Clinical Rotations - Captain James A. Lovell Federal Health Care Center
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Captain James A. Lovell Federal Health Care Center

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Clinical Rotations

The list below and subsequent pages describe currently available internship training rotations at the Captain James A. Lovell FHCC. The existence or availability of these rotations may be affected by future organizational changes. All interns are required to take three major rotations, or two major rotations combined with two minor rotations.  Detailed rotation descriptions in terms of process, content and distribution of training experiences and opportunities, as well as specific prerequisite knowledge, skill or competency, if applicable, follow this listing.

  1. Domiciliary Care for Homeless Veterans (DCHV)
  2. Addiction Treatment Program: Outpatient & Residential
  3. Post-Traumatic Stress Disorder Residential Rehabilitation Treatment Program (PTSD-RRTP; Stress Disorder Treatment Unit)
  4. Trauma Recovery Program Outpatient
  5. PTSD / Substance Use Disorder
  6. Primary Care Mental Health Integration
  7. Behavioral Medicine and Pain Rotation
  8. Department of Neuropsychology: In- and Outpatient
  9. Home Based Primary Care (HBPC)
  10. Recruit Evaluation Unit (REU)
  11. Geropsychology
  12. Building Recovery In Service of Development of Growth and Enhancement (BRIDGE)
  13. Administration and Leadership
  14. Women’s Health Primary Care
  15. Outpatient Mental Health Clinic
  16. Substance Abuse Recovery Program (SARP; Active Duty)

 

Detailed Rotation Descriptions

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 interns 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. Interns will learn much about structured treatment environments and programmatic interventions, and sharpen their clinical skills in diagnostic assessment, individual and group therapy, consultation, and psychoeducational teaching activities. Interns will also attain further hands-on experience with program development and work closely and collaboratively with the DCHV postdoctoral fellow and psychology extern.  Psychology interns 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.

Addiction Treatment Program:

The ATP offers services to Veterans who have problems with substance use and, frequently, co-occurring disorders. The program offers interns the opportunity to individualize their training experiences through involvement with a population that is diverse with respect to ethnicity, socioeconomic status, and sexual orientation.

Interns 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 intern 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.

Post-Traumatic Stress Disorder Residential Rehabilitation Treatment Program (PTSD-RRTP; Stress Disorder Treatment Unit):

Interns have the opportunity to do a major or minor rotation in this residential treatment program for Combat Veterans and Active Duty Service Members with Post-Traumatic Stress Disorder (PTSD). The typical length of stay on the PTSD-RRTP 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 [CPT], Prolonged Exposure Therapy [PE]), 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. Interns on this rotation will have the opportunity to learn the fundamentals of CPT and PE and apply them in individual therapy, as well as facilitate/co-facilitate psychoeducational and process-oriented groups.  Additionally, the intern will perform diagnostic interviews, telephone screenings, and write comprehensive patient case histories. They will participate in a variety of programmatic activities such as patient community meetings, staff meetings, patient advisories, and other milieu activities. Interns function as an integral member of the treatment team. Interns will also become familiar with the professional literatures on PTSD. They may have opportunities to follow complex patients in long-term outpatient psychotherapy during the program’s aftercare process. Interns interested in this rotation are assumed to have sound basic assessment and therapy competencies and the emotional stability, maturity and interpersonal skills necessary to cope with this highly challenging yet rewarding group of patients.

Trauma Recovery Program:

The Trauma Recovery Program (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 events 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 a one-time psychoeducational orientation group to new patients, intake assessments, individual therapy, possible group therapy (e.g., past groups have included Group CPT, In-Vivo Exposure Group, ACT for PTSD Group), interdisciplinary staff meetings, and interdisciplinary consultation. Interns who are interested in an advanced, more specialized trauma-focused training experience may opt to extend the 4-month rotation to 6 months. Examples of extended rotation experiences include, but are not limited to, working with specialized populations (e.g. MST Survivors), emphasis on complex trauma, and developing/facilitating group therapy.

