INTERNSHIP SITES AND ROTATION DESCRIPTIONS

Each of the internship sites has its own unique set of opportunities and responsibilities. A description of each site follows. It should be noted that an intern cannot possibly participate in all the options at each site. However, the intern plays a fundamental role in formulating his or her training program, and should be highly independently motivated in order to delineate desired internship experiences. A unique strength of the UCSD/VA Psychology Internship Program is its commitment to providing the intern with a well rounded clinical experience while remaining flexible with regard to the intern's specific needs and interests. Because of the diversity of available experiences, there is no "typical" schedule for an intern. However, Interns are expected to maintain a case load in each rotation that provides 12-14 hours of direct service each week. The remaining hours involve supervision, didactics, preparation for patients, and documentation.

Below is a description of each of the six Internship training sites (designated with letters) followed by descriptions of the specific rotations located at each site (designated by numbers). Please see Appendix D for the specific rotations pairings that comprise each Intern Position.

A. THE VA SAN DIEGO HEALTHCARE SYSTEM (VASDHS)

The VASDHS is a modern 350 bed general medical and surgical medical center situated adjacent to the University of California at San Diego and is closely affiliated with the UCSD School of Medicine. The VASDHS is located 10 miles north of downtown San Diego and just one mile inland from the community of La Jolla on the Pacific Ocean.

The VASDHS has approved residency training programs in medicine, surgery, anesthesia, neurology, pathology, psychiatry, radiology, and audiology. The medical staff is augmented by outstanding physicians, dentists, nurses, consultants, research investigators, and attendings in various specialties. There are over 2,000 full and part time professional and administrative staff members.

The VASDHS Psychiatry Service and Psychology Service have extensive inpatient and outpatient psychiatric facilities located in the main hospital in La Jolla. The entire second floor of the VA Medical Center La Jolla is almost exclusively inhabited by the Psychiatry and Psychology Services. There are 28 acute care psychiatry beds. In addition, there is a 30 bed Alcohol and Drug Treatment Program which features a comprehensive aftercare program for alcoholics and their families. There is a Special Treatment and Evaluation Unit (STEP) for the study of affective disorders and an outpatient mental health clinic located on the second floor, staffed by multi disciplinary treatment teams which provide over 22,000 outpatient visits per year. Patient care activities in the outpatient programs include psychiatric admissions, crisis service, diagnosis, specific medication clinics, and individual, marital, family, and group therapies. An active outpatient Gero Psychiatric Unit also exists at VASDHS. Outpatient programs for Post Traumatic Stress Disorder and Dual Diagnosis also exist. There is a 20 bed Spinal Cord Injury Unit, offering inpatient and outpatient services. There is also a Psychology presence in the primary care clinics, where interns serve the psychological assessment, treatment and consultation needs of two multidisciplinary teams.

The Psychology Service at the VASDHS, while moderate in size, represents one of the most academically oriented staffs in the Department of Veterans Affairs hospital system. Currently, there are 45 positions assigned to the Psychology Service, all of whom are available are resources for the Interns. These include 36 Ph.D. clinical psychologists, 4 psychology technicians, 3 vocational rehabilitation specialists, and 2 administrative support staff. Many of the major sub-specialties of professional psychology are represented on the staff, including clinical psychology, neuropsychology, geropsychology, marital and family therapy, alcohol treatment, behavioral medicine, trauma specialists, specialists in treating serious mental illness, and related psychology research. There are complete facilities at the VA for computer assisted psychological testing and videotaping of therapy sessions and all medical records charting is done electronically.

Located approximately 12 miles from the main hospital, in Mission Valley, there are extensive medical facilities and mental health programs for outpatient care at the VA Outpatient Clinic, housed in a modern building which opened in November, 1998. Mental health programs located at the VA Outpatient Clinic include a Mental Health Clinic, the Family Mental Health Program, all three of our trauma programs (the PTSD Clinical Team, the OEF/OIF PTSD Clinic, and the Military Sexual Trauma Clinic), and the Behavioral Medicine Program located within the primary care clinic.

Interns have the opportunity to work in rotations at both the main hospital and the Mission Valley location.

VASDHS Internship rotations within the main La Jolla hospital

Inpatient training opportunities exist primarily in the Alcohol and Drug Treatment Program. Otherwise, mainly outpatient rotations are available to the intern at the VASDHS.

