Internship in Professional Psychology |
VA Tennessee Valley Healthcare System
Rotations in Behavioral Medicine
| Women's Clinic | Inpt. Rehab.** | Organ Transplant |
| Behavioral/Hospice | Geropsychology | **Possible Rotation |
Location: An Off-Site Location Near the Nashville Campus
Supervisor: Dr. Michele Panucci
Women now comprise 17 percent of active duty deployed forces and are becoming veterans at an increased rate. Of the 22.8 million veterans who use VA for healthcare, 10% are women. By 2010, women are expected to represent over 14% of the total veteran population. According to population census estimates, there are 60,000 women veterans residing in Tennessee and Kentucky (TVHS-catchment area).
Setting: This rotation is in the new, beautifully furnished Women’s Veterans Comprehensive Health Care Center, located off-site---approximately 2 miles from the Nashville Campus. The clinic is comprised of both Primary Care providers and mental health professionals providing integrative services to veterans including: primary care, gender-specific care, mental health (including medication management, psychotherapy and brief health promotion interventions), social services and addictions treatment for women veterans. The clinic is currently staffed by a Psychiatrist, Psychiatric Nurse Practitioner, Psychologist, Social Worker, Addictions Counselor, 3 Physicians, 3 Nurses and 2 support staff.
What Interns Will Do: The intern who works at the clinic will be responsible for providing many of those services offered by the single Psychologist affiliated with the clinic. These will include: individual and group psychotherapy for Military Sexual Trauma (MST), combat-related trauma and other psychiatric issues such as depression/bipolar affective disorders, anxiety, eating disorders, adjustment problems, etc. The intern will also be responsible for seeing Primary Care patients referred by their physicians on the day of their PC visit for stress-related problems that are negatively impacting their health. Additionally, interns will participate in individual/group smoking cessation and weight management (MOVE) programs and the Addictions Intensive Outpatient program (IOP) as requested.
Important Note: The mandate for this clinic states that it will be staffed by female professionals only; therefore the rotation will be open only to female interns.
Inpatient Rehabilitation/Health Psychology Consultation and Assessment Rotation
Location: Nashville Campus
Supervisor: Thomas Hagood, Ph.D.
A wide variety of training experiences are included in this rotation. The experiences are described below.
2G-GEM: This is a 10-bed inpatient unit housing veterans in need of short-term medical care and treatment (2-3 weeks) while undergoing rehabilitation. The intern is responsible for participating in weekly multidisciplinary discharge planning meetings and medical rounds with physicians, nurses, pharmacists, physical therapists, occupational therapists, social workers and dietary consultants. Consultation requests include: cognitive testing/screening to assess limitations and determine functional status, diagnostic clarification (e.g., depression vs. dementia), and short-term treatment for anxiety and adjustment disorders. The intern is responsible for providing the medical team with information that is critical to appropriate placement of the veteran following discharge. Interns will also follow some patients for brief, supportive therapy while they are in the hospital.
Smoking Cessation Program: The intern will conduct two group sessions weekly, an Introduction to the Quit Process Group and a Relapse/Coping Group. The first group involves the provision of basic information about the process of quitting and education on the use of Nicotine Replacement, Zyban, Chantix as tools in the process of smoking cessation. The second group focuses on identification of triggers, coping skills and stress management techniques. The smoking cessation program also involves performing assessments of hospitalized patients directed to quit smoking and follow up with outpatient consult requests to assess veterans for participation in the smoking cessation group. Occasionally, individual sessions with patients unable to attend group will also be conducted. Written handouts and modules for the Smoking Cessation program will be developed. Interns co-facilitate groups at the start of the rotation and then act as main facilitators later in the rotation.
Korean War/WW II Group: This is a twice-monthly group comprised of veterans from one or both wars. Some of the participants are ex-POWs. Interns act as co-facilitator with at least one or two experiences as sole facilitator of the group.
MOVE Group: The MOVE program is a weight management program developed by the VA National Center for Health Promotion and Disease Prevention (NCP), to help veterans lose weight, keep it off and improve their health. The VA serves over 6 million veterans nationwide of whom 70% are overweight or obese. Participants are enrolled in the MOVE group through referral from Primary Care. It is a weekly to monthly support group for interested veterans involved in the MOVE program. Interns act as co-facilitators of the group and will be expected to contribute to session content through development of group exercises and written materials.
