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Rotations

The Addiction Psychiatry Residency Program has a great many options for clinical rotations, and an individualized schedule can be designed depending on each resident's prior experience and interests. Clinical rotations are available at a number of possible sites. Most residents complete about 3 months of inpatient work and 9 months of outpatient work, which they select from among the choices listed here.

VA PUGET SOUND ADDICTION INPATIENT AND OUTPATIENT STABILIZATION PROGRAMS

This 6-bed inpatient program admits about 300 patients annually. Most common diagnoses are alcohol dependence, cocaine dependence, opioid dependence, mood disorders, PTSD, and numerous serious Axis III disorders with most patients having multiple diagnoses. Residents typically spend 2 to 3 months full-time on this rotation. Residents do medical and psychiatric evaluations on newly admitted patients and direct the medically supervised withdrawal, medical, and psychiatric care for these patients. After the first month of orientation and training, residents serve as acting medical director and take primary responsibility for clinical and administrative tasks under faculty supervision. The outpatient Intensive Stabilization Service (ISS) is closely affiliated with the Inpatient Unit.  During the day Monday through Friday, inpatients and outpatients in ISS attend common psychosocial treatment activities.  Residents work as part of an interdisciplinary treatment team  and participate in the broad range of treatment provided to both the inpatients and outpatients enrolled in the intensive stabilization program.

VA OUTPATIENT CO-OCCURRING DISORDERS UNIT

This clinic has approximately 200 active veterans who experience a full range of substance use disorders as well co-occurring psychiatric disorders in the moderate-severe range.  The predominant psychiatric disorders are PTSD, mood/bipolar disorders, and psychotic spectrum.  Residents gain experience in evaluating and stabilizing new patients as well as provide psychopharmacologic treatment for veterans already established in treatment.  Residents work as an integral part of the interdisciplinary team and are expected to attend the staff meeting whenever possible in order to participate in treatment planning and a comprehensive approach to care.  If interested and depending on schedule constraints, residents are able to gain individual or group psychotherapy experience with this population.  Psychology and social work interns as well as psychology, social work, and chaplain fellows also rotate through the clinic. This rotation can be done part-time for 6-9 months.

VA INTENSIVE OUTPATIENT PROGRAMS and MONITORED MEDICATIONS

The census of the intensive outpatient programs is 35-70  patients at any one time. Patients are required to complete 4-6 weeks of treatment and attend group sessions 1-5 days per week as well as individual sessions. Most common diagnoses are alcohol dependence, cocaine dependence, opioid dependence, mood disorders, and numerous serious Axis III disorders with most patients having multiple diagnoses. Residents spend their time evaluating new patients, doing group therapy, providing individual case management for 1 to 2 patients at a time, providing psychopharmacologic services to patients, and participating in treatment team meetings. Residents will get considerable exposure to use of the addiction medications disulfiram (Antabuse) , naltrexone (ReVia), and acamprosate on this rotation. General psychiatry residents rotate through this program. Psychology and social work interns as well as psychology, social work, nursing, and occupational therapy fellows also rotate through the clinic. This rotation can be done part-time for 3-9 months.

VA OPIOID AGONIST TREATMENT PROGRAM

The clinic has 200 opioid dependent patients receiving agonist therapy. Most patients have other Axis I disorders and multiple medical disorders. After a suitable orientation period residents function as acting medical director. They evaluate new patients, prescribe methadone and buprenorphine, provide adjunctive psychiatric care, work with nurse practitioners and physician assistants to provide medical care, and attend treatment team meetings. Psychology interns as well as psychology, social work, nursing, and occupational therapy fellows also rotate through the clinic. This rotation can be done part-time for 6-12 months.

VA CONSULTATION AND EVALUATION

The clinic evaluates about 1000 patients per year. Most common diagnoses are substance withdrawal, alcohol dependence, cocaine dependence, opioid dependence, mood disorders, and numerous serious Axis III disorders with most patients having multiple diagnoses. Residents spend their time evaluating new patients, consulting to medical and surgical wards, and performing medically supervised withdrawal and stabilizing patients destined for treatment in one of the other addiction components. This rotation can be done part time for 3-12 months.

