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University of Washington School of Medicine
Psychology Internship Program

 

Rotation Descriptions

This section provides a more detailed description of the training emphasis tracks, and available rotations by institution. Not all rotations will necessarily be offered every year. These descriptions are organized according to the three emphasis tracks in the internship training program. For additional information about a particular rotation, please contact the person whose last name appears in parentheses.

I. GENERAL ADULT PSYCHOLOGY TRACK)(APPIC/NMS program code = 161913)

Current General Adult Track Psychology Residents

Each psychology resident in the general adult track participates in the three clinical training rotations described below. Participation in rotations offered by the child and/or behavioral-medicine tracks is NOT possible.

A. University of Washington Medical Center

1. UWMC Inpatient Psychiatry (7N) (Jessica Cronce, PhD, & Tiara Dillworth, PhD)

Rotation Description & Patient Demographics
The University of Washington Medical Center (UWMC) inpatient psychiatry unit (referred to as 7-North [7N], which is its physical location within the hospital) houses up to 14 patients at any given time. The patients on this unit are generally voluntarily admitted for short-term psychiatric treatment, generally 5-7 days, although shorter and longer stays are possible. Patients reflect a wide range of ages, ethnic backgrounds, and problems. Most patients are admitted with diagnoses of mood and/or anxiety disorders, often with co-morbid substance use disorders and/or Axis II pathology. Psychosis is also frequently a reason for admission. A smaller percentage comprises geriatric patients with co-morbid medical and psychiatric problems

Training Experiences & Treatment Modalities
Each psychology resident works as a member of a primary treatment team (Blue or Purple) on this unit. It is possible to spend 1 month on one team, then (with the permission of the current team’s attending) switch to the other in order to receive supervision from a different psychiatry attending; after spending 1 complete month participating in rounds with a given team, residents switch to a “consult” model, wherein they work with both teams simultaneously, participating in only those portions of rounds when patients they will be meeting with are being interviewed. Regardless of which team(s) a resident is working with, the resident has primary responsibility to serve as a team consultant on cognitive-behavioral interventions and behavior management plans, to provide brief interventions grounded in empirically supported approaches aimed at stabilization in preparation for discharge, and to lead a cognitive-behavioral skills psychotherapy group 4 days per week. On rounds, residents learn about descriptive psychopathology, interviewing, differential diagnosis, psycho-pharmacology, and biological psychiatry. In addition, the resident also oversees the training of one or more psychology practicum students, which serves to develop supervision skills

Resident Expectations

The 7N inpatient rotation is conducted on a full time basis for a period of 4 months; all adult track residents complete this rotation.

Rapid patient turnover makes it imperative that residents on this rotation be highly adaptable and mature. Many disciplines interact, including nursing, occupational therapy, social work, psychiatry and psychology, and boundaries among disciplines are not sharply defined. Much needs to be accomplished quickly, efficiently, and effectively. Initiative, appropriate assertiveness, and good interpersonal sensitivities are very important qualities on this service.

Residents are expected to conduct the CBT group from 1-2pm Monday-Wednesday and Friday. On Tuesdays, residents serve as a mentor to one or more psychology practicum students, who, after working with a resident for 6 months, independently conduct the CBT groups on Thursdays. In terms of individual interventions, the number of patients seen each day will vary based on the needs of the treatment teams and the availability of patients; however, on average residents should expect to conduct 8-10 individual interventions per week. Generally, 11am-12pm and 3pm-4pm are primary times in which to meet with patients individually. Outside these times, patients are generally engaged in other treatment activities (i.e., rounds, occupational therapy, lunch, educational groups). Except in extreme (and rare) cases, it is NOT appropriate to ask a patient to be pulled from another activity in order to meet with the resident; the resident must work in concert with the primary psychiatry team, nursing, OT, social work, and medicine. Residents are asked to administer the PHQ-9 during each group and individual intervention session (as clinically appropriate), and to include this information in the associated medical record documentation.

Residents are expected to attend the monthly UWMC case conference, which occurs the first Wednesday of each month from 4:00-5:00pm in BB1640. This is an opportunity for residents to learn from the experience of other clinicians who are often dealing with challenges related to patient care, including morbidity and mortality. Residents may be invited, or, with the full knowledge and support of their rotation supervisor, request to present a case at the monthly conference, which serves to build case presentation skills in a multidisciplinary setting.

In addition, residents are expected to give an evidence-based medicine (EBM) presentation to the psychiatry residents and faculty at the time/place specified. The resident may choose any topic related to psychological care they desire for their EBM presentation; however, topics generally focus on the range of evidence-based treatments for a specific mental disorder seen on the inpatient unit or on how a single evidence-treatment approach may be used across different disorders. Residents should speak with the Chief Psychiatry Resident during the first 1-2 weeks of their inpatient rotation to arrange the date for their EBM presentation.

Supervision
The faculty psychologists provide at least two hours per week of individual supervision, two hours of group supervision (including co-leading 1 CBT group per week with the psychology resident), and are available on an as-needed basis (ongoing informal supervision is provided by the attending psychiatrists who lead the treatment teams).

2. Outpatient Psychiatry Center (Michele Bedard-Gilligan, PhD, & Debra Kaysen, PhD )

Rotation Description & Patient Demographics
The University of Washington Outpatient Psychiatry Center (OPC) is a standard outpatient specialty care clinic staffed by faculty and residents in psychology and psychiatry. The OPC is located approximately 5 blocks west of the main campus of the University of Washington and approximately 10 blocks from the University of Washington Medical Center. The OPC serves a predominantly middle and lower-middle class population. Patients come from diverse ethnic and cultural backgrounds and sexual orientations. Patients present with a broad range of clinical problems, including mood, anxiety, adjustment and personality disorders. Portable audiotape equipment, and mobile VCRs/monitors are available for faculty and resident use. Computers are available in each clinic room, providing access to the scheduling and computerized medical chart systems, e-mail and the Internet.