PTSD / Substance Use Disorder Rotation:

In this rotation, the intern works with the PTSD / Substance Use Disorder psychologist providing assessment and treatment services to veterans who have problems with substance use and stress responses secondary to trauma, particularly combat trauma. Interns will work with veterans involved in the Addictions Treatment Program (ATP) and the Stress Disorder Treatment Unit (SDTU-RRTP), as well as outpatients. Interns will provide psychological assessments of veterans who are seeking residential or outpatient substance abuse services and are 1) designated OEF/OIF/OND or 2) have a documented history of PTSD. Interns will provide follow-up individual psychotherapy services where indicated under the supervision of the PTSD / SUD psychologist. Individual treatment modalities are geared toward patient needs and may include but are not limited to empirically validated therapies.  Interns may be involved in the screening of Veterans who are interested in substance use services, to include presenting their findings to a multi-disciplinary team.  Interns will have the opportunity to apply their knowledge base to leading psycho-educational groups on the Stress Disorder Treatment Unit.  Supervision will include a significant amount of observation of interns doing clinical work with associated personalized feedback.   There will be opportunity to talk about broader issues regarding the provision of treatment services to the associated patient populations.  Supervision is geared toward 1) helping interns gain confidence and skill in assessing and providing services to individuals who have substance use issues, post-combat adjustment reactions, and PTSD, and 2) orienting interns to the professional and pragmatic concerns associated with being a practicing psychologist in a multi-disciplinary institutional setting.

Primary Care Mental Health Integration:

The Primary Care-Mental Health Integration program serves as the co-located mental health resource for the Patient Aligned Care Teams (PACTs). The PC-MHI team is comprised of one psychologist, one social worker, and one registered nurse. The focus is on general service delivery (consultation, assessment, and treatment) for a wide range of concerns and resolving problems within the primary care service context. PC-MHI within the VA is a national endeavor to provide ease of access into behavioral health services right within the primary care setting. As such, this rotation differs from other psychology rotations in that the PC-MHI team maintains daily open-access availability to see patients as warm hand-offs from physicians who recognize emotional and/or behavioral symptoms during routine primary care visits. Often times, patients are brought directly to the PC-MHI team after a visit with their doctor for a brief assessment and introduction into the services that PC-MHI offers. After evaluating patients and developing a short-term treatment plan, members of the PCMHI team provide same day verbal or written feedback to the primary care physician or other PACT members regarding the patient’s overall presentation and care plan. The PC-MHI team also provides education to the PACT teams on behavioral health issues observed in the patient as well as consultation on tips for successful care management and patient facilitation, even when no direct patient contact is made.

Additional roles of the behavioral health providers within PC-MHI include monitoring Veteran responses to newly initiated medication trials, risk assessments and diagnostic clarification. BHPs can also provide education, prevention, adherence, and health behavior change. The PC-MHI team functions as an excellent resource for Veterans in managing issues such as insomnia, pain, lifestyle issues, adjusting to illness or adherence concerns.

Additional brief psychotherapeutic services offered include, but are not limited to:

  • Brief trauma-focused treatment
  • Tobacco cessation
  • Weight management
  • Brief interventions for alcohol misuse
  • Interventions for coping with chronic medical conditions (e.g., diabetes management)
  • Interventions for sleep difficulties such as insomnia
  • Adherence to medical recommendations
  • Brief cognitive screening
  • Brief interventions for common behavioral health concerns (e.g., depression, anxiety, grief, and loss).

The general service delivery model within PCMHI involves brief interventions (e.g., 4-6 sessions, 30-45 minutes in length) for cases that typically fall within the mild-moderate range of severity. The PC-MHI team will then triage/refer to specialty care services as appropriate if more severe or complex cases cannot be treated within the short-term PCMHI model (e.g., chronic PTSD, severe depression, bipolar disorder, etc.)

The primary responsibilities of the psychology intern within the PC-MHI rotation include:

  • Maintaining daily open-access availability to see patients as warm hand-offs from providers
  • Performing brief functional assessments
  • Providing feedback and consultation to medical staff regarding patients’ presenting concerns
  • Facilitating brief (4-6 session) evidence-based treatment models
  • Triaging/coordinating care within other specialty area of the hospital for Veterans who voice interest in treatment but may not benefit from the brief treatment model offered within PC-MHI.

*Additional opportunities include program development within PC-MHI, as the current program with a full-time psychology presence is relatively new and evolving. Interns will also have an opportunity to facilitate groups or create group content for piloting within the primary care setting. Interns may be asked to carry a PC-MHI cell phone or pager for increased accessibility during peak clinic times. Overall, this rotation provides opportunities to learn much about how the role of a psychologist in a health/medical setting differs from that of a psychologist in a traditional psychiatric setting.

