Purpose: This is an extension of the required Integrated Health Psychology Rotation. Interns that elect this track will have an additional 4 months during the year, as well as every Wednesday throughout the year, to train in those medical psychology settings that most interest them. This additional time allows an intern to explore and train in a much broader range of medical psychology experiences than is possible through the required rotation in med psych. Also, interns can use this additional time to develop expertise in one or two sub-areas of medical psychology.
This program provides evidenced based psychological assessment/evaluation, cultural formulation, and treatment in the context of interdisciplinary outpatient and inpatient treatment teams. The patients served have a broad array of problems/disorders, including a wide range of medical diagnoses (see below) with psychological comorbidities. Interns will serve in an integral role in the comprehensive care of patients through their assessment and treatment of behavioral issues related to medical treatment adherence and comorbid psychopathologies, including anxiety and mood disorders, trauma-related disorders, somatic symptom disorders, feeding and eating disorders, sleep-wake disorders, disruptive/impulse-control and conduct disorders, personality disorders, and psychotic disorders. Treatments include individual and group therapies using evidence-based psychotherapies from cognitive behavioral and contextual behavioral science traditions, such as traditional CBT, behavioral activation, motivational interviewing and acceptance-based behavioral therapies (e.g., ACT, DBT, CFT).
Settings:
At the Uptown VA Hospital:
At the Downtown VA hospital:
At AU Health:
Faculty:
Goals/Objectives of the Clinical Health Psychology Track emphasis training: We expect that interns will develop specific skills and knowledge pertinent to their settings and to the medical conditions and psychological comorbidities being treated. In addition we expect that interns will develop general competencies important for success in most medical psychology settings. Below are the 11 core competencies we promote in both the required Clinical Health Psychology Rotation and the optional Clinical Health Psychology Track experience. Please note that any reference to the patient below will likely include the patient’s family and significant others.
VA Medical Rehabilitation 10-Bed Inpatient Program: The Medical Rehabilitation Unit is a sub-acute unit located at the Uptown Division. The mission of our Comprehensive Inpatient Medical Rehabilitation Program is to work effectively as a healthcare team to provide quality rehabilitative care and training to our patients, their families, and caregivers. Our goals are to promote maximum individual independence, to enhance the lives of veterans as they transition to the highest practicable level of independent living, and to provide the best continuum of care. Psychology interns function as a member of a comprehensive interdisciplinary team including psychiatry, nursing, social work, and psychiatry, as well as physical, speech, occupational, and recreational therapy. Assessments of neurocognitive status and personality are common, and opportunities to provide individual therapy are available on a regular basis.
VA Blind Rehabilitation 15-Bed Inpatient Program: Partial or complete loss of vision can have a profound effect on one’s life and often requires a complete readjustment of roles, activities and living skills. A person faces significant psychological challenges and stressors as they try to adapt to a loss of independence and to a narrowing range of options for positive engagement in life. The VA has taken a lead role nationwide in providing comprehensive rehabilitation for veterans with vision loss by creating ten regional inpatient rehabilitation centers, one of which is located in Augusta. Psychological services are provided at each center as part of an intensive multidisciplinary program of training and adjustment services to veteran who are either losing their vision or are totally blind.
Psychology interns have the opportunity to work with Blind Center patients. Typically this involves initial assessments of changes in their quality of life due of vision changes, assistance with coping and adjustment, monitoring of pre-existing mental health issues such as depression and PTSD, positive psychological interventions designed to enhance quality of life, cognitive testing if the veteran is not learning as expected in their skills classes, and “INte consultation to the team pertaining to psychological issues.
VA Polytrauma/TBI Outpatient Clinic: The Polytrauma/TBI Outpatient Clinic provides assessment, referral, and case management services to OEF/OIF soldiers and veterans with TBI. The treatment team consists of a physiatrist, clinical psychologist, nurse, and social worker. During the multidisciplinary team interview and evaluation, a wide range of possible referrals are made to facilitate comprehensive treatment for each service member. Psychology interns function as a member of this comprehensive interdisciplinary team by conducting an interview and assessment of neurocognitive status and psychological functioning. Opportunities for short- and long-term psychotherapy as well as assessment and treatment team meeting attendance are available throughout the year. Involvement in telehealth activities and research related to TBI are also available based on the interest of the intern.