Training Experiences & Treatment Modalities
The educational model of the OPC emphasizes an empirically supported scientist-practitioner approach to psychological assessment and treatment. The psychology faculty have specialized training in evidence based cognitive-behavioral therapy, cognitive processing therapy and prolonged exposure for PTSD, and dialectical behavior therapy for borderline personality disorder.
(DBT webpage )

Resident Expectations
The OPC rotation is conducted on a full time basis for a period of 4 months; all adult track residents complete this rotation.

The training objectives of the OPC are designed to foster the acquisition of a broad generalist experience from among the following activities:

a. Treatment:  Individual psychotherapy comprises the majority of the clinical caseload; although, periodically, couple and group therapy experiences may be available. In coordination with the OPC Triage Team, attempts are made to match residents' preferences for particular training experiences. For example, residents may elect to have the majority of their caseload devoted to anxiety related disorders. Individuals with primary substance use disorders or those who report active suicidality at intake are often, but not always, referred to an alternate service or higher level of care. Should a resident desire to work with these populations specifically, it may be possible, but must be discussed with the rotation supervisors.

Considerations of differential diagnosis, case conceptualization, and treatment planning continuously evolve over the course of care. OPC supervisors are generally, but not exclusively, cognitive-behaviorally oriented. Training books, manuals, video and audio tapes, and validated measures of therapist adherence and competence in specific treatments may be used to facilitate feedback and learning by the psychology resident. A typical caseload for each day will involve approximately 4-5 hours of direct clinical contact.

Even though a resident is providing individual therapy, many patients receive medication management services from psychiatry residents and faculty in tandem with psychotherapy services provided by the psychology resident. Thus, like the 7N inpatient rotation and the HMC C/L rotation, the resident is part of a treatment team and must coordinate care with other providers across multiple disciplines.

b. Assessment: Psychology residents can administer a range of self-report indices in the outpatient clinic or refer/consult with the UWMC for more comprehensive assessment batteries (e.g., neuro-psychological assessment). The decision to obtain testing and, if so, which tests, is made in consultation with the supervisor on a case-by-case basis. In this way, residents learn the indications for testing and the clinical utility of testing results in treatment planning.

c. Case Conference: Residents are expected to attend the monthly UWMC case conference, which occurs the first Wednesday of each month from 4:00-5:00pm in BB1640. This is an opportunity for residents to learn from the experience of other clinicians who are dealing with challenging, and sometimes intractable, problems related to patient care. Residents may be invited, or, with the full knowledge and support of their supervisor, request to present a case at the monthly conference, which serves to build case presentation skills in a multidisciplinary setting.

Supervision: Psychology residents will receive individual supervision with one of the attending psychologists. They will also participate in a 1 hour per week combined psychology and psychiatry resident group supervision, moderated by the OPC training faculty. Group supervision is a combination of didactic presentations, readings and faculty/peer consultations.

B. Harborview Medical Center

1. HMC Consultation-Liaison (C/L) Service (Barbara McCann, PhD & Chris Dunn, PhD)

Rotation Description & Patient Demographics
The Psychiatry Consultation-Liaison (C/L) Service rotation at Harborview Medical Center (HMC) is one of the sites where psychology residents have the opportunity to learn and improve their consultation skills for medically hospitalized patients. HMC is a large medical center and a regional, level 1 trauma center serving patients from Washington, Alaska, Idaho and Montana. HMC also is a leading provider of medical care for minority and underserved populations in the region. The majority of patients present with complex medical and psychiatric conditions. .

Training Experiences & Treatment Modalities
This service is very active, with many new consults per day. Psychology residents on the C/L team will have the opportunity to assess and develop brief treatment plans for patients who are medically ill, need suicide assessment, are delirious or need evaluation for decisional capacity. Treatment plans are often also directed toward how the service requesting the consultation may be better able to manage the patient. Unique cases are often seen, including varying types of somatization disorders (e.g., factitious disorder). In addition, there is a high rate of traumatic injury and substance abuse seen in patients at HMC and residents receive training in brief, motivational interventions. Specifically, psychology residents spend 1.5 days per week rounding with attending psychologists on the Alcohol Intervention Service (AIS), during which time the resident conducts motivational interviews bedside with patients who were admitted with a positive urine toxicology screen for alcohol and/or another drug. While the primary focus of the C/L service is on assessment and treatment planning, the AIS portion of this rotation is an opportunity to further develop brief intervention skills.

Resident Expectations
The C/L rotation is conducted on a full time basis for a period of 4 months; all adult track residents complete this rotation.

The team on this rotation includes psychiatry and psychology faculty, two or three psychiatry residents, one psychology resident, and often medical students. The psychology resident is expected to act as a fully-functioning member of the team, seeing patients for whom medical intervention may be most appropriate as well as patients for whom behavioral interventions may be beneficial. The resident is expected to carry an equal caseload of patients as the psychiatry residents, to conduct clinical interviews, determine preliminary diagnoses, document the interview encounter (including relevant medical information, such as vital statistics, current medications, and medical history), and, in consultation with the psychiatry attendings, make recommendations to the primary medical team. Residents are also expected, when required, to write affidavits regarding patients who the C/L team determines is in need of inpatient care, but who refuse voluntary admission. These affidavits are read by the Designated Mental Health Professionals (DMHP) who independently interview patients and determine if an involuntary psychiatric hold is warranted. Residents may be called upon to go to court to testify to the content of their affidavit, although this is generally a very rare occurrence. Finally, residents are expected to provide brief bedside interventions, both as part of rounding with Dr. Chris Dunn and Dr. Barbara McCann on the AIS (conducting motivational interviews) and at the request of the C/L team, if deemed part of the treatment recommendations to the primary medical team. For example, a resident may be asked to implement a behavioral management plan with a patient to facilitate their participation in their medical care.