Behavioral Medicine and Pain Rotation

The Behavioral Medicine rotation serves patients across Primary Care and Specialty Medical Clinics who present with an array of medical and psychological disorders.  The Behavioral Medicine rotation also serves medical staff in an educational capacity, with ample opportunity for interns on this rotation to gain experience in providing in-service education and consultation to medical professionals.

The clinics served by this rotation include Primary Care Clinics, the Pain University Clinic, Biofeedback Clinic, Sleep Disturbances/Insomnia Clinic and the Whole Health Clinic.  The primary activities in this rotation fall into five main categories: 

  1. Behavioral Medicine and Whole Health Assessment, Evaluations and Interventions
  2. Psychology, Pain and Whole Health Program Development in Medical Settings
  3. Medical Staff Education and support
  4. Exposure to and experience working within the PACT model of patient healthcare
  5. Pain University

This rotation aims to develop skills across these domains through various available opportunities, including:

This rotation aims to develop skills across these domains through various available opportunities, including:

  1. Behavioral Medicine Intervention skills will be developed through opportunities to participate in one or more of these specialty clinics (Pain Management/Pain University, Whole Health, Sleep, Biofeedback).  The interested Intern will conduct assessments, individual and group-based interventions within a Biopsychosocial and Behavioral Medicine focus.  Opportunities for brief individual therapy, may be available, depending on intern interest.  Safety assessments, mood assessments, sleep assessments, and whole health coaching personal health inventories may also be available within the Primary Care clinic setting. 
  2. Interns will develop skills in educating medical staff from an array of professional backgrounds through the provision of in-services, didactics, and consultations with a focus on Whole Health/Healthy Living and Wellness within a PACT, patient-centered model of care in the medical community.  Educational emphasis will include Behavioral Health Coaching, Motivational Interviewing, and Team-Building programs as well as other behavioral health topics.
  3. Participation in the FHCC Pain University program will provide opportunities to improve overall assessment, individual and group facilitation skills within the pain management realm.  Interns will learn about Whole Health and Pain Health Coaching utilizing the Wheel of Wellness and the Personal Health Inventory as well as additional coaching and motivational enhancement skills.  Opportunities for educating patients  and providers and staff in the neuroscience of pain as well as in a multitude of topics related to the Biopsychosocial approach to pain management will be available.  Multiple opportunities will be available for building skills in developing Pain University programs in medical settings and multidisciplinary teams.  Interns will be expected to contribute to further development of existing programs.  There will also be opportunities in program marketing and promotion, and outcome research through Pain University for the interested Intern.  Interns will  be exposed to and encouraged to attend many multidisciplinary pain management meetings which include policy and legislation as well as in-depth multidisciplinary pain management review committee meetings.

* Behavioral Medicine differs from Primary Care Mental Health Integration in its’ emphasis on patient and provider education about the mind/body connection through a Biopsychosocial Whole Health approach rather than just conducting individualized, health psychology and mental health treatment in a primary care setting

Department of Neuropsychology:

Two rehabilitation psychologists, one neuropsychologist, and one master’s level psychology technician staff the Department of Neuropsychology and provide an array of psychological testing services. The bulk of referrals to this program are for neuropsychological screening for symptoms related to memory and aging, blast-related concussions, and neurocognitive dysfunction, as well as ability or personality assessment.

Referrals come from all areas of the FHCC, both inpatient and outpatient. Examples of referral questions include the following: differentiating organic from emotional disorders, description of adaptive abilities related to employability/deployability, differential diagnosis of neurological disorders, evaluation of decisional capacity, and description of cognitive abilities/deficits (primarily memory functioning related) for purposes of treatment planning. The Department of Neuropsychology also provides personality testing. Annually, the Department of Neuropsychology receives about 600 referrals for neuropsychological screening. Personality tests represent about 25% of all tests administered. The majority of the personality tests administered are objective actuarial tests. The remaining 5% reflects projective and vocational interest assessments. Interns opting for this rotation are assumed to have solid basic test administration and interpretation skills. Training follows an "apprentice" model. At the start of training the intern meets with the supervisor to set realistic goals for the training and formulate a training contract. For all referrals to the Department of Neuropsychology, the supervising psychologist individually selects the test instruments to be utilized on the basis of the referral question(s).  Although there is no standard screening battery, the supervising psychologist typically uses a brief core battery and tailors test selection after interviewing the patient. Additionally, locally modified or developed tests are utilized. Prerequisites for this rotation are such skills as the intern acquired in graduate assessment courses, labs and practicum work in general psychological testing.

