Captain James A. Lovell Federal Health Care Center
Psychology Postdoctoral Fellowship Program Lovell FHCC
The Department of Veterans Affairs (DVA), formerly known as the Veterans Administration (VA), is commonly acknowledged as the birthplace of professional psychology in the US. It is also regarded as one of the prime movers behind the process of APA accreditation for professional psychology graduate education and training programs. The VA initiated and funded the first publicly supported professional psychology internships in the US immediately after W.W.II. While accepting interns only from APA accredited doctoral programs, the first VA internships did not submit themselves for APA accreditation until the middle 1970's.
The psychology internship program at the FHCC has been in existence since its inception in the 1950’s as a VA internship at the North Chicago facility, and has been continuously accredited by the APA’s Committee on Accreditation since 1979. Its latest APA Accreditation review occurred in 2006. Its next accreditation review and site visit will occur in 2013. The psychology post-doctoral fellowship has been approved for the funding of one postdoctoral fellow since 2011 with continued support from the FHCC’s leadership. The psychology training mission is clearly consistent with the VA’s secondary (i.e., training) mission. The psychology Postdoctoral Fellowship program at Captain James A. Lovell FHCC meets all criteria for licensure in the state of Illinois. Once a Postdoctoral Fellow has completed the program at Captain James A. Lovell FHCC he or she would be eligible to apply to take the EPPP and subsequent licensure in Illinois.
FHCC Lovell Web Site Link
The FHCC Lovell web site can be found at http://www.lovell.fhcc.va.gov/.
The Psychology Training web site can be found at: http://www.lovell.fhcc.va.gov/careers/psychFellow/Psychology_Fellowship_Program.asp
Training Model and Philosophy
The Postdoctoral Fellowship at the Captain James A. Lovell Federal Health Care Center is committed to providing high quality generalist training with an emphasis in the area of Homeless Veteran Rehabilitation, Geriatrics, Posttraumatic Stress Disorder, and Substance Abuse. The overall goal of the postdoctoral fellowships at the Captain James A. Lovell Federal Health Care Center are to provide fellows with a variety of experiences in an applied setting, using a practitioner-scholar model. Training emphasizes the importance of building an effective professional identity; while also developing advanced skills in evidence-based psychotherapy, assessment, and consultation skills with homeless rehabilitation, PTSD, substance abuse, and patient centered medical home care.
Training at Captain James A. Lovell Federal Health Care Center affords psychology fellows a unique opportunity to learn about the application of evidence based principles in various therapeutic communities. Fellows will learn much about structured treatment environments and programmatic interventions, and sharpen their clinical skills in assessment, individual and group therapy, and psychoeducational teaching activities. Psychology fellows will work not only with staff psychologists to assist the Veterans, but will be part of an interdisciplinary treatment teams.
This training experience is consistent with the Captain James A. Lovell Federal Health Care Center's secondary mission to provide training for future health care providers and administrators. The Federal Health Care Center is a "Dean's Committee" teaching hospital. It therefore operates a variety of training programs, and maintains numerous teaching affiliations with institutions of higher learning, such as the Rosalind Franklin University/Chicago Medical School, Northwestern, Loyola, and DePaul Universities, the University of Illinois, and various public and private four-year colleges. These affiliations offer opportunities for continued educational involvement, possible extra-VA training opportunities and a rich source of multi- and interdisciplinary interactions with practitioners and faculty of allied health fields.
Emphasis Training in Domiciliary Care for Homeless Veterans (DCHV)
The DCHV Program in Building 66 is a time-limited residential rehabilitation treatment program that addresses the co-occurring disorders and complex psychosocial barriers, which contribute to homelessness. Eligible Veterans of all ages are provided rehabilitative and treatment services that focus on their strengths, abilities, needs and preferences rather than on illness and symptoms. These rehabilitative and treatment services aim to address medical conditions, mental illness, addiction and psychosocial issues that act as barriers to securing and maintaining housing stability. The program provides quality care in a structured, supportive environment to Veterans that require limited supervision in the activities of daily living, are motivated to participate in treatment, are psychiatrically and medically stable and are responsible enough to require minimal staff supervision. Nevertheless, many such Veterans have serious underlying mental illness and/or medical problems. The program will serve to facilitate the transition to safe, affordable and appropriate community housing. Veterans will be assisted in choosing, accessing and utilizing community and natural supports needed to be independent, self-supporting, and successful in their individual recovery.
