J., Burkhart, S., Kontos, A.P. (2012, October). A comparison of patient, parent, and clinician post-concussion symptom reports. Poster
10 presented at the 2012 Dean s Summer Research Project Symposium and Poster Session, Pittsburgh, PA. Kontos, A. P., Elbin, R.J., Burkhart, S., & Fazio, V. Incidence and neurocognitive effects on concussion in youth (8-12 yrs) American football: A prospective study. Poster presented at the American College of Sports Medicine, Annual Conference San Francisco, CA. Poster Session, June, Burkhart, S., Adams, W. A., & Frise, N. Using short-term measures to assess long-term memory in early-stage Alzheimer s disease. Poster presented at the National Academy of Neuropsychology, Annual Conference Marcos Islands, FL. Poster Session B, November, 2011.
Curriculum Vitae Saint Joseph s University Psychology 222 Post Hall Philadelphia, PA 19131 (610) 660-1804 http://schatz.sju.edu/ e-mail: email@example.com Philip Schatz Academic Preparation: Ph.D. Clinical
Vitae 2014 Pg. 1 ANNA G. ESCAMILLA, PH.D., LCSW 10120 Spicewood Mesa Austin, Texas 78759 (512) 448-8642 or (512) 771-6849 Degrees Held: A.A. Del Mar Junior College, Corpus Christi, Texas 5/70 B.A. University
Page%1%of%18% CURRICULUM VITA Rosemarie Scolaro Moser, Ph.D. 3131 Princeton Pike, Bldg. 5, Suite 110 20 Nassau Street, Suite 318 Lawrenceville, New Jersey 08648 Princeton, New Jersey 08542 (609) 895-1070
JACKSON MEMORIAL HOSPITAL In Affiliation with the University of Miami Leonard M. Miller School of Medicine Psychology Post-Doctoral Fellowship Program 2014-2015 GENERAL INFORMATION Jackson Memorial Hospital
Lakeview Specialty Hospital and Rehabilitation Center CLINICAL PSYCHOLOGY DOCTORAL INTERNSHIP 2014-2015 APPIC NMS Program #: 1916-11 Page 1 of 19 TRAINING MISSION Lakeview Internship Manual The major goal
MANUEL DAVID TOBIAS, Ph.D. 9255 Town Centre Dr. Suite 875 San Diego, California 92121 Phone 858-362-8779 Fax-858-455-5556 PROFESSIONAL EXPERIENCE Qualified Medical Examiner- State of California, Division
MARIE-CHRISTINE RUTTER GOODWORTH 1 Marie-Christine Rutter Goodworth, Ph.D. George Fox University Graduate Department of Clinical Psychology 414 N Meridian St V104 Newberg, OR 97132 firstname.lastname@example.org
PRE-DOCTORAL INTERNSHIP IN CLINICAL PSYCHOLOGY RUSK INSTITUTE OF REHABILITATION MEDICINE NEW YORK UNIVERSITY LANGONE MEDICAL CENTER Address correspondence to: Robert M. Gordon, Psy.D. Director of Intern
Jay Matthew Uomoto, M.A., Ph.D. Revised October 2005 Current Titles and Affiliation Academic Position Clinical Position Birth Date and Place Citizenship Office Address Professor, Department of Graduate
CRAIG R. LAREAU, J.D., PH.D., ABPP Hospital Address: Private Practice Address: Patton State Hospital 713 W. Duarte Ave., #G-533 Department of Psychology Arcadia, CA 91007 3102 E. Highland Ave. Phone: (626)
Curriculum Vitae January 2015 KATHY ZEBRACKI (JEFSON), Ph.D. Education: 1996-2000 B.S. Northwestern University (Human Development and Psychological Services) Honors Thesis Chairs: Dan Lewis, Ph.D. & Marion
DEPARTMENT OF VETERANS AFFAIRS VA Medical Center 5201 Raymond Street Orlando, FL 32803 PSYCHOLOGY INTERNSHIP PROGRAM Jason Steward, Ph.D. Director of Training, Psychology (407) 518-5004 email@example.com
UNIVERSITY OF CALIFORNIA BERKELEY SOCIAL WELFARE DOCTORAL PROGRAM 120 Haviland Hall #7400 510-912-8038 Berkeley, CA 94720 firstname.lastname@example.org Sarah Accomazzo EDUCATION Ph.D. University of California,
WELLSPAN BEHAVIORAL HEALTH DOCTORAL INTERNSHIP PROGRAM IN CLINICAL PSYCHOLOGY 2014-2015 Site Training Manual WellSpan Behavioral Health 1600 South George Street York, PA 17403 Tel.: 717-812-4200 WellSpan
CURRICULUM VITAE Jacqueline DeMichele Kloss, Ph.D. EDUCATION University of Pennsylvania Postdoctoral Fellowship/Traineeship Department of Psychiatry 1998-2001 (concurrent with Assistant Professor position
Nova Southeastern University Center for Psychological Studies 2014 2015 Catalog Nova Southeastern University is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools
PAUL M. DEUTSCH, PH.D., C.R.C., C.C.M.,CLCP, FIALCP Licensed Mental Health Counselor, (FL. MH#0000117) Certified Rehabilitation Counselor Certified Case Manager Certified Life Care Planner Fellow of the
CLINICAL PSYCHOLOGY INTERNSHIP PROGRAM Western Psychiatric Institute and Clinic (WPIC), part of the University Pittsburgh Medical Center (UPMC), and the Department of Psychiatry at the University of Pittsburgh
Center for Psychological Studies Master s Program in General Psychology Policies and Procedures Handbook 2011-2012 *Supplemental to Policy and Procedure Handbook at http://www.nova.edu/cwis/studentaffairs/forms/ustudenthandbook.pdf
Derryck H Smith, M.D. F.R.C.P. (C) m EDUCATION 1. University of Waterloo, Waterloo, Ontario B.Sc. Chemistry 1970 2. University of Western Ontario, London, Ontario Medical Doctor 1974 3. Internship: Ottawa
Updated October 20, 2014 Hunter Holmes McGuire VA Medical Center, Richmond, Virginia REHABILITATION PSYCHOLOGY POSTDOCTORAL FELLOWSHIP PROGRAM Accreditation Status The Rehabilitation Psychology Postdoctoral
STATE OF NEW JERSEY DEPARTMENT OF HUMAN SERVICES TRENTON PSYCHIATRIC HOSPITAL CLINICAL PSYCHOLOGY INTERNSHIP TRAINING PROGRAM Trenton Psychiatric Hospital P.O. Box 7500 West Trenton, New Jersey 08628 (609)
Sharon T. (Weaver) Wilburn, Ph.D. 1 Curriculum Vitae Sharon T. (Weaver) Wilburn, Ph.D. Current Address (Business) (Home) Education University of North Florida Brooks College of Health Department of Public
Scott E. Wilks John A. Hartford Foundation Faculty Scholar in Geriatric Social Work Louisiana State University 203 HP Long Fieldhouse Baton Rouge, LA 70803 Work: 225.578.1196 Mobile: 225.229.7466 email@example.com
INTERNSHIP/ PRACTICUM PROGRAM IN CLINICAL PSYCHOLOGY For Student Placements in 2012-13 LAKERIDGE HEALTH OSHAWA INTERNSHIP/PRACTICUM IN CLINICAL PSYCHOLOGY The Setting Lakeridge Health Corporation is an
CURRICULUM VITAE Name: Leah A. Murphy Date of Birth: 9/14/1972 Business Address: Center for Psychology and Counseling 1960 South Easton Rd. Doylestown, PA 18901 Telephone: (646) 334-6265 Email: firstname.lastname@example.org