Home Based Primary Care:

The Home Based Primary Care program is a service provided under the auspices of the Geriatrics and Extended Care line. HBPC provides comprehensive, interdisciplinary primary care services in the homes of veterans with complex and chronic disabling disease.  In addition to primary care interventions, the team provides palliative care, rehabilitation, disease management, and care coordination services.  Targeted patients are veterans with advanced stages of chronic disease and who are at high risk of recurrent hospitalizations or nursing home placement.  The interdisciplinary team is made up of a nurse practitioner/physician assistant, nurses, psychiatrist, social worker, dietician, pharmacist, physical therapist, and a physician overseen by the HBPC Program Director and Assistant Program Director.  In 2007, the VA recognized that when individuals have medical problems and associated limitations, patients often have emotional sequelae, and that this emotional sequelae further exacerbates medical problems.  As such, psychologists were included in the HBPC treatment team to address these mental health needs.

The HBPC psychologist functions as the primary mental health provider of the treatment team, providing assessment and treatment in the veteran’s home environment as well as professional consultation services to HBPC team members in formal/informal meetings. Assessments typically involve mood and cognitive screenings.  Treatment most often is focused on the veteran but may involve their family members for addressing issues related to the veteran’s care (e.g. management of challenging behaviors, caregiver stress, etc.).  Experiences in the HBPC psychology rotation will allow interns with interests in geropsychology and health psychology to broaden their skill base. 

Recruit Evaluation Unit (REU)

Recruit Mental Health is responsible for addressing the mental health needs of the entire Recruit population of the United States Navy. The REU screens over 20,000 active duty personnel per year and helps ensure that the Navy maintains quality recruits as well as affords the opportunity for personnel to maximize their potential while serving their country. The Recruit Evaluation Unit (REU) is an assessment mental health clinic that conducts suitability for service evaluations to identify conditions and behaviors that may impair a recruit’s ability to complete recruit training and perform future assigned duties.  The Psychological Resilience Outreach (PRO) psychoeducational groups and 1:1 interactions assist recruits to develop strategies to overcome the physical challenges they have experienced during basic military training. The Psychoeducational Program (PEP) provides structure and support for those recruits transitioning back into the civilian population.  Under the supervision of a credentialed provider, interns are expected to conduct psychosocial intake interviews of recruits referred for assessment, administer psychological test batteries, and co-facilitate psychoeducational groups.

Tasks and objectives:

  1. Conduct suitability for service / fitness for duty evaluations for active duty Navy personnel. 
  2. Conduct safety assessments on high risk patients.
  3. Consult with Command and active duty personnel on mental health related concerns.
  4. Complete comprehensive evaluations including objective psychological assessments. 
  5. Provide short-term, solution-focused interventions aimed at increasing coping mechanisms in the recruit training environment.
  6. Co-facilitate psychoeducational groups at PEP (Psychoeducational Program) for recruits exiting military service via administrative separation. 
  7. Co-facilitate resiliency and skill based groups for recruits pending continuation of naval basic training.
  8. Present on stress inoculation, performance enhancement and resiliency based skills to naval recruits during the first week of basic training. 
  9. Become proficient on the intersection of military regulation, medical readiness, and mental health conditions.
  10. Learn about military cultural competence within an active duty environment.
  11. Teaching and mentoring behavioral health technicians.

Geropsychology 

The Geropsychology rotation includes an amalgamation of experiences in areas of health psychology, geropsychology, rehabilitation psychology, and neuropsychology. The intern in the Geropsychology rotation will spend their time in the Community Living Centers (CLC) providing patient-centered care to aging Veterans and working with the CLC interdisciplinary teams. 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 Greenhouses Homes. All of the CLC households 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 intern 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 intern 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 intern 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 involved with the STAR-VA program. The intern will also assist with the completion of annual cognitive and psychological screenings for CLC residents. These screeners include the administerion of the Montreal Cognitive Assessment (MoCA), Geriatric Depression Scale-Short Form (GDS-SF), and Geriatric Anxiety Inventory (GAI). Additional opportunities include providing in-service education to medical doctors and nursing staff regarding psychological and cognitive challenges that aging Veterans face, and participating in family/patient council meetings. The intern works closely with various interdisciplinary teams through attendance at meetings for each CLC household where the patient, family, or guardian are often present.  The intern will graduate to engaging in independent rounds on households, which may include on-the-spot education and trouble-shooting with direct care staff to improve resident compliance or reduce problem behaviors interfering with care.