Of note, the majority of DCHV patients also carry substance use diagnoses. While many DCHV patients undergo some form of focused substance use treatment prior to entering the program, the program’s treatment approach includes a significant focus on substance use recovery and relapse prevention. The residential component of the program places a strong emphasis on addressing the issues underlying the patient’s chronic substance use and assessing and treating the psychosocial underlying contributing factors to homelessness (e.g., childhood trauma, depression). Another prominent subset of the population consists of Veterans with serious mental illness (psychotic spectrum disorders, bipolar disorder, and severe, treatment-resistant depression and PTSD).
The core philosophy of the DCHV program in Building 66 is that suffering often results when a person's behavior conflicts with their values. In an effort to reduce/eliminate that suffering, each Veteran is assisted in clarifying their personal values and taking action in accordance with their values rather than transient thoughts/feelings. The general goal is to increase the Veteran's psychological and behavioral flexibility, and resiliency. In a nutshell, the program focuses simultaneously on acceptance and change, facilitating the Veteran's efforts to get "unstuck" and move forward.
Training in the DCHV affords psychology fellows a unique opportunity to learn about the application of traditional evidence-based Cognitive Behavioral Therapy principles and third wave evidence-based Cognitive Behavioral Therapy (e.g., ACT) in a structured therapeutic community setting for Veterans experiencing homelessness. Fellows will learn much about structured treatment environments and programmatic interventions, and sharpen their clinical skills in diagnostic assessment, individual and group therapy, supervision and consultation, and psychoeducational teaching activities. Fellows will also attain further hands-on experience with program development, with opportunities for designing research to support this development, as well as the provision of supervision to the psychology extern. Fellows will work not only with the DCHV staff psychologists, but will be part of an interdisciplinary collaborative treatment team that consists of primary care physicians, physician assistants, psychiatrists, clinical pharmacists, social workers, nurses, recreational therapists, a peer support specialist, psychology fellows and externs, social work interns, as well as several domiciliary technicians.
Emphasis Training in Geropsychology
The Geropsychology Program includes an amalgamation of experiences in areas of health psychology, geropsychology, rehabilitation psychology, and neuropsychology. The postdoctoral fellow will spend the majority of their time in the Community Living Centers (CLC) providing patient-centered care to aging Veterans and working with the CLC interdisciplinary teams. The postdoctoral fellow will also advance their skills in completeing comprehensive neuropsychological evaluations with aging Veterans that have complex medical, cognitive, social, and mental health commorbidities. Additionally, a half day a week will be focused on education (i.e., didactic training) as part of the general fellowship requirements. Supervision is provided in tandem by a clinical psychologist and neuropsychologist.
The CLC at the Captain James A. Lovell Federal Health Care Center is comprised of four inpatient households and four Greenhouse Homes. All of the CLC units combined provide living space for over 100 Veterans. In general, Veterans living in the CLC are individuals dealing with significant medical, cognitive, or psychiatric impairment which impedes their ability to maintain independent living. Many of our residents have longstanding, chronic mental health conditions, as well as strong personality features which will allow the postdoctoral fellow to observe, assess, and treat severe mental illness as it presents in geriatric adults. The CLC provides a structured, supervised environment with services that include assistance with ADLs, regular medical care, nutrition management, psychological interventions, cognitive assessment, dementia care, and recreational activities. Veterans under hospice and palliative care are interspersed on the households and, while these Veterans receive the same level of care, the greater focus tends to be on maintaining quality of life.