1. Alcohol and Drug Treatment Program

The Alcohol and Drug Treatment Program (ADTP) offers a variety of programs and services for veterans, on an inpatient and outpatient basis, including group and individual therapy, educational lectures, a Couples Relationship Enhancement Workshop (CREW), and the Substance Abuse/Mental Illness (SAMI) dual-diagnosis program. The 30-bed inpatient program is a 28-day intensive treatment providing educational and therapeutic activities for veterans. The outpatient program offers educational and therapeutic services for individuals who can benefit from a less intensive yet equally structured treatment plan. The SAMI program was established for individuals with substance dependence and one or more co-existing Axis I psychiatric disorders. All ADTP programs include year-long aftercare, involvement of family and friends, and educational components. The ADTP rotation provides the opportunity for an intern to gain experience appropriate to her/his level of training in the area of alcohol and drug treatment using cognitive-behavioral, interpersonal, and motivational enhancement approaches, as well as exposure to working within an interdisciplinary team setting. The internship rotation involves participation in various components of the ADTP depending on the trainee's interests and program needs. These opportunities include group therapy, long-term individual outpatient therapy, behavioral couples therapy, psychological assessment (e.g., diagnostic interviews, personality testing), involvement in SAMI program activities, educational lectures, and clinical research training.

2. The Neuropsychological Assessment Unit

The Psychological Assessment Service at the VASDHS is comprised of four Ph.D. clinical neuropsychologists, a neuropsychology postdoctoral fellow, and three psychometricians. This rotation provides the intern with the opportunity to conduct neuropsychological evaluations on a wide range of patient populations, including neurological, rehabilitation, psychiatric, geriatric, and general medicine patients. Opportunities for assessment and cognitive rehabilitation for veterans of Iraq or Afghanistan with mild to moderate traumatic brain injury are also available. Interns are taught how to use the Boston process approach to interpret a wide range of assessment instruments (e.g., Boston Naming Test, Wechsler Memory Scale - III; California Verbal Learning Test - 2; Delis-Kaplan Executive Function System, etc.) Interns will attend the Neuropsychological Assessment Seminar twice a week. There are many opportunities to integrate research projects with clinical services.

3. Family Mental Health Program (FMHP)

The Family Mental Health Program specializes in providing conjoint therapy for relationship distress. Referrals to the FMHP are received from throughout the VASDHS. All types of cases are evaluated for treatment potential, including couples and families coping with major psychiatric disorders (e.g., major depression, substance abuse recovery, schizophrenia, dementia, personality disorders, phobias, etc.), interpersonal conflict (e.g., domestic violence, child abuse, step-parenting issues, marital dysfunction) and medical problems (e.g., cancer, cardiac disease, diabetes, HIV infection, etc.). The program features an evidence-based approach to assessment and treatment, integrating behavioral/cognitive-behavioral, emotionally-focused, and systems approaches. Interns function as co-therapists with other mental health providers or as independent therapists when appropriate to their level of training. Patients and their families are seen both at the main VA hospital and a separate location in Mission Valley.

4. The Mood-Sleep Clinic

The Mood-Sleep clinic is formally comprised of the Cognitive and Behavioral Interventions Program and the Behavioral Sleep Medicine Program. The Clinic trains psychologists and other mental health professionals in cognitive-behavioral treatments for mood and sleep disorders (with or without mood comorbidities). The focus is on developing skills in cognitive-behavioral interventions, and developing a strong theoretical understanding of this empirically based approach to treatment. Interns are trained in a case formulation approach to cognitive-behavioral therapy, and in evaluating the effectiveness of clinical interventions. Training opportunities include: a) individual and group CBT for mood disorders; b) individual and group CBT for insomnia; c) individual and group imagery rehearsal therapy (IRT) for nightmares; and d) the use of semi-structured and structured clinical interviews for assessing psychiatric disorders. The sleep disorders patients provide interns with exposure to patients with sleep difficulties as a primary diagnosis, as well as patients with a range of co-morbid diagnoses, including mood, PTSD, anxiety, and pain patients. Interns can also participate in a dialectical behavior therapy (DBT) program for treating Borderline Personality Disorder. All interventions employed are empirically supported, and most have manuals for group and/or individual interventions. Supervision includes individual supervision, group supervision, team meetings, review of videotape sessions, didactics, and co-therapy. Interns are encouraged to develop both clinical and research interests related to this rotation (e.g., co-leading a group that is of particular interest to the intern, conducting outcome research).

5. Schizophrenia Psychosocial Rehabilitation Program

The Schizophrenia Psychosocial Rehabilitation Program provides psychosocial treatment services to patients with schizophrenia and related psychotic disorders in inpatient and outpatient settings at the VASDHS. Group and individual psychotherapy is provided using psychoeducation, motivational interviewing, cognitive-behavioral therapy (CBT), cognitive rehabilitation, and social skills training interventions. Clinical trials of manualized psychotherapy interventions are conducted. Diagnostic evaluation and psychological and neuropsychological assessment are also available. Interns participate in all of these clinical and research activities in diverse patient settings. Services may be provided in a variety of VASDHS settings, including inpatient psychiatry units, the Substance Abuse/Mental Illness Program serving outpatients with psychotic disorders and comorbid substance dependence (dual-diagnosis), Geropsychiatry serving older outpatients with schizophrenia, and the Cognitive Disorders Clinic serving outpatients with chronic schizophrenia and pharmacologic-treatment resistant psychotic symptoms. Interns will develop a strong theoretical understanding of empirically based individual and group psychosocial approaches to treating psychosis, with an emphasis on evaluating the efficacy of psychotherapy for psychosis. Interns are encouraged to develop both clinical and research interests related to this rotation.