The intern will also have the opportunity to gain expereince or refine their skills in completeing comprehensive neuropsychological evaluations with aging Veterans that have complex medical, cognitive, social, and mental health commorbidities. 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 intern’s previous experience with neuropsycholgical testing, they will develop and/or refine their skills in test selection, data interpretation, report writing, diagnostic clarification, and the provision of examination findings to the patient, family, and interdisciplinary teams.

The intern, Geropsychology postdoctoral fellow, CLC psychologist, and neuropsychologist will participate in a monthly journal club. The intern will be responsible for choosing an article and leading a discussion among those present.

Building Recovery In Service of Development of Growth and Enhancement (BRIDGE)

The Building Recovery In service of Development of Growth and Enhancement (BRIDGE) Program is an intensive outpatient program designed to provide mental health services to individuals whose needs are not likely to be met through more traditional outpatient services. The population served includes individuals with serious mental illness (i.e., the schizophrenia and psychotic disorders, the bipolar disorders, and severe presentations of major depressive disorder and PTSD), as well as individuals with other diagnostic presentations. Services provided include group psychotherapy and psychoeducation, case management, and community integration, among others. The psychology intern will facilitate groups, conduct initial psychological assessments, and participate in interdisciplinary team meetings including intake and discharge planning. If desired, intern may also provide individual psychotherapy and assist in community integration at times. Evidence-based treatments utilized on this rotation include Social Skills Training, Dialectical Behavior Therapy, Acceptance and Commitment Therapy, the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders, and Cognitive-Behavioral Therapy generally. This rotation is available as a minor rotation.     

Administration and Leadership (Minor Only)

The Administrative and Leadership Minor rotation is designed to provide interns with greater exposure to the operations of Mental Health services in the VA system.  Psychologists are committed to promoting and enhancing patient care and well-being. Part of this work involves determining whether Veteran’s needs are being met and evaluating whether they are receiving the best quality of care. This rotation provides interested interns with the opportunity to learn about and actively engage in program development, oversight and evaluation from an administrative level.   Moreover, interns will have the opportunity to observe and participate in the activities of leadership staff to better understand health care at the macro level.  Finally, this rotation is designed to provide potential methods of preparing for leadership opportunities in areas of clinical health care administration.  The rotation is aligned with the VHA strategic plan which has three guiding principles to their problem solving and decision-making process: being people-centric (enhance connections with Veterans and engage with its own employees), results-driven (new emphasis on data collection, metrics, performance measures, and accountability), and forward looking (investment in technology, systems, programs, and business processes for requirements of the future).  Intern activities on this rotation may lead to beneficial outcomes for programs at the Lovell FHCC Medical Center.

Upon completion of the Administrative minor rotation, interns will have gained a deeper understanding of the systems-level operation of Mental Health programs throughout the facility and the multitude of factors that influence implementation of healthcare policy and impact patient care. This understanding will include knowledge of the various roles of psychologists as administrators and leaders in VA and the Veterans Integrated Service Networks (VISNs), which will guide discussion of potential developmental steps to take toward administrative roles in a variety of areas. Factors such as finances, physical structure limitations, political initiatives, and health care systemic considerations will be discussed. An understanding of the VISN’s role in implementing directives from Central Office as well as relaying initiatives from the hospital level to Central office will be explored. 

The intern will complete an Individual Development Plan. Additionally, the intern will complete a pre and post rotation self-rating and post-rotation supervisor rating on the same measures. Intern will also engage in a leadership 360 degree rating process and engage with VHA National Center for Organization Development in leadership training and initiatives.  Interns will also develop a strong understanding of the Uniform Mental Health Services Handbook, and key mental health performance measures.  Specifically, Interns will become more familiar with mental health quality improvement data found on the Mental Health Management Systems Dashboard (MHMS), Strategic Analytics for Improvement and Learning (SAIL); and become aware of how it is collected and analyzed.  Interns will develop an understanding of the gaps that exist between mental health policy and patient care operationalized at the facility as well as develop working knowledge of the challenges involved in bridging this gap.  The intern will also gain experience working collaboratively with facility mental health leadership, medical center leadership, clinics or programs to develop an administrative project related to a national initiative implemented at their local facility. 