The CLC psychology service is comprised of a clinical psychologist and neuropsychologist. In the CLC, the postdoctoral fellow will have the opportunity to provide individual patient-centered psychotherapy, which includes end of life support as a member of our Hospice and Palliative care team. The postdoctoral fellow will provide behavior modification intervention (i.e., on household observation, behavioral analysis, contingency development, and plan implementation with direct care staff) with an opportunity to become invovled with the STAR-VA program. The postdoctoral fellow will also assist with the completion of annual cognitive and psychological screenings for all CLC residents throughout the year. These screeners include the administration of the Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale-Short Form (GDS-SF), and Geriatric Anxiety Inventory (GAI). The postdoctoral fellow may also have the opportunity to supervise a psychology intern with psychotherapy cases and the administration, scoring, and completion of the write up for the annual screeners. Additional opportunities include providing in-service education to medical doctors and nursing staff regarding psychological and cognitive challenges that aging Veterans face, as well as participating in family/resident council meetings. The postdoctoral fellow works closely with various interdisciplinary teams through attendance at meetings for each CLC unit where the resident, family, or guardian are often present. The postdoctoral fellow will engage in independent rounds on households, which may include on-the-spot education and trouble-shooting with direct care staff to improve compliance with behavior modification plan implementation or assistance with reducing problem behaviors of residents that are interfering with care.
Under the supervision of the neuropsychologist, the postdoctoral fellow will complete comprehensive neuropsychological evaluations with Veterans of geriatric age in both inpatient (e.g., long-term care households, rehabilitation household, and acute medicine or psychiatric households) and outpatient settings, depending on consult source and availability. Examples of typical referral questions include clarifying capacity to make decisions related to medical care or financial management, identifying normal aging versus MCI/dementia process, differentiating neurological from emotional disorders, clarifying sudden changes in mental status, and delineating cognitive strengths/weaknesses for purposes of treatment planning and improved cooperation with care. Depending upon the postdoctoral fellow’s previous experience with neuropsychological testing, they will develop and/or advance their skills in test selection, data interpretation, report writing, diagnostic clarification, and the provision of examination findings to the resident, family, and interdisciplinary teams.
The postdoctoral fellow, psychology intern, CLC psychologist, and neuropsychologist will participate in a monthly journal club. The postdoctoral fellow will be responsible for choosing an article and leading a discussion among those present.
Emphasis Training in PTSD
The overall goal of the postdoctoral fellowship at the Captain James A. Lovell FHCC’s PTSD programs is to provide fellows with experience in treating PTSD and other trauma-related disorders in an applied setting. The post-doctoral fellowship uses a practitioner-scholar model to emphasize the importance of building an effective professional identity as a trauma psychologist, to become ready for licensure, while also developing advanced skills in evidence-based psychotherapy. The postdoctoral-fellow will also learn how to provide trauma-focused therapy in different levels of care and modalities including residential treatment, outpatient treatment, and telehealth treatment.
Over the course of the training year, the post-doctoral fellow will split their time between the outpatient Trauma Recovery Program (TRP) and the residential Stress Disorder Treatment Unit (SDTU). The post-doctoral fellow will have the opportunity to encounter trauma-focused treatment utilizing a team-based, patient-centered approach. The programs collaborate with each patient to create individualized Mental Health Suite treatment and recovery plans. The focus is always on the patient’s values, goals, and desires to create a personalized strategy to optimize the patient’s health, healing, and well-being.
TRP provides outpatient trauma-focused therapy to Veterans and Active Duty Service Members who are experiencing posttraumatic stress symptoms from DSM-5 Criterion A military trauma(s). Patients present to TRP from all eras of service and traumatic event include, but are not limited to, combat, first response, Military Sexual Trauma (MST), training accidents, and motor vehicle accidents. Patients may present with Posttraumatic Stress Disorder (PTSD), subthreshold posttraumatic stress, depression, anxiety, substance use, bipolar disorder, eating disorders, psychosis, and personality disorders. Although treatment is specialized to be trauma-focused, patients may also present with difficulty with readjustment, anger toward the military and VA system, traumatic brain injuries, chronic pain, and other medical conditions. TRP treatment interventions are grounded in a flexible, recovery-oriented approach, and can include evidence-based treatment approaches of Cognitive Processing Therapy (CPT; Resick & Schnicke, 1996) and Prolonged Exposure (PE; Foa, Hembree & Rothbaum, 2007), as well as less structured interventions still based on clinical judgment and evidence. Treatment modalities include individual and group therapies (in-person or telehealth), and duration of treatment may be brief or longer-term depending on the patient’s presenting concerns, needs, goals, and progress in therapy. Training activities include intake assessments, individual therapy, developing and facilitating a group therapy (e.g., past groups have included Group CPT, In-Vivo Exposure Group, ACT for PTSD Group), interdisciplinary staff meetings, interdisciplinary consultation, and potential supervision opportunities.
