BEHAVIORAL HEALTH - PRIMARY CARE
The Behavioral Health rotation provides for the development of fundamental consultation and assessment skills necessary to provide psychological services to the outpatient primary care areas. During this rotation, the intern will develop a psychosocial and behavioral orientation to healthcare while honing skills in the psychological assessment and treatment of common health problems. As the majority of the rotation will occur within the Primary Care Clinics, there will be a need for frequent cooperation with other health care professionals (especially physicians and nurses) to ensure continuity of care. Diverse assessment instruments and intervention techniques will be utilized, dependent upon the referral question, the medical/emotional condition of the patient, and time constraints. The rotation will focus on a collaborative practice model to address common problems in behavioral health such as anxiety and depression as well as such issues as the life-changing effects of chronic illness and lifestyle conditions such as diabetes, obesity, cancer, and hypertension. An eclectic theoretical orientation, personal flexibility, significant communication skills, and the ability to manage ambiguity effectively are all significant assets developed by interns who successfully complete this rotation.
Specific objectives of the rotation include: (1) enhancement of psychological diagnostic and intervention skills with primary care outpatients; (2) refinement of interviewing and assessment skills relevant to a range of different types of patients and their diagnoses; (3) a broadening of the scope of the intern's theoretical framework with effective and brief therapeutic interventions; (4) exposure to a variety of cases ranging from acute to chronic with a broad spectrum of diagnoses; (5) increased ability to facilitate active coping and treatment compliance; (6) comprehensive understanding of the impact of illness, disability, and treatment on the totality of a patient's life; and (7) effective communication with medical personnel and patients with an increased understanding of medical terminology, diagnostic procedures, treatments, and conditions.
The intern in this rotation is primarily supervised by the psychologist assigned to provide coverage to the Primary Care clinics. Patient referrals also come from all specialty areas of the medical center, including the Community Based Outpatient Clinics (CBOC's). Typical referral questions often request assessment of personality functioning, compliance issues, mood disturbance, and other diagnostic considerations. There are also opportunities for involvement in a variety of types of pre-surgical assessment. Pre-surgical anxiety, initial adjustment to serious or life-threatening illness and altered body image are frequent concerns. Adjustment to major life style change, compliance with treatment regimens, and altered life span realities are common issues addressed in psychotherapy. Interns may also provide more traditional psychotherapy (on a limited basis), brief psychotherapy, family support, and marital interventions. Many of these issues can be addressed in time-limited groups that will either be psychoeducational or psychotherapeutic in nature. There will be opportunities for the intern to develop and lead such time-limited groups that are specific to the intern's areas of interest. Given the nature of this rotation, there will also be a need for the intern to have an interest in developing a greater familiarity of the various aspects of the pharmacological treatments of patients being seen within the rotation, including indications, contraindications, and side-effects. This will also necessarily apply to a variety of medical procedures as well. Overall, the intern will develop an appreciation and understanding of the interplay of medical problems and psychological, emotional, and behavioral symptoms or conditions. This developing awareness will better help the intern to identify the impact of medical treatment on a patient's life situation (especially issues such as quality of life, support system, vocation, finances, and even basic activities of daily living) in order to formulate an effective treatment plan and healthy therapeutic relationship. Conversely, the intern must also account for the impact of the patient's lifestyle (especially issues such as stress, diet, activity level, substance use, sleep patterns, mood, life outlook and expectations) upon the medical condition. Lastly, the intern will also need to include individual factors such as age, race, gender, SES, cultural beliefs, and religious affiliation when considering a patient's health perspective. Finally, all of this assessment information will not only be incorporated into the treatment plan but will also need to be presented to the patient in order to elicit compliance in working toward adjustment and symptom management.
Primary competency: Consultation and assessment
Secondary competency: Group and individual psychotherapy
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CENTER FOR SEXUAL TRAUMA SERVICES
The Center for Sexual Trauma Services (CSTS) was established to provide treatment for the effects of sexual trauma that occurred during military service. The CSTS encompasses programs for both female and male veterans and includes separate residential treatment programs and outpatient care. Both the male and the female residential programs are seven-week, full-time programs designed to provide intensive, time-limited treatment for the effects of sexual trauma for patients who have not been responsive to outpatient care alone. The primary components of the programs include exposure-based work, skills training, therapeutic recreation, health education, goal setting, and aftercare planning.