VA Primary Care Psychology Services: There are 6 primary care medical teams at the VA with embedded mental health staff assigned to them. These are busy outpatient VA primary care medical clinics dedicated to providing embedded mental health services and assisting the clinical staff. The intern can negotiate his or her role in this clinic from shadowing staff to independent provision of services.
VA Geriatric Services: The VA has a full-time geropsychologist covering the community Living center, palliative care and home-based programs. Interns interested in this area can arrange for training and supervision in selected areas of geriatric psychological care.
VA Health Promotion and Disease Prevention Program: The Health Promotion and Disease Prevention (HPDP) initiative is designed to integrate behavioral health principles into the continuum of health care at the VHA. The initial initiatives are paired with the refocusing of the primary care clinics to provide comprehensive patient centered health care thorough Patient Aligned Care Teams (PACT) and Community Based Outpatient Centers (CBOC). The philosophy is for each veteran to become actively involved in their health care. Initial prevention and health promotion targets are for each veteran to be tobacco free, physically active, choose good nutrition, strive for a healthy weight, manage stress, limit alcohol, receive recommended screenings and immunizations and be aware of safety issues. Bariatric surgery evaluations are also part of the routine clinical duties.
VA Spinal Cord Injury/Disorders Center: The Charlie Norwood VAMC Spinal Cord Injury/Disorders (SCID) Center covers much of the southeastern United States and is one of 11 VA SCID Centers in the nation. This center provides services to veterans and active duty service members who have acquired a spinal cord condition. Services include a 71-bed inpatient unit, an outpatient program for medical and psychological management, and a home based health care program. All patients receive a psychological evaluation on admission. The SCID service continues to follow veterans for their general medical care for the remainder of their life, so all veterans also receive a psychological evaluation annually. Clinical activities involve rehabilitation of newly acquired spinal cord conditions and multiple sclerosis. Additional activities involve psychological consultation and management of veterans with SCI who have co-occurring mental health conditions, traumatic/acquired brain syndromes, and/or substance abuse conditions. Psychology works closely with other members of the multidisciplinary team that includes physicians, physician assistants, physical therapists, occupational therapists, recreational therapists, nurses, pharmacists, a speech/language pathologist, a nutritionist, and respiratory therapists. There is also frequent consultation with a variety of medical specialists from psychiatry, neurology, neurosurgery, oncology, orthopedics, and infectious disease. Caseloads vary with opportunities to work in rehabilitation for veterans/active duty personnel with new spinal injuries and/or multiple sclerosis, with veterans diagnosed with comorbid psychological and/or acute medical conditions, and in behavioral-health consultation. Intern activities typically involve evaluation of emotional and cognitive functioning; health behavior assessment, education and treatment; treatment of emotional and behavioral complications associated with adjustment to their medical condition; behavioral pain management; and treatment of a variety of traditional psychological conditions.
MCG/AU Health Infectious Diseases – HIV/AIDS clinics: The AU Health Infectious Diseases Clinic treats close to over 1200 HIV-positive individuals and is the recipient of Ryan White Title B and C funding that provides primary and ancillary medical services to indigent HIV-positive patients. The intern functions as part of a large interdisciplinary primary care team, training and practicing alongside physicians, physician assistants, nurses, case workers, treatment navigators, peer specialists, fellows, medical students, and social workers. In this setting, the intern will gain skills in consultation to physicians and patients, rapid assessment, crisis intervention, motivational interviewing and behavioral interventions. The Pediatric Infectious Disease Clinic provides similar services to the adult clinic, but on a smaller scale due to the small caseload in this clinic. The intern will also spend more time in consultation with parents and families of HIV-positive children and may also participate in the clinic support groups.
MCG/AU Health Behavior Outpatient Clinic: Interns will have an opportunity to work within the department Health Behavior outpatient clinic as a part of an interdisciplinary team consisting of clinical psychologists, psychiatrists, psychiatry residents, and social work. Primary responsibilities will include intake evaluations for clients interested in pursuing psychotherapy and maintaining a case load of weekly psychotherapy clients. Interns will meet weekly with the interdisciplinary HB team to present cases, discuss medication and psychotherapy recommendations, and milieu treatment options.