The SDTU is a 26-bed residential unit focused on the treatment of combat PTSD in Veterans and Active Duty Service Members. The typical length of stay on the SDTU is seven weeks but may be adjusted based on the patient’s needs and progress in treatment. The program provides individual trauma-focused interventions utilizing evidence-based psychotherapies (Cognitive Processing Therapy, Prolonged Exposure), combined with intensive supportive and adjunct therapies in individual and group formats. The program also provides a variety of psychoeducational and process-oriented groups aimed at teaching adaptive coping, affect tolerance and regulation, and stress reduction skills. The fellow will have the opportunity to apply CPT and PE in individual therapy, as well as facilitate/co-facilitate psychoeducational and process-oriented groups. Additionally, the fellow will perform diagnostic interviews, telephone screenings, and write comprehensive patient case histories. The fellow will participate in a variety of programmatic activities such as patient community meetings, staff meetings, patient advisories, and other milieu activities. The fellow functions as an integral member of the treatment team. The fellow may have the opportunity to follow complex patients in long-term outpatient psychotherapy during the program’s aftercare process. There are also supervisory opportunities for the fellow including supervision of practicum students.
Research opportunities in the TRP/SDTU include but are not limited to: examining predictors of program/therapy completion, assessing the efficacy of cognitive behavior therapy tools in promoting behavioral change, and following up with patients who have successfully completed from the program to determine what factors have contributed to their success.
Emphasis Training in Addiction Treatment Program
The postdoctoral fellow in this position would be assigned to the Addiction Treatment Program (ATP). The ATP offers services to veterans who have problems with substance use and, frequently, co-occurring disorders. The program offers fellows the opportunity to individualize their training experiences through involvement with a population that is diverse with respect to ethnicity, socioeconomic status, and sexual orientation.
Fellows have the opportunity to develop skills in all of the areas covered by psychologists within the ATP, which includes residential, outpatient, and consultative services. Residential ATP consist of 39 beds that provide Veterans with a structured, supportive housing environment during their treatment course. Average length of stay is 35 days, though the program emphasizes individualized treatment plans based on the veteran’s clinical and psychosocial demands. Outpatient services are offered for veterans based on clinical need or whose circumstances are not well-aligned with residential placement (e.g., employment). Veterans engaging in outpatient treatment utilize the same groups and classes as those in the residential program. The goal of the consultation service is to connect veterans in acute psychiatry and medical units to ATP services. The intent is to ensure that patients are able to move seamlessly between services to connect with the appropriate substance use treatment.
The fellow would be an integrated member of the interdisciplinary treatment team, which is made up of a psychiatrist, nursing staff, psychologists, social workers, addiction therapists, vocational rehabilitation therapists, psychology technicians, recreation therapists, domiciliary technicians, domiciliary supervisor, nutritionists, a peer support specialist, and a program support assistant. The ATP has two full-time psychologists and one half-time psychologist available to provide supervision and mentoring. The half-time position is the facility’s PTSD/Substance Use Disorder psychologist, who also works with the PTSD treatment units on campus.
The position emphasizes advancement in the areas of triage, crisis management, risk assessment, psychological assessment, addiction assessment, individual/group psychotherapy, psychoeducation lectures, treatment planning, aftercare/discharge planning, and care coordination. ATP offers programming that includes a variety of evidence-based interventions that focus on psychoeducational and skills-oriented individual and group services. Examples of evidence-based practices offered within the ATP include Motivational Interviewing (MI), Motivational Enhancement Therapy (MET), Seeking Safety, 12-Step Facilitation, Contingency Management, Relapse Prevention from a Cognitive Behavioral perspective, Anger Management, and Acceptance and Commitment Therapy (ACT). In addition to interventions offered within the ATP, there is also an opportunity to participate in more population-specific groups such as male veterans with Military Sexual Trauma (MST), gender-specific groups for female veterans, and dually disordered veterans with PTSD and SUD issues.