Supervision
Residents receive two hours per week of individual supervision from attending psychologists on the C/L rotation. Residents also receive on-going group supervision with the C/L team, during regular team meetings and teaching rounds.

II. GENERAL CHILD PSYCHOLOGY TRACK (APPIC/NMS program code = 161912)

Current General Child Track Psychology Residents

A. Seattle Children's Hospital (Formerly Children's Hospital and Regional Medical Center (CHRMC))
Department of Psychiatry and Behavioral Sciences-Division of Child and Adolescent Psychiatry
Seattle Children's Hospital (SCH) is a private, nonprofit, University-affiliated, 312-bed hospital with numerous outpatient clinics. It is the primary pediatric training site for the University of Washington School of Medicine and is the major regional children's medical center. SCH is also the major training site for the Department of Psychiatry and Behavioral Sciences' Division of Child and Adolescent Psychiatry. The Division of Child and Adolescent Psychiatry at SCH provides a variety of services for children with acute and chronic medical problems that are associated with developmental and psychological consequences as well as for children with primary psychiatric disorders. The psychology resident has an excellent opportunity to engage in a wide range of clinical activities and to become skillful with a variety of assessment methods and treatment modalities. Along with patient contacts and consultation to multidisciplinary teams, residents are expected to become familiar with the literature pertinent to their clinical activities and to attend didactic sessions and conferences on the services assigned. Psychology residents have opportunities to participate in research projects during their rotations at SCH. In the following section, a brief overview of each service is given.
1. Inpatient Psychiatry (Kelly Schloredt, PhD)
Rotation Description & Patient Demographics
The IPU is a 20-bed acute care psychiatric unit that provides multidisciplinary assessment, crisis intervention and stabilization, and long-term treatment planning for children and adolescents between the ages of 4 and 18. The children and adolescents seen on this unit present with a variety of severe psychological/psychiatric problems, including psychotic, mood, disruptive, , anxiety, eating, and developmental disorders, as well as chronic medical problems with concomitant behavioral difficulties. In addition, many youth struggle with significant psychosocial stressors related to child abuse and neglect, and other types of trauma.

Training Experiences & Treatment Modalities
The IPU is a multidisciplinary unit with routine contributions made by nursing, education, parent-support, nutrition, speech and language pathology, adolescent medicine, pediatrics, art therapy, recreational therapy, and occupational and physical therapy. The IPU provides children, adolescents and their families with acute crisis stabilization through solution focused intervention and works to facilitate connections to community resources. Components of the IPU Program include: 1) Intensive skill building in context of a behavior management philosophy of "Natural and Logical Consequences", 2) Individual and family crisis management and stabilization centered on skill building through the use of evidence informed Clinical Pathways, 3) Medication evaluation, 4) Crisis Prevention Planning and 5) Disposition Planning and Connection to Community Resources.

Resident Expectations & Supervision
Residents are expected to: 1) participate in team care and to function as a team clinician (individual and family intervention) for a range of patients with support and direction from Attendings and case managers, 2) participate in clinical activities related to diagnostic evaluation/formulation, medication management/evaluation, teaching emotion regulation and distress tolerance skills (including diagnostic specific skills outlined in Clinical Pathways), crisis prevention planning, and disposition planning. Residents review and integrate information from outside sources (school, caseworker, previously involved mental health professionals, current providers, etc.), write reports (daily chart notes, intakes, discharge summaries, support letters, Crisis Prevention Plans, CPS Reports, etc.) and participate in completing intakes/admissions for patients assigned to their team. Psychology residents receive individual supervision from a psychologist and a psychiatrist on a weekly basis, and group supervision through daily clinical huddles and weekly patient reviews.

2. Neuropsychological Consultation Service (David Breiger, PhD)

Rotation Description & Patient Demographics
The Neuropsychological Consultation Service provides evaluations to most clinics in the hospital, including Psychiatry, Neuro-oncology, Hematology, Genetics, Cardiology, Rheumatology, Neurodevelopmental and Neurology. Neurodevelopmental disorders frequently seen include autism, ADHD, learning disabilities, and intellectual disabilities. In addition, children are seen before neurosurgical intervention and during treatment and follow-up of brain tumors.

Training Experiences & Treatment Modalities
Psychology residents are primarily affiliated with the Neuropsychological Consultation Service. In addition, residents participate in the School Contract Evaluations which provides an independent evaluation of children and adolescents with learning problems. The resident is involved in the neuropsychological assessment of a wide age range of children, and becomes familiar with a number of commonly used neuropsychological assessment instruments. The psychology resident will become competent in using a structured interview to gather developmental and diagnostic information from parents. The resident is involved in consultation with schools and in reporting results to parents, referral sources, and treatment teams.

Resident Expectations & Supervision
Interdisciplinary consultation, information gathering from a variety of sources, and integration of psychosocial, medical, neuropsychological data requires that the psychology resident be well-organized and adaptable. Through supervision and directed readings, the resident is exposed to different theoretical approaches to pediatric neuropsychology.

Evaluation of Psychology Residents
Psychology residents participate in standard evaluation practices that are part of the overall internship which includes self-evaluation, evaluations by their supervisors, resident evaluation of their supervisors and resident evaluation of the rotation site.

3. Consultation/Liaison (C/L) (Cynthia Flynn, PhD)

Rotation Description & Patient Demographics
The Consultation/Liaison Service provides clinical consultations to the inpatient pediatric units, emergency room, and outpatient clinics at SCH as well as to community care providers. Primary consultations include safety/risk assessment, eating disorders, medically ill children presenting with needs for behavioral management of pain, somatoform symptoms, psychological distress related to medical conditions, and disruptive or non-adherent behavior.

