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Bay Pines VA Healthcare System

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Women's Clinic - Psychology Postdoctoral Fellowship Training

Supervisor: Kelly White, Psy.D.

1. Patient population: The patients are primarily women veterans. A small number of ChampVA-eligible women and active duty and reservist women are seen in the clinic. The women range in age from early 20's to elderly women who receive Primary Care services and/or gender-specific medical care in this setting.

2. Psychology's role in the setting: Provision of general and gender-specific mental health services by the psychologist assigned to Primary Care.

3. Other professional and trainees in the setting: Physicians, social worker, nursing staff, pharmacist, clerical staff. The Women's Clinic is managed by the Women Veterans Program Manager who is responsible for assuring that women veterans receive appropriate and gender-sensitive care throughout the facility.

4. Nature of clinical services delivered: The emphasis of the rotation is on the provision of gender-specific and evidence-based psychotherapy for the treatment of a variety of mental health disorders and behavioral health issues within a primary care setting for women. An integrated model of service delivery is used in this setting that takes advantage of the multidisciplinary team, the co-location of medical and mental health staff, and the expertise in gender-specific care. Mental health care always begins with thorough assessment and collaborative treatment planning. Primarily individual therapy is offered, but group, couples, and family therapy may also be used.

5. Fellow's role in the setting: The Fellows are a part of the multidisciplinary team and provide the full range of mental health services. The Fellows are frequently called on for informal and formal consultation, especially in complex cases with co-morbid mental health and medical problems. They complete evaluations, objective assessments, treatment planning, psychotherapy, and psychoeducation. They may also be involved in developing additional programs and services for the patient population, teaching and training other clinicians, program evaluation projects, and research.

6. Amount/type of supervision: Formal weekly supervision is provided. There are also multiple opportunities for additional supervision and consultation with the supervisor and others regarding specific cases and general issues related to treatment of mental health and behavioral health problems. In addition, the supervisor often works with the Fellows on preparing presentations for local and national audiences, research, and program evaluation activities.

7. Didactics in the setting: A bi-monthly conference (presentations and case discussions) is held in the Women's Clinic and is open to staff from several disciplines. Occasional in-services on topics of special interest are scheduled.

8. Pace: Patients are scheduled during open clinic hours with time allotted for preparation and documentation. Requests to see walk-ins and requests for brief consultation with staff are reasonably frequent. Documentation is expected to be completed in a timely fashion.

Since June of 1988, the Bay Pines VA Healthcare System has operated a special clinic to address the unique needs of women veterans. This "Well Women's Clinic" was created to promote the periodic health screening and maintenance programs for eligible women. That original program has expanded over the years into a full primary care clinic co-located with the specialty care clinics pertinent to women's health care on the Bay Pines campus. The Bay Pines Women's Clinic, where comprehensive women's health care is the focus, is currently staffed with 3 full time primary care physicians, 4 nursing staff (2 RNs, 1 LPN and 1 Health Technician), a full time Doctor of Pharmacy with special experience in women's health, a social worker, and the clerical support staff. In addition, Breast Clinic is held one day per week by a General Surgeon with special training in breast care, and GYN Clinic is held two days each week. GYN surgery is also done at the Bay Pines campus. Maternity care is provided through a fee-for-service arrangement with community obstetricians, in collaboration with the Fee Basis Office.

The Fellows work with the Women's Clinic four half-days per week throughout their Fellowship year in order to maintain a focus on gender-specific issues in treatment and to develop ongoing interdisciplinary and collaborative relationships with the Women's Clinic staff. The Women's Clinic rotation provides experiences with a diverse population of women who present with a wide range of issues including including a history of trauma, behavioral health concerns, adjustment issues, and a variety of mental health concerns. Co-morbid psychiatric disorders and concurrent medical problems are common and the women veterans also frequently have complex psychosocial issues. This necessitates competence in several evidence-based psychotherapies and other adjunctive interventions.