The goal of the ATP is to provide opportunities for Veterans to achieve and maintain their highest level of independent functioning and community reintegration. Services are designed to assist Veterans in reaching their stated goals related to mental health, psychosocial management and recovery, and breaking the relapse cycle. ATP objectives are to provide services in collaboration with the Veteran to identify and negotiate barriers with a focus on the strengths, needs, abilities, preferences and goals of the individual.
Role of the Fellow
Fellows at FHCC pursue the fellowship’s training objectives while assuming the role of early career professional psychologists within their clinical training assignments. Such a role requires full awareness of, and adherence to principles of professional ethics and conduct as well as a genuine commitment to the welfare of the patients under their care.
In addition to pursuing the commonly assumed objectives of professional skills training, fellows become socialized into their profession through contacts with psychology staff, interns, and practicum students. An open-minded, non-judgmental but thoughtful attitude, active listening skills and the ability to exercise critical thinking, combined with a well-developed sense of humor, are necessary assets in this professional socialization process. Tolerance for ambiguity, variability and change are other desirable assets for the fellowship role. Fellows who are unable to develop those attitudes will find themselves sorely tried by the often frustrating and sometimes amusing random vagaries of a large and complex health care operation.
To develop into full-fledged professionals, fellows must be willing to assume the responsibility of being teachers as well as learners in their interactions with staff, interns, practicum students, and clients. After all, the title “doctor” simply means “teacher”, and to be able to teach well one must always be willing to learn. Fellows must therefore actively seek and accept supervision and request performance feedback whenever they feel the need to so do. They provide their supervisors with thoughtful feedback on their supervision, to become used to having their supervisors as peers. Fellows are expected to respond to and follow up on supervisory input and feedback in a mindful and mature manner. As participants, fellows also learn experientially about the supervision process.
Fellows are treated as early career professionals and must comport themselves accordingly, their tasks are primarily learning oriented; to the extent that they deliver services, such service delivery is considered entirely incidental to the learning process and unrelated to revenue generation. Fellows are never expected to assume duties, responsibilities or workloads above and beyond those assigned to the professional psychology staff, nor is a fellow’s service delivery meant in any way to substitute for staff effort. Fellows are expected to work no more than 40 hours per work week with 50-60% in provision of clinical services, 10% in supervision, 10% in training, and 20-30% in administrative tasks.
At the end of the training year, the psychology fellow may be able to obtain licensure pending the passing of EPPP and the state’s licensure laws as well as obtain entry-level employment as an unlicensed/licensed psychologist.
As colleagues, fellows participate in the Psychology Department’s clinical, administrative, in-service training and staff meetings, take responsibility for certain clinical and training documentation activities and perform at least three service level presentations (e.g. case presentations, seminars, colloquia) during their tenure as a fellow at FHCC. Fellows serve on a variety of the Psychology Department’s professional committees as full voting members (e.g. Psychology Training Committee-Intern Selection Subcommittee, Postdoctoral Fellow Selection Subcommittee, and Intern Rotation Assignment Subcommittee).
The Psychology Staff of the Lovell FHCC
The Psychology staff is comprised of 42 full-time licensed doctoral psychologists, 4 postdoctoral fellows, and 6 psychology interns. Psychologists operate in a variety of multidisciplinary and interdisciplinary treatment settings as licensed independent service providers with clinical practice privileges. The Executive Psychologist functions as the administrator of the Psychology Professional Community and as the Senior Psychology Consultant to FHCC management.
The broad range of expertise, training backgrounds and experience represented in the Psychology Service staff is reflected in the diversity of their professional duty assignments throughout the FHCC. Staff Psychologists at the Captain James A. Lovell FHCC offer a complete range of psychodiagnostic and behavioral assessment, psychological evaluation and intervention services, as well as consultative and administrative services.
