During this rotation, interns have an opportunity to practice conducting intake interviews, outpatient group and individual psychotherapy, and completing psychological assessments such as personality, ADHD, or Learning Disorder. On this rotation, interns will have an opportunity to continue working on their differential diagnosis skills, building their repertoire of evidence-based treatments in both individual and group modalities, working on formulation of and ongoing case conceptualization, as well as continue finetuning their clinical skills through close individual supervision. Given the general mental health nature of MHC, it provides an especially ideal setting for the further development of differential diagnosis and case conceptualization competencies. Examples of some of the current groups include Cognitive Behavioral Therapy for Depression, Anxiety, and Insomnia; Acceptance and Commitment Therapy for Mood Concerns; Anger Management; Mindfulness; and much more. The MHC is comprised of team members from multiple disciplines, including psychologists, social workers, nurse practitioners, and psychiatrists. Interns are encouraged to interact and consult with other disciplines during formal program meetings and as needed.

During this rotation, the intern will have the opportunity to work with the Behavioral Medicine Consultation & Liaison Service. The psychologists on this team respond to consultation requests from the inpatient Medicine, Surgery, ICU, and Community Living Center units. The intern will conduct brief neuropsychological screening evaluations, utilize interview and questionnaire data to evaluate psychiatric symptoms, and generate reports describing their findings to assist physicians, nurses, and other treatment team members in planning for patient discharge and ongoing outpatient care. Interns will also participate in daily rounds where team members discuss current patient status and there will be ample opportunity to interface with attending physicians and resident physicians, as well as other team members, from the medicine, surgery, geriatrics, and palliative/hospice teams. Interested interns may also work with the psychologist covering Home Based Primary Care. The intern will also spend time working with the psychologists and social workers covering the Emergency Department, evaluating Veterans who present with a variety of psychiatric concerns, including those with suicidal/homicidal ideation and other psychiatric crises. Interns are encouraged to take part in outpatient treatment modalities that relate to the practice of Behavioral Medicine, e.g., pain management group, cancer support group, CBT for insomnia, smoking cessation classes, etc.

During this rotation, the intern will be trained in and conduct intake evaluations and psychotherapy with patients who are referred to the PTSD Clinical Team (PCT) for evaluation of PTSD and trauma/stressor-related disorders. Psychotherapy groups which may be open to intern participation and co-facilitation include Seeking Safety, Cognitive Processing Therapy (both co-ed and women’s groups), Skills Training in Affective and Interpersonal Regulation (STAIR), CBT-Insomnia, and Imagery Rehearsal Therapy (IRT). Interns also conduct individual psychotherapy, which often focuses on teaching coping skills for PTSD. Interns who demonstrate strong foundational psychotherapy skills may be approved to provide individual trauma focused psychotherapy (Cognitive Processing Therapy or Prolonged Exposure). The intern will attend our weekly interdisciplinary team meetings. Training focuses on developing strong differential diagnostic and treatment planning skills.

The ADTP rotation consists of evaluations and interventions for veterans referred for substance use disorders and/or gambling disorder in an outpatient setting. Evaluation experiences will include screening appointments, intakes, and psychological assessment batteries, with particular emphasis on differential diagnostic skills and formulating appropriate treatment recommendations. Intervention experiences will primarily be in the group format, with treatment modalities ranging from CBT, Mindfulness-based, and 12-Step approaches. Individual intervention opportunities may also be available, with particular emphasis on developing Motivational Interviewing skills. Other opportunities may include inpatient consults, inpatient groups, individual and/or group interventions for gambling disorder, and exposure to Suboxone (buprenorphine) treatment for opioid use disorder with medical staff. Interns will attend weekly case conference and staff meetings with the multidisciplinary ADTP team.

The Integrated Behavioral Healthcare (IBHC) Program utilizes a blended model, combining a co-located, collaborative care model with care management to address the needs of a diverse patient population presenting in the primary care setting. During this rotation, the IBHC intern collaborates with primary care providers; RNs, and pharmacists on a regular basis. Additionally, other treatment providers (including social work, dietitians, and specialty medical and mental health providers) are consulted on an as-needed basis. It is a busy, relatively fast paced program. Interns who succeed in this rotation learn to quickly assess patient needs via a focused assessment; present the case very concisely to a supervisor or to a physician to inform or to implement immediate plans for change; be available for “curbside” consultations and warm handoffs from medical providers; develop an overall treatment plan for behavioral health intervention, which may include a multidisciplinary approach; and provide brief, evidence-based treatment for a wide variety of both medical and behavioral components of health related issues. Additionally, brief cognitive evaluations are frequently requested and administered by IBHC interns and psychology staff. The intern is included in Updated September 2020 both IBHC team and Primary Care staff meetings, as well as other team meetings which may align with training goals or interests.

Geropsychology offers the opportunity to deliver geriatric services in the Community Living Center, and through Home Based Primary Care (HPBC). The CLC is a skilled nursing facility where interns work with veterans, many of whom are older adults undergoing short-stay or long-stay rehabilitation. The CLC also has dedicated beds for veterans admitted for palliative care for chronic illnesses, and hospice care at the end of life. In contrast, HBPC gives interns exposure to home bound older adults living in the community who are adapting to the challenges of disability and aging in place. In these settings, the intern typically works on interprofessional teams and provides conceptualizations from a biopsychosocial perspective while collaborating with providers from a number of disciplines. In addition, the intern may educate other providers on these teams about psychological and/or aging issues through consultation. The intern performs assessment (e.g., psychological, cognitive, neuropsychological, decision-making and capacity, risk, etc.) and intervention skills commonly used for older adult issues (e.g., grief, end-of-life, caregiving, chronic health problems, role/life transitions, etc.).

During this rotation, the intern will conduct neuropsychological evaluations on veterans referred for testing for a variety of concerns including effects of traumatic brain injury and possible dementia. The intern will gain exposure to a variety of test batteries depending on the referral question and will also be responsible for writing a comprehensive neuropsychological report for each veteran they evaluate.

During this rotation, the intern will provide services in our intensive outpatient program for veterans diagnosed with serious mental illness (SMI) such as schizophrenia and bipolar disorder. The intern is fully involved in all aspects of the program and will have opportunity to conduct intakes, complete individual recovery plans, provide individual and group therapy, and complete cognitive and personality screenings. The PRRC team works closely with the RANGE team, which provides community case management; interns will have the opportunity to work with this team in the community as well. Interns will work on a multidisciplinary team including psychologists, social workers, psychiatrists, peer supports, and nurse practitioners. Interns will gain exposure to evidence-based treatments for SMI and will be given the opportunity to create groups of interest for this population.

This rotation provides interns the opportunity to work with Mental Health Service leaders to develop an understanding of the administrative roles of psychologists within the VA system. Interns in this rotation will have the opportunity to participate in program development and process improvement projects as well as the opportunity to understand the collaborative relationship of senior leadership across services through participation in senior level meetings and possibly facility-level projects. Trainees will become familiar with and help examine data to identify opportunities for improvement and the support of best practices. Exploration of leadership styles and approaches will occur through readings, exercises, and discussions.