6. Substance Abuse/Mental Illness (SAMI) Program

The SAMI Program is a dual-diagnosis specialty clinic within the Alcohol and Drug Treatment Program, providing outpatient treatment to veterans with substance use disorders as well as independent major psychiatric disorders (including depression, PTSD, social phobia, schizophrenia, and bipolar disorder). Interns participate as integral members of a multidisciplinary treatment team providing cognitive behavioral, motivational enhancement, relapse prevention, behavioral, Seeking Safety, acceptance and commitment therapy, and psychoeducational group psychotherapies. Individual cases and inpatient experiences are available to interested interns. Training in diagnostic evaluation is provided, and experience in neuropsychological assessment with substance users is available to interested interns.

7. Anxiety Disorders Program

The Anxiety Disorders Clinic is a multidisciplinary specialty clinic that provides services for veterans with panic disorder with and without agoraphobia, social phobia, GAD, civilian PTSD, OCD, OC spectrum disorders, specific phobias, and adjustment disorders. Interns in this rotation assess patients using clinical interviews supplemented by standardized self-report and clinician administered measures. The clinic runs general groups for managing stress and anxiety as well as disorder specific groups. Individual cognitive behavioral therapy is used to supplement group treatment or as the primary intervention.

8. Traumatic Brain Injury Cognitive Rehabilitation Program

The rotation within the Traumatic Brain Injury Cognitive Rehabilitation Program at the VASDHS provides the intern with the opportunity not only to conduct neuropsychological assessments but also provide cognitive rehabilitation to veterans of Iraq or Afghanistan with mild to moderate traumatic brain injuries. Opportunities are available for cognitive rehabilitation focused on compensatory strategies, family education, and other interventions. Supervision is provided in both group and individual contexts. Given the high rate of comorbid mental health, orthopedic, and other health concerns within this veteran group, this rotation provides interns with numerous opportunities for interdisciplinary interactions. Additionally, there are many possibilities to integrate research projects with clinical services.

9. Behavioral Medicine: Primary Care La Jolla

This rotation is located in the primary care clinic at the VA Hospital in La Jolla. The training in this setting emphasizes the integration of mental and physical health services. Responsibilities include leading or co-leading psychoeducational groups (e.g., pain, oncology, tinnitus), conducting mental health assessments and brief individual intervention, providing consultation to other providers in primary care and other specialty clinics, and giving lectures in the alcohol and drug treatment program. The intern will also have the opportunity to consult with oncology services and facilitate an ongoing, multidisciplinary psychosocial cancer support group. The intern will also conduct cognitive testing for patients undergoing organ transplant, amputee, and interferon evaluations. Typical patient problems include chronic medical conditions (e.g., diabetes, obesity), somatic symptoms (e.g., fatigue, pain), health-threatening behaviors (e.g., noncompliance) and mental health concerns (e.g. stress, depression). The training in this setting emphasizes the integration of mental and physical health services. Responsibilities include leading or co-leading psychoeducational groups (e.g., pain, oncology, tinnitus), conducting mental health assessments and brief individual intervention, providing consultation to other providers in primary care and other specialty clinics, and giving lectures in the alcohol and drug treatment program. The intern will also have the opportunity to consult with oncology services and facilitate an ongoing, multidisciplinary psychosocial cancer support group. The intern will also conduct cognitive testing for patients undergoing organ transplant, amputee, and interferon evaluations. Typical patient problems include chronic medical conditions (e.g., diabetes, obesity), somatic symptoms (e.g., fatigue, pain), health-threatening behaviors (e.g., noncompliance) and mental health concerns (e.g. stress, depression).

10. Behavioral Medicine: Spinal Cord Injury and Smoking Cessation

This rotation provides interns with experiences in the smoking cessation and spinal cord injury clinics. Interns on this rotation participate in the Mental Health Tobacco Use Cessation Clinic. Interns co-lead two weekly tobacco cessation groups; a group for veterans with substance use disorders, and a group for veterans with chronic mental illness. In addition, the intern delivers bi-weekly educational lectures regarding tobacco use on the inpatient alcohol and drug treatment unit. Opportunities for individual treatment for smoking cessation are also available. Interns spend 5-7 hours/week in this clinic.

The Spinal Cord Injury (SCI) unit is a multidisciplinary inpatient and rehabilitation unit for Veterans with new and existing spinal cord conditions. The SCI psychology team provides a range of services, including inpatient assessment and interventions, behavioral management planning, psychosocial rehabilitation with newly injured spinal cord patients, outpatient consultations, and group treatments. The most common psychosocial concerns include depression and adjustment disorders, substance abuse, chronic pain, and cognitive impairment. Interns spend 10-12 hours/week in this rotation.