Psychologists provide these services across the entire continuum of patient care (from preventative to aftercare services), and serve as Primary Care Mental Health care providers, as well as in several “specialized” outpatient service delivery settings and inpatient or residential care programs. Psychologists' primary care mental health care activities therefore range from mental health intake, admission and crisis intervention tasks to treatment duties, consultative and administrative tasks in acute and long-term care inpatient mental health and medical programs, and follow-up outpatient therapy in aftercare, such as community based treatment.
Psychologists are also involved in specialized provider activities, such as those of the Medical Consult/Liaison team, and with inpatient and residential facility based programs, such as the Post-Traumatic Stress Disorder Residential Rehabilitation Treatment, the Acute and Long-term Substance Abuse Programs and the Homeless Veteran Domiciliary Program. In all of the aforementioned efforts, psychologists participate as both independent service providers and consultants, or as program administrators.
Psychology also operates one “unidisciplinary” program. The Psychology Testing Laboratory administers a broad array of neuro-cognitive, ability, personality, vocational interest and achievement assessment instruments to patients from all over the FHCC on a consultation/referral basis and is staffed by two rehabilitation psychologists and one MA level Psychology Technician.
Role of the Staff
The Director of Training serves as the interns' overall supervisor, advisor and advocate throughout the training year. The Director of Training maintains an open door policy, and meets regularly with the fellow, both in regularly scheduled meetings and informally on an as-needed basis. The Training Committee will also provide guidance to the fellow throughout the year.
The professional psychology staff members are expected to provide the fellow with viable role models in the areas of:
- Responsible and competent professional practice within the scope of their clinical privileges.
- Caring and respectful treatment of patients, colleagues, interns, other supervisees and staff.
- Adherence to psychology’s ethical principles and standards of professional conduct.
- Participation in professional self-regulatory and self-review activities, as exemplified in the Psychology Peer Consultation Program.
- Commitment to continued professional self-development through participation in training and continuing education activities.
- Promotion of professional autonomy as exemplified in membership in and/or active involvement with local, state and/or national professional organizations and activities.
All licensed doctoral psychology staff members are eligible to serve as training supervisors. Clinical training supervisors may decline the privilege of training supervision; additionally, intern and fellow supervision is a privilege that may be denied to individual staff members.
Additionally, staff members who function as training supervisors are expected to:
- Be appropriately licensed psychologists, capable of independently supervising fellows with minimal consultative guidance from the Director of Training and/or Associate Director of Training.
- Assist the Director of Training and Associate Director of Training with program coordination activities by serving on the Training Committee’s two sub-committees, as assigned by rotation.
- Assess the fellows’ level of competence in relation to the program’s Training Goal and Objectives, at the start of training rotations.
- Provide fellows with activity schedules and caseloads that are appropriate to their level of competence, optimize their learning and facilitate the achievement of Training Objectives
- Discuss, at the beginning of each training rotation, activity schedule and caseload, expectations for the fellow’s performance, methods of performance evaluation and feedback.
- Discuss, negotiate and complete with the fellow a training contract specifying the training and supervision to be provided, in terms of goals, content, method, and duration, and provide the properly completed, signed and dated training contract to the Director of Training.
- Assume supervisory responsibilities for no more than one other Psychology trainee (intern OR practicum student) per rotation, and provide the fellow with regularly scheduled, direct (face-to-face) individual supervision for a minimum of two hours a week (more may be negotiated, depending on the fellows needs). Additional informal or unscheduled supervision and such samples of references to the professional literature and other background readings as are pertinent to the training rotation may also be provided.
- Provide fellows with timely, regularly scheduled formal feedback, as well as unscheduled informal performance feedback. Feedback should inform fellows of their level of performance in relation to agreed-upon expectations and training objectives, and of problems in performance (if any), as well as methods of correcting those problems (if remediable).
- Provide the Director of Training with regular informal updates on their supervisees' progress, performance, and problems (if any) and their remediation.
- Exchange and review with supervisees, at the end of each rotation, properly completed signed evaluations to be forwarded to, reviewed and signed by the Director of Training for 1) transmittal to the intern's graduate program and 2) filing for future reference.