The CSTS outpatient program uses a case management model, offering a wide range of time-limited group and individual services with individually designed treatment plans. Psychological interventions include exposure therapy, problem-focused therapy, psychoeducational groups, and process-oriented groups.
Interns have the opportunity to work with both outpatients and residential patients and typically co-facilitate treatment groups, patient education groups, and coping skills groups. Interns also follow individual patients for intake assessment, treatment planning, individual psychotherapy and coordination of care, and interns participate as active members of an interdisciplinary team. Assessment training opportunities are available during the course of the rotation, especially in the use of the Minnesota Multiphasic Personality Inventory (MMPI-2) and trauma-relevant assessment tools.
The CSTS also provides education and consultative services to practitioners from other facilities. The CSTS offers regular clinical training programs for providers from across the United States. The CSTS also engages in research activities to further the understanding and treatment of the sequelae of sexual trauma. Interns may choose to participate in the ongoing research or develop a related research project of their own.
Primary competency: Individual and group therapy, consultation and treatment planning.
Secondary competency: Assessment (psychological)
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GEROPSYCHOLOGY
The Geropsychology rotation provides an intensive training experience in the context of both inpatient and outpatient programs within Geriatric and Extended Care Service. The Bay Pines Health Care System Psychology Internship program is a member of The Council of Professional Geropsychology Training Programs (CoPGTP) (http://www.usc.edu/programs/cpgtp/ *) and the Geropsychology rotation provides training consistent with the Guidelines for Psychological Practice with Older Adults of the American Psychological Association (http://www.apa.org/practice/Guidelines_for_Psychological
_Practice_with_Older_Adults.pdf *)
Interns on this rotation are actively involved in a variety of psychological services including psychological assessment, neuropsychological evaluation, individual psychotherapy, and consultation with treatment teams. The assessment and treatment of the elderly patient requires a solid understanding of both the normal aging process and the sequelae of various medical conditions. A major focus is on assessment of the psychological factors which are either caused by or are now complicating a range of medical problems. Common examples include alterations in mental status, mood, cognitive functioning, coping skills and socialization. Because the elderly are so susceptible to a variety of neurological conditions, a substantial focus in neuropsychology is provided. Interns receive training in the administration and interpretation of a variety of psychological and neuropsychological assessment tools frequently utilized in geropsychology. Interns receive didactic training and clinical experience with a variety of organic brain disorders including Alzheimer's, vascular, Parkinson's and alcohol-related dementias. Training in brief psychotherapeutic interventions within the context of inpatient medical settings is also provided. These interventions can range from supportive therapy to cognitive/behavioral interventions targeting issues including depression, anxiety disorders, adjustment disorders, functional loss, behavioral problems secondary to dementia, bereavement, and palliative care. The level and sophistication of training experiences will be determined by the intern's previous learning, special interests, and motivation. At a minimum, interns can expect to accomplish the following during a rotation: (1) a solid understanding of the aging process and the psychological needs of the elderly from both theoretical perspectives and clinical experience; (2) increased competence in interviewing and assessment relevant to geriatric and medical populations including familiarity with appropriate psychological and neuropsychological tools and normative data for this population; (3) experience working in the framework of the interdisciplinary treatment team model of patient care; (4) refinement of individual therapy skills effective with the geriatric and medical populations; and (5) enhanced skills in crisis intervention, family consultation, and behavioral management techniques.
The Geriatric Primary Care Clinic (GPC) is an outpatient clinic specifically tailored to provide comprehensive healthcare to older veterans. The clinic is staffed by geriatricians, nurse practitioners, nursing staff, social workers, and pharmacists. .Geropsychology provides psychological assessments, neuropsychological assessments, and individual psychotherapy for veterans in this clinic. In addition, all consultations requests for neuropsychological assessments from the entire Bay Pines Healthcare System for veterans age 75 and older is conducted by Geropsychology at GPC. The GEM Outpatient Clinic provides the opportunity to conduct a neuropsychological assessment, provide immediate feedback to the geriatrician, and then accompany the geriatrician during the medical assessment of the veteran. The intern has the opportunity to provide education on the psychological assessment of older adults to medical residents, geriatric fellows, and pharmacy students by inviting them to attend the neuropsychological assessment portion of this comprehensive evaluation.