11. Behavioral Medicine: Pain and Weight Control

The VA Weight Control Clinic is a multidisciplinary clinic for Veterans with obesity (BMI > 30), and includes services for patients considering surgical treatments (e.g., bariatric surgery) and non-surgical options for weight loss. Psychology provides comprehensive intake assessments for patients being considered for weight loss surgeries, offer individual therapy and consultation services, participate in multidisciplinary rounds, direct intake classes for the clinic, and lead psychoeducation and support groups covering a variety of topics. Interns will spend 10 hours/week in this clinic.

The VA Anesthesia Pain Clinic is a multidisciplinary outpatient clinic comprised of physicians, nurses, and psychologists providing treatment for chronic pain. The psychology service provides a range of services for the clinic, including individual pain management and therapy services, directing pain management groups, completing evaluations for patients being considered for chronic opioid therapy, and carrying out pre-surgical evaluations for patients being considered for implantable pain devices. Interns in this rotation will also attend multidisciplinary rounds where they will provide case presentations for team discussion. A time commitment of 10 hours/week is required.

VASDHS Internship rotations within the Mission Valley clinics

12. OEF/OIF Program

The Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Program at the VASDHS trains psychologists and other mental health professionals in assessment and treatment of posttraumatic stress disorder (PTSD) and its comorbidities (substance use disorders, depression, other anxiety disorders, re-adjustment issues) in recently deployed veterans. The focus is on developing skills in empirically supported interventions for these disorders, and developing a strong theoretical understanding of empirically based approaches to treatment. Training opportunities include: a) the use of structured clinical interviews for assessing PTSD and its comorbidities; b) individual and group cognitive processing therapy for PTSD; c) individual prolonged exposure therapy for PTSD; d) group Seeking Safety therapy for concurrent PTSD and substance use disorders; and e) interventions to reduce guilt related to combat experiences. The Program is part of a multi-disciplinary team represented by psychology, psychiatry, and social work. Staff members interface with primary care, the polytrauma team, and other mental health providers to provide integrated care for the myriad of physical and mental health concerns of OEF/OIF veterans. The clinic continues to grow and evolve as we learn more about the needs and preferences of OEF/OIF veterans. Thus, the intern will have the opportunity to take part in program development and evaluation. Supervision includes both group and individual supervision, review of videotape sessions, didactics, and co-therapy. Interns can take part in consultation groups in prolonged exposure therapy, cognitive processing therapy, and seeking safety therapy. Interns are encouraged to develop both clinical and research interests related to this rotation (e.g., co-leading a group that is of particular interest to the intern, conducting outcome research).

13. Posttraumatic Stress Disorder Programs

The Posttraumatic Stress Disorder (PTSD) Clinical Team (PCT) trains psychologists and other mental health professionals in cognitive-behavioral treatments for PTSD and related symptoms (e.g., nightmares, depression, anxiety, guilt, anger). The OIF/OEF PTSD Program serves veterans who have returned from the ongoing wars in Iraq and Afghanistan, and the PCT Program serves all other veterans (e.g., Vietnam War, Persian Gulf I/Desert Storm, Somalia, Korean War, World War II). In both programs, the focus is on developing empirically supported assessment and treatment skills for working with a veteran population, and developing a strong theoretical understanding of empirically based approaches. Interns will learn how to administer and interpret the major structured clinical interviews and self-reports for PTSD and associated features. They will also have opportunities to learn the state-of-the-art treatments for PTSD, including Prolonged Exposure Therapy, Cognitive-Processing Therapy, Seeking Safety, and Imagery Rehearsal Therapy. Supervision includes both group and individual supervision, review of videotape sessions, and didactics. Interns are encouraged to develop both clinical and research interests related to this rotation (e.g., co-leading a group that is of particular interest to the intern, conducting outcome research).