MCG/AU Health Eating Disorders Program: The AU Health Eating Disorders Program primarily offers comprehensive outpatient assessment and treatment services to patients struggling with eating disorders and other forms of feeding disturbances. Inpatient treatment is also available, especially to children and adolescents, but the emphasis is on the delivery of outpatient services and consultation/liaison services for patients hospitalized at AU Health and the Children’s Hospital of Georgia. Interns will be expected to work with a team of health professionals, including physicians from various specialties, psychiatrists, dietitians, social work, and a variety of other health care professionals on campus and within the Augusta community and surrounding areas. Specific treatment modalities may include individual, group and family therapies with an emphasis on empirically-validated forms of treatment.
MCG/AU Health Child & Adolescent Consultation/Liaison Service: The Division of Child, Adolescent, and Family Psychiatry provides consultation and liaison services to the Children’s Hospital of Georgia and the MCG/AU Pediatric Outpatient clinics. In this service, Interns have opportunities to provide consultations for inpatients and outpatients that include triage assessment for children/adolescents who have engaged in self-harm, differential diagnostic evaluation of children presenting with possible Somatic Symptom and related disorders, management of chronic illness and its associated challenges, and facilitative care in which support is provided for children and their families enduring medical trauma or diseases with poor prognoses.
Adult Psychiatry (supervised by Vanessa Spearman, M.D.) Inpatient Consultation/Liaison service: Interns will have an opportunity to work within the Adult Psychiatry’s Consultation/Liaison service under the supervision of a double board certified physician (Psychiatry & Internal Medicine). The interdisciplinary CL team includes Dr. Spearman, psychiatry residents and nurses, and potentially other trainees, including medical students and nurse practitioners. Interns will participate in rounds on the medicine floors and assess and treat patients with a wide variety of medical problems and psychiatric comorbidities. Interns will have a unique opportunity to share their behavioral medicine and cognitive behavioral skills with the rest of the team who have not necessarily had such training and experiences.
MCG/AU Health Center for Obesity & Metabolism: Interns will have an opportunity to work within the AU Health Center for Obesity & Metabolism as part of an interdisciplinary team consisting of surgeons, a nurse coordinator, dietitian and physician’s assistant. Primary responsibilities will include conducting a thorough evaluation to determine patient readiness for bariatric surgery and the likelihood of a positive outcome to the surgery. Assessment consists of a clinical interview and psychological testing. Interns will meet with members of the team to discuss the recommendations. Interns may also see the patients as a precursor to their surgeries if such is warranted and may also work with patient’s post-surgery to enhance treatment adherence and promote healthy coping with significant changes.
AU Health Cancer Center: The Division of Psycho-Oncology provides comprehensive psychiatric evaluation of medically ill (e.g., cancer or other illnesses) patients, throughout all phases of illness: initial diagnosis, during treatment, recurrence, chronic phases of illness, advanced cancer, end of life care, and during cancer survivorship at the Georgia Cancer Center at Augusta University. In this service, Interns have opportunities to provide: diagnosis and treatment of psychiatric syndromes associated with medical and surgical conditions (e.g., cancer or other illnesses) and the effects of these treatments; assessment and management of the major psychiatric disorders encountered in the medically ill/cancer patient including: Adjustment Disorders, Anxiety Disorders (e.g., Panic Disorder, Post-Traumatic Stress Disorder), Mood Disorders (e.g., Major Depression), Cognitive Impairment Disorders (e.g., Delirium), Psychotic Disorders, and Somatoform Disorders (e.g., Pain Disorder); assessment and management of psychiatric syndromes and psychosocial issues impacting families and caregivers of medically ill (cancer) patients, including issues related to palliative care and bereavement; and utilization of nonpharmacologic approaches in the management of psychiatric symptoms and syndromes in medically ill (cancer) patients, including specific knowledge of the use of individual psychotherapies (e.g., psychodynamic, supportive, interpersonal, existential, and spiritually oriented), cognitive-behavioral interventions (e.g., relaxation techniques, self-hypnosis, meditation), sleep improvement techniques, and bereavement counseling.