Community Living Center-West is a 20 bed extended-stay inpatient unit providing medical services to veteran requiring longer term medical treatment, physical rehabilitation, and/or palliative care. Also located on this unit, The Geriatric Evaluation and Management (GEM) program provides interdisciplinary assessment and treatment to hospitalized geriatric patients in an effort to avoid institutional placement and to facilitate their return to the community. The intern is involved in interdisciplinary team meetings and interdisciplinary medical rounds in both of these settings. . In addition to geropsychologist, the Interdisciplinary Team is comprised of geriatricians, nurse practitioners, nursing staff, pharmacists, dieticians, social workers, recreational therapists, and rehabilitative therapists. Geropsychology offers comprehensive clinical services to these programs including Individual psychotherapy, psychological assessment, neuropsychological; assessment, and consultation.
Consultation requests for psychological services are also received from other inpatient medical units including the Community Living Center (rehabilitative nursing home), Physical Medicine and Rehabilitation, surgery, acute medicine, and Hospice. These consultations typically involve psychological assessments and brief behavioral-medicine interventions. This provides the intern to become familiar with working in a variety of inpatient medical settings.
Primary competency: Assessment (cognitive and psychological), Individual psychotherapy, Consultation and treatment planning.
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Home Based Primary Care (HBPC)
Home Based Primary Care (HBPC) provides interdisciplinary primary care services in the homes of veterans with chronic medical conditions. The HBPC program caters to veterans in advanced stages of chronic disease and specifically targets veterans who are at high risk for recurrent hospitalization or nursing home placement. During this rotation, the intern will work closely with HBPC team members including representatives from medicine service, nursing, pharmacy, social work, rehabilitation, and dietetics. The rotation will focus on applying diagnostic methods and evidence-based intervention strategies to a diverse patient population in the home environment. Duties include providing screening, assessment, diagnosis, and treatment of depressive and anxiety-related disorders, as well as other Axis I conditions, with an emphasis on time-limited, evidence-based approaches. Providing services to the family members and caregivers of veterans enrolled in the HBPC program is also an integral component of the HBPC rotation. The intern will have numerous opportunities to provide psychoeducational and supportive interventions to caregivers and family members in an effort reduce caregiver burden and allow the family to sustain the veteran in the home environment.
Specific objectives of the rotation include: (1) enhancement of psychological diagnostic and treatment skills with veterans in a home environment; (2) broadened experience in conducting cognitive screening to address specific functional questions, particularly for elderly patients and/or patients with co-occurring medical diagnoses; (3) comprehensive understanding of the nature of capacity assessments, particularly when addressing patients' abilities to make own decisions and live independently; (4) exposure to individual interventions designed to support patients who are coping with feelings of grief and loss associated with disabilities, loss of loved ones, and other life transitions (5) experience in providing consultation about mental health diagnoses with other medical providers.
The intern in this rotation is primarily supervised by the mental health provider assigned to the HBPC team. Initially, the supervising psychologist will accompany the intern on all patient visits. However, the intern has the opportunity to provide more independent care for the veteran once the intern exhibits sufficient clinical experience, judgment, and technical skill which has been formally documented. Patient referrals are originated by the members of the HBPC team and are discussed during weekly team meetings. Common referral questions consist of assessment of a mood disorder (e.g., depression/anxiety), dementia, medical non-compliance, and bereavement issues. When individual therapy is initiated, it is often time-limited and focused on issues such as adjustment to a new living situation (e.g., recent nursing home placement), depression, bereavement, and pain management. Given that all of the HBPC patients have a chronic medical diagnosis, it is important that the intern develop a knowledge base of common medical conditions that often afflict our older patients (e.g. diabetes, COPD, stroke, dementia). The intern will have numerous opportunities to broaden their understanding of these medical conditions and observe the psychological impact of these diseases on the patients overall physical health. At the conclusion of the rotation, the intern will have advanced knowledge of psychological diagnosis, cognitive assessment, and behavioral health skills that will adequately prepare the intern to provide mental health services to a primarily geriatric population with co-morbid medical and psychiatric conditions.