14. Military Sexual Trauma (MST) & Women’s Posttraumatic Stress Disorder (PTSD) Clinic

Activities in the MST & Women’s PTSD Clinic include screening, educating, assessing and treating male and female veterans who are experiencing psychological distress primarily related to MST. The clinic also serves men and women who are affected by other interpersonal trauma, and facilitates gender-specific services for female veterans with posttraumatic distress from any kind of trauma. The MST & Women’s PTSD Clinic also is tasked with awareness raising and education efforts to increase the MST screening rate throughout the VASDHS and to inform VA, military and community providers as well as veterans about sexual trauma, its sequelae and treatment. The Clinic engages in ongoing research efforts aimed at increasing knowledge about the population served by the clinic, uncovering risk and resiliency factors of posttraumatic distress, and identifying treatment outcome predictors. Direct clinical duties of the intern will include providing assessment, psycho-education, and individual and group psychotherapy. The intern will work in a multidisciplinary setting where treatment planning includes consultation with clinical psychologists, clinical pharmacists and psychiatrists, social workers, primary care physicians, and other trainees. Training in assessing PTSD using standardized interviews (e.g., CAPS, SCID) and in providing empirically supported treatments for PTSD (e.g., Prolonged Exposure [PE], Cognitive Processing Therapy [CPT], Seeking Safety [SS], Acceptance and Commitment Therapy [ACT]) will be an important part of this rotation. The intern will attend weekly PE and CPT training and consultation meetings, a PTSD Seminar, and the MST & Women’s PTSD Clinic Team meeting, during which the intern will give formal case presentations. The intern will also be involved in the education and research efforts of the clinic.

15. Behavioral Medicine: Primary Care Mission Valley

This rotation is located in the primary care clinic at the VA Mission Valley Outpatient location. The training in this setting emphasizes the integration of mental and physical health services. Responsibilities include leading or co-leading 2 psychoeducational groups per week, conducting mental health assessments and brief individual intervention, providing consultation to other providers in primary care, and giving lectures in multidisciplinary hypertension, tobacco cessation, and weight control programs. The intern will also perform pre-transplant evaluations. Typical patient problems include chronic medical conditions (e.g., diabetes, obesity), somatic symptoms (e.g., fatigue, pain), health-threatening behaviors (e.g., noncompliance) and mental health concerns (e.g. stress, depression).

B. UCSD OUTPATIENT PSYCHIATRIC SERVICES

The UCSD Outpatient Psychiatric Service is one of the primary outpatient psychotherapy and psychosocial rehabilitation training sites in the Department of Psychiatry for psychiatric residents, psychology students and interns, social work and marriage and family therapy interns and medical students. It consists of three interlocking clinical programs: 1) Gifford Clinic, a public mental health service; 2) the Co-Occurring Disorders Integrated Treatment and Recovery Program; and 3) Psychiatric Associates, a private practice model mental health service. Over 2,000 patients from diverse socioeconomic, cultural and ethnic backgrounds are served annually.

16. UCSD Outpatient Psychiatric Services rotation

Interns selected for this service are provided a rich variety of clinical learning opportunities with supervision from a multidisciplinary group of experienced faculty and staff whose primary mission is clinical training. Interns work within the Gifford Clinic, a publicly funded outpatient mental health service. They evaluate one new patient a week and provide approximately 10 clinical hours weekly. Services include brief-focused and ongoing psychotherapy to individuals, couples and families, crisis intervention and care coordination. Each intern co-leads at least one psychotherapy group using evidence based group interventions such as Dialectical Behavior Therapy (DBT) and Seeking-Safety. Interns work closely with psychiatric faculty and residents regarding psychopharmacologic treatment of their patients. Interns may also have the opportunity to work within the IOP Programs for individuals with Borderline Personality Disorder and/or Co-Occurring Substance Abuse and other Mental Disorders. Experiences would include evaluation, individual and group psychotherapy utilizing a Dialectical Behavior Therapy approach and other evidence based practices.

As part of the overall internship assessment requirement, interns conduct up to 5 assessments over the year. They have the opportunity to combine neuropsychological with personality assessment measures in the evaluation of patients with challenging diagnostic issues. They also collaborate with psychiatric residents in an integrated case presentation for Departmental Professor’s Rounds.

Learning opportunities include weekly individual supervision using videotapes and audiotapes, a weekly multidisciplinary evaluation team meeting, weekly group supervision on assessment, a weekly clinical seminar focused on issues in psychotherapy and treatment of personality disorders and a weekly DBT consultation group for those involved in that program. All interns are encouraged to attend the Department of Psychiatry weekly Grand Rounds and other lectures and workshops sponsored by the Department.

C. UCSD CHILD PSYCHIATRY DEPARTMENT AT RADY CHILDREN'S HOSPITAL

Rady Children's Hospital and Health Center is the major comprehensive pediatric health care facility for San Diego County. Rady Children's Hospital has had a long standing relationship as a teaching facility for the Child Psychiatry division of UCSD Department of Psychiatry. It is located about six miles southeast of the UCSD Medical School and VA Medical Center in La Jolla. It is also equidistant between the downtown UCSD Medical Center and the UCSD Child and Adolescent Psychiatry Service (CAPS).

There are 200 beds at Rady Children's Hospital for acutely ill inpatients as well as extensive outpatient services in more than 37 specialized clinics. As part of the affiliated divisions of Rady Children's Hospital and Health Center, the Children's Outpatient Psychiatry Clinic serves diverse needs of children and their families from San Diego and Imperial Counties as well as from the hospital. The clinic is the largest provider of county funded outpatient services for youth and also serves as a teaching facility for clinical psychology training, general psychiatry residents, fellows in Child Psychiatry, and graduate students in social work and counseling.