The Administrative Minor is designed to be flexible and support the personal and professional goals of the intern.  However, core components include the following:

  1. Develop an administrative project. The nature of the project will be determined by the intern in collaboration with the rotation supervisor and will depend on the opportunities currently available within the VISN and the facility. Projects may include but are not limited to program assessment, implementation and evaluation. Ideally, the project will be implemented and applied at Lovell FHCC Medical Center, allowing the intern to gain firsthand experience with the implementation of initiatives from the national to local level. 
  2. Attend leadership meetings. These meetings may include mental health manager’s meeting, division meetings, and specific mental health work groups, etc., all of which discuss issues relevant to the operation of mental health across the network.
  3. Shadow a member of the Management or Leadership Team within the VISN. The nature of the shadowing will be determined collaboratively by the staff member being shadowed, the rotation supervisor, and the intern. Shadowing may involve spending several hours to one day with the staff member, attending meetings, and/or conducting an informational interview with the staff member.
  4. Demonstrate knowledge of key mental health databases, performance measures and metrics: The intern will be introduced to mental health performance measures such as SAIL, Mental Health Management Systems Dashboard ( MHMS), Mental Health Information Systems Dashboard (MHIS); labor mapping; clinic grid set-up; NEPEC; access measures; and demonstrate an understanding of the ways that data analysis informs program implementation and evaluation.
  5. Meet with Network Officers and Hospital Level Leadership: The intern will engage in individual 30-60 minute meetings with Network Directors of each program area in order to gain an understanding of that individuals responsibilities and the function of the program they oversee including challenges and successes of that program. This includes but is not limited to program directors, Mental Health Chief, Training Directors, Designated Education Officer, Suicide Prevention Coordinator, Disruptive Behavior Committee Leadership, Executive Psychologist, Quality Management Officer, Evidence-Based Coordinator, and others’ in leadership.
  6. Complete readings of program evaluation, needs assessment, and managerial literature. The reading list will inform and support the personal and professional program evaluation goals of the intern. Some materials will be standard and will be assigned as the rotation develops while other materials will be assigned as they become relevant (e.g., a research study or report that comes out which is influencing current policy decisions in VA).
  7. Understand relevant policy initiatives and how they are being implemented at our medical facility: The intern will stay up-to-date with various VA, VISN, and local policy initiatives such as the Mission Act, No Suicide Campaign, REACH Vet, etc. They will have a working knowledge of the initiatives, complete related TMS trainings and attend relevant calls pertaining to these initiatives.
  8. Variable activities. As they arise the intern will engage in activities that come up that may not be known or planned at the start of the rotation. These include events such as accompanying the interns supervisor to a presentation they are giving, fielding emergency phone calls from facilities, visiting Central Office, and attending unplanned meetings at the VISN and hospital level. 

The frequency and intensity of supervision will vary, based on the intern’s level of experience and training.  An intern would be expected to meet for face-to face supervision once per week for one hour.  Spot supervision will be available as needed.  Psychologists can serve across the organizational charts in a variety of ways, both within mental health and outside of mental health.  Supervision works to aid the trainee in identifying where their potential interests combined with areas of strength match with future administrative or organizational roles.  Lastly, supervision also assists the trainee in developing an individual development plan which would be regularly reviewed in supervision.

Women’s Health Primary Care

Women’s Health Primary Care is a dedicated primary care clinic space within the main hospital that offers a comprehensive array of services to individuals whose birth sex or gender identity qualifies them for women’s health care including CHAMP VA and Tricare receipients, transmale, nonbinary and transfemale patients. Women’s Health Primary Care patient population is characterized by significant portion of patients with complex psychosocial backgrounds due to sexual trauma, post-traumatic stress disorder, intimate partner violence and homelessness.  Services within Women’s Health Primary Care clinic are provided by an integrated mutlidisciplinary team to include corpsman, clinical pharmacists,  dietician, social work, nursing and primary care physicians.  Women’s Health Primary Care shares clinc space and works in close collaboration with other associated services to include the Women’s Veteran Program Manager, LGBT coordinator, Gynecology, Mammography and a Pelvic Floor Physical Therapist. Providers are closely aligned with the Whole Health model of service delivery and offer a range of complimentary and integrative medicine approaches (CIH).