Training Experiences & Treatment Modalities
The psychology resident will learn how to conduct consultations with patients in tertiary and primary care settings. Opportunities for limited-term interventions are available. The C/L conferences are open to all C/L team members including Nursing, Social Work, Psychiatry, Psychology, and students.

Resident Expectations & Supervision
All consultations are supervised by the attending psychiatrist and attending psychologist on service (Ian Kodish, M.D., Brent Collett, Ph.D., Cynthia Flynn, Ph.D. and, Ph.D.). A weekly teaching conference is held to conduct case discussions or didactic presentations on topics relevant to C/L services. The resident will receive weekly individual supervision in addition to informal supervision provided during "rounds" conducted on each new patient.

Evaluation of Psychology Residents
Psychology residents participate in standard evaluation practices that are part of the overall internship which includes self-evaluation, evaluations by their supervisors, resident evaluation of their supervisors and resident evaluation of the rotation site.

4. Child and Adolescent Outpatient Psychiatry Program (Gretchen Gudmundsen, PhD)

Rotation Description & Patient Demographics
This rotation provides a mix of assessment and treatment opportunities, within a clinic team that consists of psychologists, child psychiatrists, nurses, and case managers. New and ongoing cases are discussed during twice weekly team meetings. Psychology residents will work with a variety of presenting problems including ADHD, disruptive behavior disorders, anxiety disorders, and depression, as well as less common psychiatry conditions (OCD, suspected early onset bipolar disorder, autistic spectrum, eating disorders) and rare medical disorders with associated psychopathology (e.g., craniofacial disorders and other genetic syndromes). The rotation includes opportunities to work with younger children (i.e., from infancy to the early elementary school years) as well as adolescents.

Training Experiences & Treatment Modalities
The psychology resident learns to work collaboratively with other disciplines; e.g., some cases are treated by a combination of medication and psychological interventions. Assessments of children typically include observation and videotaping of parent-child or family interaction. School visits and developmental testing of the child are often done. Primary treatment strategies include parent-child interaction training, brief family therapy, school consultations, and cognitive-behavioral treatment for the child. Interventions are formulated within the context of a developmental model. There are opportunities for training in psychopharmacology, Dialectical Behavioral Therapy (DBT) and cognitive-behavioral treatments for OCD.

Resident Expectations & Supervision

Supervision consists of direct observation, review of DVDs, case conferences, and weekly individual and group supervision..

Evaluation of Psychology Residents
Psychology residents participate in standard evaluation practices that are part of the overall internship which includes self-evaluation, evaluations by their supervisors, resident evaluation of their supervisors and resident evaluation of the rotation site.

III. BEHAVIORAL MEDICINE/NEUROPSYCHOLOGY TRACK

(APPIC/NMS program code = 161914)

Current Behavioral Medicine/Neuropsychology Residents

A. University of Washington Medical Center Department of Rehabilitation Medicine
Training faculty: Jeanne Hoffman, PhD, ABPP-RP (inpatient consultations and outpatient rehabilitation), Ivan Molton, PhD, (inpatient rehabilitation), Lauren Schwartz, PhD, (outpatient rehabilitation clinic), Kevin Alschuler, PhD (outpatient rehabilitation), Naomi Chaytor, PhD, ABPP-CN (outpatient neuropsychology and rehabilitation psychology), and Myron (Moe) Goldberg, PhD, ABPP-CN, (Director, Neuro Rehabilitation Program & Neuropsychology Service)
Rotation Description
The Rehabilitation Medicine rotation provides an array of clinical experiences to train clinical psychologists within a multidisciplinary team framework in a medical setting. Psychology residents will have opportunities to work collaboratively with physicians, nurses, speech pathologists, physical therapists, occupational therapists, vocational counselors, therapeutic recreation therapists, and social workers, from within the medical center as well as from the community in developing and implementing treatment plans. Psychology is an integral part of the medical team. The patients reflect a wide range of medical problems, ethnic backgrounds, and ages. Psychology residents will have an opportunity to see patients with a variety of presenting problems including: spinal cord injury; brain injury due to trauma, stroke, tumor, aneurysm, hemorrhage, hypoxia, etc.; multiple sclerosis; muscular dystrophy; post-polio syndrome; amyotrophic lateral sclerosis; cancer; and chronic obstructive pulmonary disease. The rotation provides a mix of inpatient and outpatient, assessment and treatment opportunities, including opportunities to utilize neuropsychological test data to formulate disposition and treatment plans. Residents who desire more in depth neuropsychological training will have the opportunity to participate in more intensive outpatient evaluation experiences, including interviewing, test selection, administration, scoring, and interpretation, results integration, differential diagnosis, report writing, and feedback to patients, family, and referral sources.

Training Experiences
The training model emphasizes empirically supported scientist-practitioner approach to assessment and treatment. The rotation offers psychology residents a good introduction to medical psychology and rehabilitation neuropsychology. Prior experience in a medical rehabilitation setting or with neuropsychology is helpful but not necessary to have a rewarding training experience. Psychology residents learn to function as an integral member of an interdisciplinary rehabilitation team. Psychology residents respond to consultations and referrals primarily from the acute inpatient rehabilitation unit, and outpatient rehabilitation clinics, and, to a lesser extent, the inpatient consultation-liaison service. Typical patient referrals involve assessment of psychological and/or neuropsychological functioning, identification of patient and family concerns, development and implementation of appropriate treatment programs, and mobilization of resources to integrate the patient into the community. Psychology residents are involved in a range of clinical activities, including psychological and neuropsychological assessment; utilization of neuropsychological test results in treatment planning; development of behavioral programs; consultation to team members and community agencies; case management of patients; and provision of individual and family therapy. Participation in weekly rounds and team/family conferences is an important part of the psychology residents' experience. There is also the opportunity to observe or participate in outpatient treatment groups. Psychology residents who are involved in the behavioral medicine/neuropsychology rotation participate in a monthly rehabilitation psychology journal club. Psychology residents also have opportunities to attend the Department of Rehabilitation Medicine's Grand Rounds which occurs twice per month and covers various rehabilitation topics, many of which are of interest to residents.