17. UCSD Child Outpatient Psychiatry rotation

In the Children's Outpatient Psychiatry Clinic placement, interns gain experience in diagnostic evaluation, psychological testing, individual, group, and family psychotherapy, parent education and training, and psychiatric consultation/liaison services. Interns will gain experience with a diverse patient population, ranging in age from toddlers through adolescents and presenting with a variety of diagnoses, including disruptive, mood, anxiety, substance abuse, and developmental disorders. The patient population is also diverse in terms of socio-economic status, race/ethnicity, and family composition. Interns will collaborate with an interdisciplinary "Treatment Team" coordinating the care of all families receiving services. Interns also provide psychiatric consultation/liaison services for medical patients at Rady Children's Hospital, including crisis intervention, pain evaluation and management, parental education and training regarding needs of chronically ill children, and evaluation of suicide risk. The theoretical orientations of the faculty and staff in the clinic are eclectic. Exposure to, and supervision in, cognitive behavioral and behavioral interventions including parent training, family systems, humanistic, and psychodynamic approaches, is provided in the context of an understanding of developmental psychopathology. Depending on the patient characteristics and funding mechanisms, some patients and families receive intensive short term treatment, whereas others may remain in treatment for more than one year. Work with the families often includes case management and community liaison activities, including interaction with child protective services, family or juvenile courts, other health care providers, and the school systems.

In addition to individual and group clinical supervision, interns participate in a variety of didactic and professional development activities within the Division of Child and Adolescent Psychiatry at UCSD. These include Grand Rounds presentations, Consultation/Liaison seminar, forensic seminar, case conferences, journal club meetings, and staff in-service training sessions. On alternate years a neuropsychiatry seminar is also available.

D. UCSD CHILD AND ADOLESCENT PSYCHIATRIC SERVICES - (CAPS)

UCSD CAPS is a licensed inpatient unit that provides empirically supported psychiatric and psychological treatment to a largely under-served population of children and adolescents. CAP is part of the UCSD Medical Center and is currently located about 15 minutes from the San Diego VA Hospital and about 15 minutes from Rady Children’s Hospital. It is an integral part of a broad system of healthcare and is an important component of the Department of Psychiatry, both at UCSD and at Children’s Hospital.

CAPS is an outstanding academic and clinical center of excellence in patient care, scholarship and teaching. The multidisciplinary treatment team provides comprehensive services to emotionally disturbed children and adolescents between the ages of two and eighteen. As its goal, CAPS offers state of the art interventions which include both biological and psychological treatments. All intervention strategies reflect empirically based, humane, responsible and progressive techniques. Aside from patient care activities, CAPS is also a teaching venue for doctoral interns and practicum students in clinical psychology as well as fellows in child psychiatry, residents in adult psychiatry and medical students electing rotations in child and adolescent psychiatry. The multidisciplinary treatment team includes psychiatrists, psychologists, pediatricians, fellows in child/adolescent psychiatry, social workers, nurses, pharmacists and educators.

18. UCSD CAPS rotation

The psychology internship at UCSD CAPS is designed to provide interns with hospital-based experience in the comprehensive assessment and treatment of children, adolescents and their families. Children/adolescents admitted to CAPS typically have histories of emotional disturbance complicated by a variety of psychosocial stressors, such as physical/sexual abuse, abandonment, in utero exposure to drugs and alcohol, family histories of substance abuse and psychiatric disorders and legal problems. Nearly all youngsters admitted to the facility have one or more major psychiatric disorders. Length of stay is variable but often averages 1 week. A multidisciplinary treatment team meets weekly to develop a comprehensive treatment plan that includes individual, family and group therapy as well as pharmacological intervention, nursing care, and occupational and recreational therapy. Active involvement of the family is strongly encouraged and extensive contact with community and social service agencies augment the internship training experience. In addition, psychology interns provide assessment services including intellectual, achievement, neuropsychological and personality evaluations. All interns will train under the guidance of a licensed psychologist but will participate as active members of a multidisciplinary treatment team. Each intern will have experience working with both children and adolescents.

E. UCSD MEDICAL CENTER, HILLCREST

UCSD Medical Center, Hillcrest, is a modern 440-bed full-service teaching and research facility. The Medical Center is located near the Downtown area of San Diego, about 20 minutes by car from the main UCSD campus in La Jolla. The UCSD Medical Center is a rich environment which offers exposure to state-of-the art treatment and research opportunities and participation in educational opportunities in the area of psychology/psychiatry and other related specialties.

UCSD MEDICAL CENTER rotations

Two positions in the Behavioral Medicine cluster have rotations at the UCSD Medical Center (see 19-20, below). Both interns in these positions will spend half of their time at their VA sites (see Appendix D), and the other half of their time at UCSD Medical Center sites. For one intern, the Medical Center rotation will include the UCSD Pain Clinic and the UCSD Burn Center. For the other intern, the rotation will include the Pain Clinic and the UCSD Moore’s Cancer Center. The rotations are described below. The Pain Clinic, Burn Center, and Cancer Center are described below.