The Women’s Health Primary Care rotation provides training in consultative behavioral health care using brief and traditional evidence based interventions.  However it is not a PCMHI rotation and the model for mental health care delivery is most in line with a trauma informed hybrid approach with higher level of co-located mental health services available.  Referrals for mental health services provided are generated by the providers of the clinic.  The Women’s Health Primary Care rotation occurs within the Primary Care Department and is not situated within the Mental Health Directorate.  The standard appointment time includes 60 minutes sessions with session limits that are tailored to the nature of the service being offered and patient.  Behavioral health training opportunities may include same day consulation and shared medical appointments as requested by the primary care provider.  Trainees may also have opportunity to pariticpate in health coaching and brief therapies for common behavioral health complaints (e.g. insomnia).  Trainees will expect to participate in staff huddles, team meetings and related committes including the Whole Health Steering Committee and Women Veteran’s Committee.  Key aspects of the rotation also include facilitating or co-facilitation of group psychoeducation, group psychotherapy, and providing patient and staff education on mental health topics. Specialty services offered in this rotation may include biofeedback and evidence based  ROSE postpartum depression prevention program training and class facilitation.  Additionally the rotation supervisor is a site contact for local transgender evaluations and co-facilitates the Pride and Service LGBT support groups.  Trainees are welcome to participate in program development activities as the current rotation and service continues to evolve. 

Outpatient Mental Health Clinic

The Outpatient Mental Health Clinic provides outpatient treatment to male and female Veterans and active duty service members presenting with a range of psychological conditions, including, but not limited to: depression, anxiety, Bipolar Disorder, Adjustment Disorder, PTSD, Personality Disorder, relationship and work-related/career issues. The Outpatient Mental Health Clinic involves a multi-disciplinary team comprised of psychologists, psychiatrists, social workers, nurses, psychology technicians, program support assistants, along with active duty service members. Treatment addresses a broad range of short-term and long-term services. Supervisors in this rotation have been trained in Cognitive-Behavioral Therapy and Acceptance and Commitment Therapy, as well as certain evidenced-based practices. Interns on this rotation would be part of one of 2 Veteran teams in the clinic. Interns on this rotation would be expected to perform a number of initial evaluations, carry a caseload of short and long-term individual and/or family/couple psychotherapy clients, attend weekly staff meetings, conduct one integrated assessment, and complete one diversity project. Opportunities to co-facilitate or create a group are also available. Interns on this rotation may choose to do a major or minor rotation.

Substance Abuse Recovery Program (SARP):

The SARP offers substance use evaluation, early intervention services (level 0.5), outpatient (level I), intensive outpatient (level II), and continuing care support to active duty service members who have problems with substance use. The program offers interns the opportunity to engage in a training experience with a population of diverse active duty military across the spectrum of substance use severity.

The intern will develop skills in all the areas covered by psychologists within SARP, including evaluation, psychoeducation, treatment and continuing care (e.g. psychotherapy and recovery planning), and treatment planning with service members. The SARP provides services to military members referred for an alcohol or drug related incident (ARI), members who are referred by their command due to concern about substance use, and individuals who self-refer for treatment or education.

The intern on the SARP rotation is an integrated member of the interdisciplinary treatment team, made up of an active duty psychiatrist, support staff, psychologists, social worker, civilian addiction rehabilitation technicians and active duty substance abuse counselor trainees. The SARP has two full-time psychologists available to provide supervision and/or mentoring.

The position emphasizes advancement in the areas of biopsychosocial assessment, risk assessment, addiction assessment, individual/group psychotherapy, psychoeducation lectures, treatment planning, aftercare/discharge planning. In addition, the intern will receive unique training experience in care coordination with referral sources, including member’s command and other outside treatment facilities. SARP 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 SARP include Motivational Interviewing (MI), Twelve Step Facilitation (TSF), Relapse Prevention from a Cognitive Behavioral perspective, and Acceptance and Commitment Therapy (ACT).

The mission of the SARP is to provide active duty service members with treatment for alcohol and other substance use disorders. Services are designed to assist service members in reaching their goals for engagement in healthy behaviors, substance use recovery, and return to full vocational functioning in the military. SARP objectives are to provide services in collaboration with the service member to identify and negotiate barriers with a focus on the strengths, needs, abilities, preferences and goals of the individual.