Expectations of Psychology Residents
Psychology residents participate in all aspects of the training experiences listed above. Psychology residents follow a variable number of patients depending on the needs of the psychology service and the residents' experience. Psychology residents can typically expect to follow 4 to 6 inpatient cases, and 4 to 6 outpatient cases, in addition to 2 to 4 psychological evaluations per month. For those desiring in more intensive neuropsychological experiences, expect to be involved in at least a one outpatient case per week.

By the end of the rotation, psychology residents are expected to: a) have an understanding of a psychologist's role on an interdisciplinary rehabilitation team; b) demonstrate an increased awareness of and ability to assess the emotional, behavioral, and cognitive sequelae of various traumatic and chronic medical conditions; c) have a fundamental understanding of the functional implications of neuropsychological test results; d) recommend and implement basic therapeutic interventions with patients and their families; e) apply ethical and legal principles to practice; f) develop the knowledge and skills necessary for basic competence in the neuropsychological evaluation of patients with known or suspected organic brain dysfunction (if applicable); and g) have an awareness of personal strengths and limitations as they relate to providing psychological services to this population. .

Training Methods

Psychology residents will have an orientation session with tours of the facility. Residents will then have an opportunity to accompany and observe the supervising psychologist(s) performing clinical work. Residents will then have opportunities to see patients with direct observation and supervision provided. The eventual goal is for psychology residents to work fairly independently with patients and to move towards a co-treatment model. Psychology residents are provided with examples of psychological /neuropsychological evaluation reports, progress notes, and other written communications as models. Residents have access to a training manual and numerous articles and books to supplement their learning experiences. Psychology residents participate in scheduled individual and group supervision each week. They have additional opportunities for contact and supervision with the supervisors during weekly rounds and conferences. Residents are encouraged to drop by or page the supervisors with day-to-day questions concerning patients. Supervision is provided by the four attending psychologists, and at times by a post-doctoral fellow.

Evaluation of Psychology Residents
Supervisors provide frequent, ongoing feedback on the psychology resident's performance throughout the rotation. Residents and supervisors discuss the resident's progress and training needs at the mid-rotation point. Psychology residents participate in standard evaluation practices that are part of the overall internship which includes self-evaluation, evaluations by their supervisors, resident evaluation of their supervisors and resident evaluation of the rotation site.

B. Harborview Medical Center Department of Rehabilitation Medicine (Charles Bombardier , PhD)
Training Faculty: Jeffrey Sherman, PhD, (Consults) Shelley Wiechman, PhD (Burns, Pediatrics), Josh Dyer, PhD (Inpatient rehabilitation), Dawn Ehde, PhD (CORP neuropsychology), Gina Formea, PhD, ABPP-CN (CORP neuropsychology), Myron (Moe) Goldberg, PhD, ABPP-CN (Inpatient rehabilitation neuropsychology), Christina Graham, PhD (Madison Clinic), Eric Strachan, PhD (Madison Clinic), Charles Bombardier, PhD, ABPP-RP (CORP).

General Rotation Description & Patient Demographics
Behavioral Medicine/Neuropsychology rotations provide training in medical psychology and neuropsychology and operate within several areas of the medical center and related clinics: Inpatient Rehabilitation (Dyer), Comprehensive Outpatient Rehabilitation Program (Formea, Ehde and multiple faculty), Inpatient Consultation Service (Sherman), Burn Unit (Wiechman), Pediatric and Burn Clinics (Wiechman) and Madison Clinic (Graham, Strachan). These rotations are described in greater detail below, after the rotations have been described more generally. An important aspect of these rotations is understanding the role of clinical psychologists within an interdisciplinary team framework and within a health care delivery system. Psychology residents work with multidisciplinary teams that include physicians, nurses, speech pathologists, physical therapists, occupational therapists, social workers, and vocational counselors. This rotation provides abundant opportunities to apply psychological principles in a medical setting with patients experiencing a variety of medical conditions.

Patients are commonly admitted to HMC due to trauma or acute illness. Psychology residents typically work with patients who have sustained traumatic brain injury, cerebral vascular accidents, spinal cord injuries, severe burn injuries, and multiple traumas. Patients come from diverse backgrounds in terms of ethnicity, socioeconomic status, and geographical location. The Burn Unit provides residents with extensive experience in pediatric consultation and liaison. Psychology residents have access to IBM computers for report-writing, and dictation experience is offered. A shared, on-site office space is provided.

Training Experiences & Treatment Modalities

The mission of the psychologists at the Harborview Medical Center (HMC) rotation is to provide primary psychological care for inpatients on the Rehabilitation Medicine and Burn Units as well as patients followed by the Outpatient Rehabilitation Medicine Service. Also, consultations are provided for inpatients on Neurosurgery, Orthopedic Surgery, Neurology, General Medicine, Intensive Care Units, and occasionally on the Psychiatric units. Psychology residents on the HMC rehabilitation psychology rotation therefore are exposed to a wide variety of consultation and liaison experiences and learn to work on interdisciplinary medical teams in both inpatient and outpatient settings. Harborview Medical Center is a Regional Level I Trauma Center serving five states with a highly diverse patient mix. Psychologists play a prominent role in the care of these patients. This rotation provides a unique opportunity to work with a multiethnic patient population and to obtain training from psychologists who regularly integrate clinical and research activities. It also gives the experience of providing psychological services in a fast-paced, intense, but extremely collegial environment.