19. UCSD Medical Center Pain Clinic and UCSD Moores Cancer Center

The intern in the UCSD Center for Pain and Palliative Medicine (at the UCSD Thornton Hospital in La Jolla) will play a central role in a multidisciplinary treatment team. The clinic is under the auspices of the Department of Anesthesiology and the patient population represents a fairly wide range of chronic pain diagnoses.

The bulk of intern time (probably 75-90%) in the clinic will be devoted to initial assessment and consultation on patients. This will include:

1) Pre-procedure psychological evaluations of patients being considered for invasive surgical techniques (including intrathecal pump and neurostimulator implant procedures);
2) Chronic opiate psychological evaluations intended to provide input to the attending physicians who are making recommendations to primary care providers for long-term management of chronic pain conditions;
3) General psychological evaluations of patients with co-morbid psychiatric issues, substance abuse problems (both prescription and illicit), and other behavioral and coping-related issues.

All evaluations include a short battery of self-report questionnaires with which the intern will become familiar through the year, and interns are encouraged to supplement these measures with more extensive personality or neuropsychological tests when the case warrants it. Interns will also have the opportunity to participate as a co-facilitator of ongoing Pain Management psychotherapy groups, to periodically work on a short-term basis with patients in individual psychotherapy, and to become involved in clinical research. The multidisciplinary treatment team meets once per month for one hour to review the cases of patients seen by our service, and interns are expected to present their cases to the team and facilitate discussion of relevant issues. In addition, interns will be expected to consult on cases as needed with the multidisciplinary pain clinic team.

The intern in this rotation will also play a central role in the fast-growing psychosocial program of this NCI-designated Comprehensive Cancer Center. Working with a team consisting of social workers, psychiatrists, psychologists and other psychology trainees, the intern will primarily focus upon providing consultation, brief assessment, individual psychotherapeutic intervention and therapy/support group facilitation. The intern will spend one day per week in this clinic and will periodically also include attendance at multidisciplinary psychosocial rounds with the treatment team. In the course of the year, the intern will also have the opportunity to take on some supervisory duties in working with practicum-level students also providing services in the Cancer Center.

20. UCSD Medical Center Pain Clinic and UCSD Medical Center Burn Clinic

The Intern in this rotation will split time between the Burn Clinic described here and the Pain Clinic described above.

The UCSD Burn Center is located at the UCSD Medical Center in Hillcrest on the 5th floor. The intern at the UCSD Burn Center will work primarily with adult and child inpatients and their families in the 8-bed Intensive Care Unit or the 10-bed Special Care Unit (step down from ICU).

Roles consist of (1) psychological assessment to assess for psychiatric disorders and past or current substance abuse problems, (2) use of various interventions and provision of support for patient and families in coping with physical injuries and treatment (including behavioral interventions to assist patient with acute pain, emotional/cognitive/behavioral responses to traumatic experience, discussion of body image concerns, brief motivational interviewing for substance use-related injuries), and (3) providing recommendations to multidisciplinary staff to enhance outcomes of working with the patient and his/her family. The intern will also participate in weekly Friday morning rounds. The intern will learn extensively about burn care and the physical and psychological effects of burn injury. As part of the Medical Center Psychiatry consult-liaison team, the intern will gain experience in rapid psychiatric and psychological assessment and formulation of treatments recommendations for medically ill patients with psychiatric symptoms. Interactions with patients can be as brief as a one-time meeting or twice weekly follow-up with the patient and his/her family lasting up to a few months depending on the extent of the injury. In addition, the intern will learn how to work closely with other medical disciplines, combine assessment and brief intervention in the span of a few sessions, and tailor your recommendations to fit with the fast-paced trauma care environment. The intern will be at the Burn Center two half-days per week. Additionally, the intern will have the opportunity to assist in supervising practicum students who are working at the Burn Center.

21. UCSD Medical Center,Senior Behavioral Health (SBH)

SBH is a voluntary, inpatient, geriatric psychiatry unit located at the UCSD Medical Center in Hillcrest on the 7th floor. As an intern at SBH, you will work with elderly adults suffering from a variety of neurologic illnesses (e.g., dementia, stroke) and psychiatric conditions (e.g., depression, psychosis, bipolar disorder).

Roles consist of (1) conducting inpatient neuropsychological assessment to identify cognitive decline and assist in the diagnosis of dementia or other neurologic conditions; (2) providing recommendations to multidisciplinary staff to maximize treatment outcomes and develop effective staff interventions; (3) leading a weekly Connections Group geared toward helping patients manage diverse issues such as disease-related stress, age related losses, or other psychosocial stressors. You will also participate in treatment team rounds on Monday, Wednesday, and Friday mornings. In addition to working with inpatients, you will also conduct one weekly outpatient neuropsychological assessment, and have the opportunity to provide direct feedback to patients and families.