VA WOMEN'S TRAUMA AND RECOVERY CENTER

This program treats women only in a gender specific program.  There are two tracks within the clinic, onewith a substantial focus on trauma issues and the other track focusing primarily on addiction issues.  WTRC has a multidisciplinary approach and residents can be an important member the team.  Treatment approaches include medication management, group therapy and individual therapy/case management. Residents will treat veterans with primary addiction issues although most women will also have another psychiatric disorder in addition to substance abuse/dependence.  Residents can provide psychopharmacologic,  individual, and group psychotherapeutic treatment to women veterans. This rotation can be done part-time for 3-9 months.

HARBORVIEW MEDICAL CENTER OUTPATIENT SEVERE MENTAL ILLNESS/DUAL DIAGNOSIS PROGRAM

This units treats dual diagnosis patients who require emergent inpatient stabilization. Responsibility will shift from apprentice to primary responsibility over the course of the first month. Diagnoses include acute intoxication/withdrawal states and other Axis I disorders from adjustment disorders to schizophrenia. Work includes interviewing, diagnosis, orders, physical exams, team leading, charting, rounds, co-leading groups, discharge summaries. This rotation can be done full-time or part-time for 3-6 months.

HARBORVIEW Addictions Program INTENSIVE OUTPATIENT PROGRAM  (HAP  IOP)

This clinic treats addiction patients in intensive group therapy. Residents will serve as psychiatric consultants and also function as group therapists. This rotation can be done part-time for 3-9 months. One highlight of this program is the Women’s Addiction Recovery program which treats a substantial number of drug court referred women.  This program has won both in internal Harborview merit award from patient feedback and a King County Exemplary award for innovative programs in 2008.  There is a corresponding Men’s track also, with special content.  Each of these IOP programs are probably best experienced as one day rotations over the course of 6 months or so, such that a combination of both groups and individual sessions can be experienced, and so that progress across time can be both fostered and observed by the Fellow.  Often the Fellow may be doing auxiliary psychiatric therapy or medications to enhance the group therapy treatment.  A unique opportunity available here is supervision using Twelve Step Facilitation, and evidence based treatment to enhance linkage and successful utilization of community 12 step meetings.   Best day of the week for the Women’s Track is Fridays.  The Men’s IOP track meets on M T and Th evenings such that the rotations could be on one of those days starting at noon and ending at 8 pm.

HARBORVIEW MEDICAL CENTER CONSULTATION AND MOTIVATONAL INTERVIEWING

This program provides consultation and motivational interviewing to patients with substance use disorders who are hospitalized on medical or surgical units in Harborview,  Dr Chris Dunn, well known national trainer in  in Motivational interviewing will work one to one with Fellows taking this rotation which works well in combination with the IOP rotations. Residents will learn and practice fundamentals of motivational interviewing. This rotation can be done part-time for 3-6 months and is only available for either Mon or  Weds.

Harborview Addictions Program - Suboxone track

This track provides the opportunity for Fellows to learn how to best use Suboxone for opiate dependence, and as well participate in both group, 1:1 psychotherapy and psychiatric medications management with their assigned patients.  They may also learn to use 12 step facilitation as part of this rotation as this is a key part of our suboxone recovery track.  Again this rotation is probably best done for a full day, one day a week ( usually Tues or Wed) over the course of 6 months

SEATTLE CHILDREN'S ADOLESCENT CONSULTATION AND EVALUATION

This elective is offered by the Adolescent Substance Abuse Program at Seattle Chldren's Hospital, the premier pediatric hospital in the five state region.  Fellows will evaluate and manage adolescents with psychoactive substance dependence and co-occurring psychiatric disorders in the hospital's outpatient psychiatry clinic.  The large outpatient psychiatry clinic serves many adolescents of both sexes with a wide range of ethnic and racial backgrounds and a wide spectrum of socioeconomic backgrounds.  Fellows work closely with the adolescent addiction psychiatry attending who receives many referrals and consultation requests from community physicians and mental health/chemical dependency treatment providers.  Fellows have opportunities to see patients individually or jointly with the attending to learn about adolescent-specific interventions and psychotherapeutic techniques.  General psychiatry residents and child psychiatry fellows also rotate through the clinic.  This rotation can be done part-time for 6-12 months.

 
Department Harborview Medical Center UW Medical Center VA Puget Sound Health Care System