Psychology residents work closely with a variety of medical and adjunctive medical disciplines such as physical therapy, occupational therapy, speech pathology, nursing, social work, rehabilitation counseling, and therapeutic recreation. Surgery and rehabilitation medicine physicians are our two most prominent medical colleagues. HMC rehabilitation psychologists must rely on treatment modalities that fit well into the trauma setting. As such, there is a heavy emphasis on consultation/liaison, brief psychotherapy, and focused assessment. Behavioral and cognitive-behavioral frameworks are used frequently. More traditional psychotherapy is practiced through the outpatient rehabilitation and burn clinics as well. Training in hypnosis for pain control and motivational enhancement therapy for substance abuse is available. The psychologists often rely on a systems approach in which the patient is evaluated and treated within the context of the interdisciplinary health care team and family. Assessing and treating team behaviors is often essential to assisting the patient.

Psychology residents at HMC rehabilitation first undergo a group orientation session with tours of the facility. Residents then accompany and observe an attending psychologist doing clinical work. Based on the residents' level of comfort they are then provided with the opportunity to see patients under visual supervision. As the comfort level of residents' further progresses, supervision increasingly takes the form of CO-treatment or face-to-face review of cases. Group supervision meetings are held on a weekly basis as well as individual sessions with each of the psychologist supervisors. Generally there is a minimum of two hours of individual supervision a week, although psychology residents are encouraged to page the supervisors with day-to-day questions about the patients. A psychology resident handbook is provided that contains extensive reading materials pertaining to the patient populations served and resident clinical responsibilities. Model reports, structured evaluation formats and practical clinical care guidelines are also included. Psychology residents typically attend multidisciplinary Rehabilitation and Burn Unit rounds, thereby becoming familiar with the work of other professionals. They continue to attend the regular internship didactics through this rotation as well as specialized seminars for rehabilitation.

The rotations at Harborview are as follows:


1. Inpatient Consultation Liaison Service, Burn Unit and Pediatrics Service.
Consultation Liaison Residents on this service are actively involved in a thriving psychology consultation service that provides treatment for the majority of the services in a regional, level 1 trauma center. The main focus of this rotation is the Burn Unit, which is world famous and provides interdisciplinary care on an inpatient and outpatient basis. Frequent clinical issues include facilitating adjustment to burn injuries, managing acute pain, assessing for reactions to trauma, and behavioral management. One third of the patient population on the Burn Unit is pediatric and residents are given the opportunity to work with children. Training with hypnosis is available and often emphasized on this service.

Residents on this rotation spend roughly half their time on the Burn Unit and the other half doing consultation on most units of the hospital. Patients are commonly seen on the Neurosurgery, Neurology, Orthopedics, Medicine, and Surgery units. Clinical work with such patients often involves assessment and treatment after multiple traumas. This service differs from Psychiatry Consultation/Liaison in that the emphasis is on adjustment to physical trauma and brief psychotherapy as opposed to Psychiatry's emphasis on suicide assessment, treatment of psychosis, and pharmacologic treatments. The services differ enough so that residents can rotate through both and receive different types of training.

2. HMC Inpatient Rehabilitation
For the inpatient rehabilitation aspect of the rotation residents are the first line consultants to the medical, nursing and therapy team members regarding the assessment and treatment of psychiatric disorders, substance abuse disorders, adherence to treatment issues, and overall adjustment to injury or disease. Residents learn about common cognitive, behavioral, and psychological conditions associated with traumatic injuries such as brain injury and spinal cord injury as well as neurological conditions such as stroke and aneurysms. They learn how to help patients, their loved ones, and rehabilitation team members cope more effectively with the rehabilitation process. Residents will also learn to interpret and report on results from a brief neuropsychological testing battery supervised by the consulting neuropsychologist, Dr. Goldberg.

3. HMC Comprehensive Outpatient Rehabilitation Program (CORP)
On the outpatient side of the rotation, residents will similarly function as an integral member of an interdisciplinary outpatient rehabilitation medical team that serves outpatients with neurological conditions (brain injury, stroke, spinal cord injury), chronic pain, and other medical/surgical conditions such as amputations. Residents provide a range of psychological services including psychological assessment, consultation, and psychotherapy. Psychotherapy is typically short-term (4-12 sessions) and problem-focused. Residents work with the family as well as the patient, consult to team members and community agencies, and utilize neuropsychological test results in treatment planning. Interested residents also have the opportunity to receive training in comprehensive outpatient neuropsychological assessment. Resident receive education and training in neuropsychological aspects typical rehabilitation populations (see above), interviewing skills, test selection, test interpretation, report writing, conducting testing feedback sessions and using neuropsychological test results and knowledge about brain-behavior relationships to inform multidisciplinary rehabilitation programming.

4. The Madison Clinic
The Madison Clinic is an outpatient clinic located near Harborview Medical Center that provides medical care and social services for persons living with HIV/AIDS regardless of sexual orientation, race, or ability to pay. Each patient has a primary care provider who organizes services required. Care at the Madison Clinic is interdisciplinary. Mental health services are provided by psychologists and psychiatrists. Other providers include nurses, pharmacists, nutritionists, social workers and other specialists. Psychology residents will function as part of this interdisciplinary team to provide assessment and treatment for a broad range of disorders found in patients living with HIV/AIDS such as depression, anxiety, and PTSD and issues related to adjustment to chronic illness and adherence to medical recommendations.