On this rotation, you will learn extensively about psychiatric and neuropsychological issues in the geriatric population, and be exposed to a myriad of medical and social issues important in the care of geriatric patients. In addition, you will learn how to work closely with other disciplines (psychiatry, social work, internal medicine, nursing, occupational therapy) in creating a comprehensive plan for each patient’s care after discharge.

22. UCSD Medical Center Neuropsychological Assessment Program

This rotation is ideal for those who have trained in neuropsychology and want to further develop their skills in the use of integrating standardized neuropsychological testing results, as well as specialized neurobehavioral examination techniques. Interns will develop interpretative and consultative skills that are necessary to evaluate individuals with cognitive, central nervous system and medical disorders. At the UCSD Medical Center we offer neuropsychological services in support of the various medical services at hospital. Consequently the interns are exposed to a variety of patient populations.

UCSD Transplantation program: There are three solid organ transplant teams and we evaluate over 250 patients per year - Heart/Lung, Kidney/Pancreas, and Liver.

UCSD Comprehensive Epilepsy Center: Interns conduct pre- and post-operative neuropsychological assessments with epilepsy patients, including intracarotid amytal procedures (aka. Wada procedures) and intraoperative language mapping (where we assist the neurosurgical and neurology teams in the operating room.)

General Neuropsychology Service: We provide comprehensive assessment from a broad range of referral sources including neurologists and primary care physicians, occupational medicine and insurance companies.

Forensic assessment: The faculty are often involved in a variety of forensic assessments that include civil proceedings, independent medical evaluations, workers compensation, fitness for duty, and competency assessments. Interns often have the opportunity to become involved in these activities.

Supervision includes at least one hour of individual supervision in addition to weekly group supervision, weekly Neuropsychology Clinical Training Seminar, and a host of other possible opportunities (Transplant Rounds, Transplant Selection Committees, Epilepsy Case Discussions, Brain Pathology (brain autopsies with neuropathology), Psychiatry Consultation/Liaison, and Psychiatry Grand Rounds. The weekly Neuropsychology Clinical Training seminar covers training in neuroanatomy, neurobehavioral syndromes (e.g., visual field deficits, aphasia, alexia, agnosia, etc.), and neurobehavioral injuries (e.g., cerebrovascular accidents, multiple sclerosis, traumatic brain injuries, HIV, dementia, Parkinson's Disease, Huntington's Disease and more). This neuropsychology training format is consistent with the Houston Guidelines.

More information can be found at: http://www.medicalneuropsych.com/training/UCSD_Internship.html

Please contact the program for training site passwords.

F. UCSD EATING DISORDERS (ED) PROGRAMS

The Eating Disorders (ED) Program at UCSD is a newly developing program and the selected interns will have an opportunity to both participate in treatment of patients as well as assist in developing new treatment strategies. Our objective is to foster interns who approach their clinical work with an inquisitive, investigative and empathic attitude and are competent to function exceptionally as clinicians. The program is based on the scientist-practitioner model. Interns selected for this service will work with a team of multidisciplinary professional staff. This group will incorporate results from empirical science into the treatment approach for eating disorders.

23. Intensive Outpatient Program for Eating Disorders rotation

Interns will have the opportunity to receive specialized training in the assessment and treatment of anorexia and bulimia nervosa, as well as more general concerns with weight and/or physical appearance. Interns will have the opportunity to work with teens as well as adults. Treatment is multidimensional and may involve combinations of individual, group, family, and couples psychotherapy. The intern will carry a caseload of approximately 5 individual eating disorder clients and co-lead treatment groups throughout the training year. Interns will train under a licensed psychologist but will also collaborate with a multidisciplinary treatment team. This will include work with psychiatrists and thus the coordination of appropriate care for each patient. Interns will learn about the interface of psychotherapy and psychopharmacology and their integration in individualized treatment. Interns will evaluate the efficacy of their work with clients on an ongoing basis with their supervisors and will review the current literature for guidance about which treatment strategies are best suited to particular problems. Our objective is to train interns to integrate empirically driven interventions with an empathic approach to treatment.

Interns will participate in comprehensive assessments including specialized eating disorder questionnaires, neuropsychological testing, as well as individual and group therapy and advanced methods for symptom recovery of eating disorder patients. Interns will collaborate with a multidisciplinary treatment team, consult with medical staff, and participate in patient rounds. Regular team meetings will provide the opportunity to present cases, bring up issues for supervision and foster team cohesion. Interns will also be able to further develop their skills in report-writing. Furthermore, interested interns will have the opportunity to participate in ongoing research opportunities, including genetic and brain imaging studies.