Bariatric Evaluations: The intern will learn to conduct psychological evaluations that are required for patients who are interested in having bariatric surgery. The evaluations include psychological testing, clinical interview, and review of medical records. Psychological tests used in the evaluation include the Drug Use Screening Test (DAST), Questionnaire on Eating and Weight Patterns-Revised (QEWP-R©), Multidimensional Health Locus of Control (MHLC), Alcohol Use Disorder Test (AUDIT-C), and the Millon™ Behavioral Medicine Diagnostic (MBMD™). The intern will also learn to write the psychological report in compliance with VA standards for bariatric psychological evaluations. Please note, the opportunity to fully participate in this activity is dependent on the flow of consults during the rotation.
Location: Nashville Campus
Supervisor: Dr. Saundra Appelt Saporiti
Setting: The psychologist on the liver, heart, stem cell, and kidney transplantation services is an integral part of the transplant teams at this regional academic transplant center, which operates in conjunction with Vanderbilt University. Psychological evaluations of potential transplant candidates and their support person(s) are performed. These evaluations involve a diagnostic interview, cognitive and personality assessment, and a collateral interview. The psychologist formulates specific recommendations regarding suitability for transplantation, and possible interventions or behavioral markers which should be met before the candidate is listed. Follow-up in regard to the patient’s progress in meeting intervention goals is an ongoing part of the evaluation. Results of the evaluation are presented in an interdisciplinary team meeting involving psychologists, transplant physicians, transplant surgeons, nurses, and social workers. Candidacy for transplant is decided at these meetings. In addition to evaluation, psychological interventions (psychotherapy and support groups) are provided for pre- and post-transplant patients and their families/support persons.
What Interns Will Do: The intern and the staff psychologist attend team meetings together and are jointly involved in all aspects of the rotation. A goal of this rotation is the objective assessment of the risk of noncompliance, including relapse to smoking and substances of abuse, presence of dysfunctional family systems, presence of psychopathology, and cognitive impairment, any of which might be a barrier to successful transplantation. The intern must learn to communicate and report to non-mental health medical personnel clearly, both orally and in writing, and to work closely with medical center staff from a variety of disciplines. In addition, the intern will attend the Liver Support Group for pre- and post-transplant patients, as well as provide psychotherapy to pre- and post-transplant patients, as needed.
Research: While there is no ongoing research project on this rotation, there is great potential for research if the intern is interested in initiating a project.
Behavioral Medicine/Hospice Rotation
Location: Murfreesboro Campus
Behavioral Medicine Supervisor: Dr. Lori Vehring
Hospice Supervisor: Dr. Sharon Gordon
This rotation is designed to provide the intern with an opportunity to "try on" the practice of Health Psychology. Supervisors work with the intern to develop the Behavioral Medicine experience that s/he would like during this rotation. While the rotation includes experiences from a variety of clinical opportunities, it is comprised of 3 core components (ICU, Hospice, and Preventive Medicine) that allow for exposure to clients typically seen with a specialty practice in behavioral medicine: patients seen in the hospital setting, individuals newly diagnosed or coping with a chronic medical condition or a terminal illness, patients being considered for a medical treatment in which there may be significant psychological factors, and/or the family members of any these patients.
The majority of the patients encountered on this rotation are in the geriatric age group.
Core Training Components
Intensive Care Unit (ICU) – Interdisciplinary Treatment Team – Ten-Bed Medical/Surgical Intensive Care Unit - Interns screen for psychiatric and cognitive problems by conducting interviews and mental status exams as well as attending bed rounds with other staff including physicians, residents, medical students, nursing, social work, respiratory therapy, and nutrition.
Hospice/Palliative Care – Twelve-Bed Unit – Interns conduct supportive psychotherapy for patients and family centering on life review and end of life issues.