5. HMC Outpatient Burn Clinic
Patients who are discharged from our inpatient burn unit continue to get care from our outpatient burn clinic often for at least two years after discharge. Much like the inpatient burn unit, it serves the surrounding five state region as the only verified burn center in the region. The clinic also accepts referrals for patients not treated on the inpatient burn unit. The Outpatient burn clinic served 2457 patients (both adults and children) this past fiscal year. Given the multitude of issues that burn survivors face, including ongoing pain, high rates of depression, PTSD and body image concerns, the psychologist is a valued member of the multidisciplinary team. The psychologist screens every patient during their clinic appointment, in conjunction with the medical team. Longer interventions are conducted on those patients who screen positive for psychological issues. Training opportunities include the opportunity to conduct brief screens and consult with the larger medical team, as well as providing evidence-based interventions targeted at managing distress (PTSD, depression, sleep disturbance) and adjustment to injury. Finally, trainees get to see the full spectrum of recovery from a serious injury when they can follow a patient from the ICU, to the acute floor, and on to the outpatient burn unit.

6. HMC Outpatient Pediatrics Clinic
The Pediatric Clinic provides primary care services to children and teenagers, with a mission of serving patients from underserved populations. Approximately 3200 children receive care from this clinic as their medical home. Most patients (>90%) are not Caucasian. Recent immigrants are prevalent: 68% of the parents of children seen in the clinic were born outside the U.S. Fewer than 30% of the families speak English at home. These families rely on the clinic'’s accessibility, interpreter services and outreach to specific ethnic and linguistic communities. The clinic is staffed by pediatric residents, attending physicians and mid-level practitioners. A broad range of consultants are housed in this clinic and include psychiatrists, adolescent specialists, social workers, psychologist, lactation consultants, and nutritionists. Psychology residents on this rotation get experience working with medical staff in a pediatric primary care setting. Common referral questions include assessment, treatment, and recommendations for a broad range of childhood internalizing and externalizing disorders such as ADHD/ADD, anxiety, depression, learning problems, eating disorders, eneuresis/encopresis, and disorders along the autism spectrum. Additionally, residents receive training in delivering interventions for behavior change and treatment adherence with common medical problems (obesity, substance abuse, asthma, and diabetes). Treatment planning for children and adolescents with behavior problems such as oppositional defiant disorder and conduct disorder, as well as culturally sensitive parent training strategies, are also common referral questions.

General Resident Expectations & Supervision
HMC rehabilitation psychologists seek to train residents in a scientist/practitioner model. In addition, psychology residents learn to provide assessments and treatment within a primarily medical context. Thus our objective is that residents completing this rotation are comfortable in medical settings in general, as well as rehabilitation and burn unit placements specifically. General skills that are taught during this rotation include clinical assessment of people with disabilities, DSM IV diagnosis, behavioral management, hypnosis for pain control, brief interventions for psychological distress related to medical conditions/grief, brief interventions for substance abuse problems, working with adult and pediatric patients with burns, and working with families of people who have had trauma or disability.

What follows are some general expectations. The activities described below are dependent on what HMC Rehabilitation rotation the resident chooses. Psychology residents are generally expected to be responsible for eight inpatient beds on the rehabilitation medicine unit. Residents provide an initial comprehensive psychological evaluation on each of their rehabilitation patients. Clinical responsibilities with such patients include seeing the patients once a week and combining their input with those of a multidisciplinary team during weekly rounds. Psychology residents are also expected to attend the burn unit psychosocial rounds each Monday morning and to respond to whatever consults are generated during those rounds. After evaluating patients with burns, residents then report to the general medical team rounds held once or twice weekly on the burn unit. Psychology residents also provide consults on several different floors throughout the hospital. Residents generally follow two to three outpatient therapy cases throughout the rotation. Outpatient residents are expected to carry a caseload of 8-12 patients, attend outpatient team rounds, collaborate with multidisciplinary team and participate in groups. Psychology residents participate in standard evaluation practices that are part of the overall internship which includes self-evaluation, evaluations by their supervisors, resident evaluation of their supervisors and resident evaluation of the rotation site. Residents and supervisors exchange verbal feedback at the mid-rotation point. Written and verbal feedback is exchanged at the end of the rotation. In addition, residents are provided with feedback throughout the rotation based on observations of treatment, as well as participation in multidisciplinary team rounds. Training is provided by attending psychologists (faculty within the Department of Rehabilitation Medicine) and, frequently, one or two postdoctoral fellows. At least two hours of individual supervision per week is provided by psychology faculty, with additional supervision offered on an as-needed basis. One hour per week of group supervision is required. The neuropsychology faculty holds a weekly neuropsych seminar for interested residents.

C. Seattle Children's Hospital - Department of Rehabilitation Medicine Training Faculty:
Sharon Ashman, Ph.D., ABPP (Inpatient and Outpatient Rehabilitation), Christine Clancy, Ph.D., ABPP (Outpatient Rehabilitation).

General Rotation Description & Patient Demographics
Seattle Children's Hospital (SCH) is a 254-bed facility located in Seattle, WA in King County. SCH is the pediatric referral center for the WAMI (Washington, Alaska, Montana, Idaho) region and is the pediatric teaching hospital for the UWSOM. Fifty-four percent of patients seen at SCH are from the WAMI region and Washington State locations outside of King County. The hospital specializes in meeting the unique physical, emotional and developmental needs of children from infancy through young adulthood regardless of their family's ability to pay. In fiscal year 2011, SCH provided uncompensated care to nearly 124,000 patients at a total cost of $103,391,000. Forty-six percent of patients are on Medicaid. More than 70% of patients have a chronic, lifelong condition or illness.