Primary Competency: Consultation and assessment
Secondary Competency: Individual psychotherapy
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MENTAL HEALTH CLINIC
Outpatient services are provided through a comprehensive Mental Health Clinic (MHC) which receives referrals from all parts of the hospital, including Inpatient Psychiatry, Medicine and Surgery, Domiciliary, Substance Abuse Treatment Program, Nursing Home, Community Health Nursing, Primary Care, and the Women's Clinic. A wide variety of cases and diagnostic categories are evaluated and treated.
The Mental Health Clinic (MHC) is organized into two treatment teams. MHC psychologists are assigned to both teams. The teams consist of psychiatrists, psychologists, a social worker, and a pharmacist.
Group and individual psychotherapeutic approaches vary and are prescriptive in nature, depending upon the major problem area being treated. The clinic currently provides group therapy facilitated by social work clinicians and psychologists. For example, social work provides groups for dually diagnosed (i.e. mentally ill and chemically addicted) patients, a life adjustments/anger management group, and a life transitions group. Psychology provides dialectical behavior therapy, women's support group, trauma symptom management group, and a mental health screening group. Most groups meet weekly or bi-weekly, with emphasis on time-limited therapy. Interns function as co-therapists within the psychologist-led groups, along with the supervising psychologist. Observation of other group modalities may be offered on case-by-case basis. Interns may participate in diagnostic interviewing, personality testing, and select short-term individual psychotherapy.
Interns will participate in weekly interdisciplinary treatment team meetings and other pertinent training seminars throughout the rotation. Interns have access to introductory training in clinic systems, if desired.
Primary competency: Individual and group therapy, assessment.
Secondary competency: Consultation and treatment planning
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NEUROPSYCHOLOGY TESTING
A Neuropsychology testing rotation is available with Dr. Epstein in the testing center. The testing center is located in Bldg. 1-3 A367. The focus of the rotation for the intern is to become familiar with a wide variety of neuropsychological tests, test administration and report writing. A flexible battery approach is utilized. Referrals are from throughout the medical center and address a variety of clinic issues. Primary patient populations include TBI's, dementias, CVA's, and seizure disorders. Test selection is based not only on the needs of the patient, but to enhance the learning experience of the intern. Training in the application of test results in a clinical setting is the primary focus of the Geropsychology rotation with Dr. Slack. Clinical application of test results on the Neuropsychology rotation is limited to feedback with the patient and family (if available).
An experiential training model is utilized on this rotation. Initially, the intern is expected to observe Dr. Epstein administer, score and write up evaluations. Afterwards, the intern is observed and feedback provided by Dr. Epstein. Supervision is provided on all report write-ups. During the rotation the intern is encouraged to become familiar with as many different instruments as possible.
The most frequently used instruments on the rotation are the RBANS (Repeatable Battery for the Assessment of Neuropsychological Status), Wechsler Tests, CERAD (the Consortium to Establishment a Registry for Alzheimer's Disease) Tests, COGNISTAT, Clock Drawing, Trail Making Test, TOMM (Test of Memory Malingering), Wisconsin Card Sorting Test, Shipley Scale, MMSE, Stroop Color-Word Naming Test and the Category Test from the Halstead-Reitan Battery. Other tests are available on request.
Familiarity with brain/behavior relationships and testing is recommended, but not essential for participation in this rotation. During the rotation, the intern will be encouraged to become familiar with the following readings/resources:
- Fractured Minds by Jenni A. Ogden - 1996
- Selected chapters from Prognosis of Neurological Disorder - eds. Evans, Baskin & Yatsu - 1992
- Selected chapters from Neurological Assessment by Muriel Lezak - 1995
- Clinical Neuropsychology - eds. Snyder & Nussbaum - 1998
Primary competency: Assessment
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STRESS TREATMENT PROGRAM
The Stress Treatment Program (STP) was established to provide comprehensive mental health services to men and women experiencing psychological problems related to trauma combat experiences. The program consists of an array of residential and outpatient services designed for veterans who have Post-Traumatic Stress Disorder (PTSD), or stress-related problems that may have been caused by combat experiences or other traumatic events while on active duty. The programs include psychiatric and psychological assessment, individual and group psychotherapy, specific war era support groups, couples therapy, psycho-education groups, consultation, vocational and recreational therapy. The veteran population served through the Stress Treatment Program range from WWII veterans to the current Iraq and Afghanistan war veterans.