Preventive Medicine – Consult Service – Evaluation of patients being considered for treatment in Hepatitis C Clinic and co-facilitation of Stress Management Group for veterans newly diagnosed with diabetes mellitus. Psychology also periodically facilitates smoking cessation, healthy lifestyle/weight management, and pain management groups using a combination of cognitive behavioral strategies and clinical protocol developed by the VA National Center for Health Promotion and Disease Prevention.
Additional Training Opportunities:
Acute Medicine/Surgery – Consult Service – Interns evaluate and provide recommendations for patients with terminal illness, family problems, behavior problems, and mental status changes.
Biofeedback Service – Consult Service – Interns will have the opportunity to gain experience in peripheral biofeedback techniques for the management of ongoing health related concerns, particularly chronic pain conditions.
Intermediate Medicine – Consult Service – This component of the rotation is similar to the Acute Medicine/Surgery component. However, the patients in Intermediate Medicine are usually undergoing rehabilitation services and are not as sick as those in Acute Medicine/Surgery.
Spinal Cord Injury Clinic (SCI) – Consult Service – Interns screen for psychiatric and cognitive problems by conducting brief assessments, mental status exams, and clinical interviews. Interns participate in annual screenings and provide recommendations for patients with recent and long term spinal cord injuries, family problems, behavior problems, and mental status changes
Preservation-Amputation Care and Treatment (PACT) – Consult Service – This component of the rotation is similar to the Spinal Cord Injury component. However, these patients are new amputates versus the SCI patients who have typically passed the acute adjustment phase. The focus of this evaluation is to assess level of adjustment and coping. The intern will provide support as needed for the veteran and/or family members via direct intervention or appropriate referral.
Research – Interns will have the opportunity to participate in ongoing Geriatric Research, Education, and Clinical Center (GRECC) projects involving the examination of long-term cognitive outcome of critical illness.
Location: Murfreesboro Campus
Supervisors: Drs. Erin Patel and Cara Pendergrass
Setting: Interns on this rotation will provide psychological services to six long-term care units within the hospital and attend the weekly treatment team meetings. Interns will also be involved in cultural transformation activities on these units, such as providing staff education regarding non-pharmacological behavioral management and promoting an environment of care. Most of the veterans on these units are 65 or older and most have co-morbid medical, cognitive, and psychiatric conditions. Interns will have substantial opportunity to work on interdisciplinary teams; engaging with medical staff, nurses, dieticians, pharmacists, physical and occupational therapists, chaplains, social workers, and recreational therapists, as well as family members. This rotation can include the multiple training experiences listed below:
CLC-9B- Patients on this unit are undergoing physical rehabilitation for a variety of medical reasons (i.e., amputation, stroke, accidents or falls, cardiac-related surgeries, multiple sclerosis, traumatic brain injury, etc). Interns will evaluate and provide recommendations for patients on this unit; psychological and cognitive assessment and therapy opportunities available.
CLC-8A- This unit provides long-term care to veterans with dementia and/or chronic psychiatric conditions. Consults for this unit typically result from patient non-compliance and/or behavioral problems. There are opportunities to work with staff to develop behavioral management plans for patients and to perform individual psychotherapy, assessment, and group psychotherapy.
CLC-8B- This unit provides long-term care to veterans with chronic psychiatric conditions who have been unable to live successfully in less-restrictive placements. Assessment, individual therapy, and group therapy opportunities are available. The intern will also be able to work with staff and/or veterans in developing behavioral management plans/contracts.
CLC-E- This unit is more typical of a community nursing home setting. Health psychology interventions are available on this unit, such as medication compliance, smoking cessation, palliative care, chronic pain management, etc. Interns will be asked to complete diagnostic interviews, assessment (may include capacity assessment), individual and group therapy, and to assist in the development of behavioral contracts with veterans.
CLC-W- This unit provides care for residents with dementia. This is a secured unit due to many of the veterans being at high risk for wandering. Interns will be involved in staff education on managing inappropriate behaviors, assessment, and possibly group therapy. There are also opportunities available to work with family members, such as running a caregiver support group.
CLC-SW- This is a 12-bed gero-psychiatric unit. Assessment, individual therapy, group therapy, and behavioral management opportunities are available.
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9-22-2009