The Rehabilitation Medicine rotation provides an array of clinical experiences to train clinical psychologists within a multidisciplinary team framework in a medical setting. Interdisciplinary care is provided by a team of professionals, including rehabilitation medicine physicians, rehabilitation nurses, physical therapists, occupational therapists, speech-language pathologists, rehabilitation psychologists, social workers, therapeutic recreation specialists, nutritionists, and education specialists. Training opportunities will include assessment of psychological factors affecting recovery, brief psychotherapy, neuropsychological assessment, behavioral management, patient and family education, and consultation with team members, schools, and community providers. Trainees will also participate in weekly treatment team meetings and family team meetings. The rotation provides a mix of inpatient and outpatient, assessment and treatment opportunities, including opportunities to utilize neuropsychological test data to formulate disposition and treatment plans. Residents who desire more in depth neuropsychological training may have the opportunity to participate in more intensive outpatient evaluation experiences, including interviewing, test selection, administration, scoring, and interpretation, results integration, differential diagnosis, report writing, and feedback to patients, family, and referral sources.

Training Experiences & Treatment Modalities

The rotations at SCH are as follows:

1. Seattle Children's Hospital Pediatric Inpatient Rehabilitation Program:
The inpatient rehabilitation unit is certified as a Pediatric Family-Centered Program by the Commission on Accreditation of Rehabilitation Facilities (CARF) and has been named a Level 1 Pediatric Trauma Rehabilitation Center by the Washington State Department of Health. The unit provides care to an ethnically diverse population. In the fiscal year 2011, there were 109 admissions to the inpatient rehabilitation unit. Forty percent (40%) of those served were Caucasian, 19% Black, 10% Hispanic, and 31% were from other ethnic groups (e.g., Native American, Alaska Native, Asian).

The Inpatient Rehabilitation Unit at SCH is a 12-bed unit that serves children with physical and/or developmental disabilities arising from congenital defects, illness, or trauma. The Inpatient Rehabilitation rotation involves delivery of care to children and adolescents with traumatic brain injury, brain tumor, spinal cord injuries, stroke, burns, white matter diseases (e.g. multiple sclerosis, ADEM), and other acute and chronic medical conditions. Interdisciplinary care is provided by a team of professionals, including rehabilitation medicine physicians, rehabilitation nurses, physical therapists, occupational therapists, speech-language pathologists, rehabilitation psychologists, social workers, therapeutic recreation specialists, nutritionists, and education specialists. Other hospital services are available as needed. Training opportunities will include assessment of psychological factors affecting recovery, brief psychotherapy, neuropsychological assessment, behavioral management, patient and family education, and consultation with team members, schools, and community providers. Trainees will also participate in weekly treatment team meetings and family team meetings. Supervision is provided by two psychologists who hold Board Certification in Clinical Neuropsychology, Sharon Ashman, Ph.D., ABPP and Christine Clancy, Ph.D., ABPP.

2. Seattle Children's Hospital Outpatient Rehabilitation Clinics:
The Department of Rehabilitation Medicine at SCH offers several outpatient clinics, including the Inpatient Rehabilitation Follow-up Clinic and Mild - Moderate Traumatic Brain Injury Clinic, as well as clinics for children with neurodevelopmental disorders and neuromuscular disorders. As with the inpatient rehabilitation unit, outpatient clinics are interdisciplinary and serve children and adolescents with neurological conditions (TBI, stroke, SCI), neuromuscular disorders, and other congenital and/or acquired conditions. A large portion of the population served is underserved, including ethnic minorities, non-English proficient patients and families, economically disadvantaged families, and rural populations from the four state WAMI region. Trainees will provide a range of psychological services, including psychological assessment, consultation, psychoeducation, and short-term, problem-focused psychotherapy. Trainees will work with patients and their families, consult with team members, schools, and community agencies, and utilize neuropsychological assessment results in formulating treatment plans and recommendations. Residents also have the opportunity for training experiences in conducting comprehensive outpatient neuropsychological evaluations.

General Resident Expectations & Supervision
SCH rehabilitation psychologists seek to train residents in a scientist/practitioner model. In addition, psychology residents learn to provide assessments and treatment within a primarily medical context. Thus, our objective for residents completing this rotation is for them to be comfortable in a pediatric medical setting. General skills that are taught during this rotation include knowledge of child development and the impact of hospitalization on the developmental trajectory, clinical assessment of children and youth with disabilities, DSM IV diagnosis, behavioral management, pain management, brief interventions for psychological distress related to medical conditions/grief, and supportive counseling for families of patients who have experienced trauma or disability.

On the inpatient unit, psychology residents are responsible for the provision of services to patients and their families. Residents provide an initial comprehensive psychological intake interview with each of their rehabilitation patients/families. Clinical responsibilities with such patients include seeing the patients individually or in co-treatments with other multidisciplinary team members and participating in weekly family/team meetings. Psychology residents are also expected to attend the Monday morning team meeting (Huddles). When clinically indicated, residents will provide psychological/neuropsychological assessment services and assist with transition planning to home, school and community. On a less frequent basis, residents may also provide consultation to patients on other services who have rehabilitation needs.

In the outpatient Rehab Medicine TBI clinic, residents are expected to conduct an intake interview with patients and their family members, write a clinic note, and provide case management and provide consultation to the rehabilitation medicine physician or ARNP, outpatient providers and school personnel. For patients who are seen for outpatient neuropsychological assessment, residents may have the opportunity to conduct interviews, administer tests, provide feedback, and generate reports.

Residents participate in standard evaluation practices that are part of the overall internship which includes self-evaluation, evaluations by their supervisors, resident evaluation of their supervisors and resident evaluation of the rotation site. Residents and supervisors exchange verbal feedback at the mid-rotation point. Written and verbal feedback is exchanged at the end of the rotation. In addition, residents are provided with feedback throughout the rotation based on observations of treatment, as well as participation in multidisciplinary team rounds. Training is provided by attending psychologists (faculty within the Department of Rehabilitation Medicine. At least two hours of individual supervision per week is provided by psychology faculty, with additional supervision offered on an as-needed basis. One hour per week of group supervision is required. The neuropsychology faculty holds a bimonthly journal club and monthly case consultation for interested residents. Rehabilitation Medicine also offers monthly inservice trainings for staff.


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