The residential component is a highly structured and intensive 7-week program. The treatment provided includes group psychotherapy (trauma group), family/couples counseling, individual psychotherapy, anger management, assertiveness training, stress management, psycho-education, relapse prevention, cognitive behavior interventions for panic disorder and therapeutic recreational activities.
The outpatient Post-Traumatic Stress Disorder clinic consists of a multidisciplinary team to include psychiatrists, psychologist, social workers, counselors, nurse practitioners and psychiatric nurses. Services offered are similar to those mentioned above.
Interns will have the opportunity to fully participate in both programs and will gain supervised experience in the treatment of Post-Traumatic Stress Disorder.
Primary competency: Group therapy, consultation
Secondary competency: Individual therapy
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SUBSTANCE ABUSE TREATMENT PROGRAMS
Since 1988, the SATP has focused on providing relapse proneness and prevention treatment from the perspective of a cognitive-behavioral, social learning theory and practice. This approach is used in all components of the SATP, including intensive outpatient treatment with residential support, core outpatient treatment, and aftercare. In 2007, the SATP became multi-model by the addition of groups for AA, family relations, motivational enhancement and dual diagnosis. The SATP consists of 23 staff members from a variety of disciplines. The staff work independently as primary therapists and as a team to provide a variety of assessment and treatment services to male and female veterans with substance use disorders.
The residential component is a four-week program that is multifaceted, intensive, and highly structured in nature. The types of treatment available include couples and family counseling, multi-family group therapy, assertiveness training, anger management, relaxation training, problem solving, substance abuse education, relapse prevention, self help groups, medical aspects of substance abuse, and discussions of substance abuse related films and videotapes. Interns selecting the residential rotation conduct assessments of patients admitted to the program, individual counseling, attend and learn how to lead didactic groups using a cognitive-behavioral and multi-modal model of relapse proneness and prevention, and function as multidisciplinary treatment team members and learn how to do case management activities.
Generally, the intern will be expected to act as a professional member of the multidisciplinary team and, under the supervision of the psychologist, learn to perform the duties of a staff psychologist. Specifically, most of the interns' training and experience on the residential SATP will be in assessment and running relapse proneness/prevention groups. When an intern chooses a second rotation in SATP he/she is eligible to participate in SATP outpatient groups, State Certified Domestic Violence Intervention Program (DVIP) groups, outpatient Opioid Substitution Component and aftercare groups. Primary supervision will be given by the SATP Staff Psychologist. Supervision will also be available by other staff disciplines to develop skills in specific areas. Program evaluation studies and research opportunities are available, also.
Primary competency: Individual and group therapy, treatment planning
Secondary competency: Assessment (psychological), program evaluation and research
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VOCATIONAL REHABILITATION
Occupational identity and stability are often regarded as central features of healthy life adjustment. The onset of medical or psychiatric conditions often necessitates a job change which requires careful vocational assessment, realistic goal setting, retraining referrals and/or job placement assistance in order to preserve or restore a sense of identity and self-efficacy. At Bay Pines, these Vocational Rehabilitation services are organized under the direction of our Counseling Psychologist who provides direct supervision for Interns on this rotation.
The major emphases during this rotation are assessment of vocational potential and subsequent goal oriented therapy to achieve that level of adjustment. Referrals are received from all areas of the Medical Center and include newly disabled individuals who must alter their traditional occupational roles as well as those whose former employment histories have been marked by frequent transience and unemployment for a variety of reasons. Interns provide support and referral for job-ready individuals and more in-depth assessment, exploration, and therapy for those whose life circumstances and/or poor work adjustment now threaten their economic and emotional stability. Experience will be acquired in vocational interest and aptitude testing, as well as assessment of intellectual and psychological functioning. Interns will gain experience in disability determination and have the opportunity to work with both State and VA liaisons for rehabilitation.
Primary competency: Assessment
Secondary competency: Individual therapy
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About this Program
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