Behavioral Medicine Rotation A: Chronic Illness and Sexual Health - Lifespan Hospital System

Faculty Supervisor(s): Julie Boergers, PhD, Ernestine Jennings, PhD, Megan Pinkston-Camp, MA, PhD, and Victoria Quinones, PhD

The Chronic Illness and Sexual Health rotation within the Lifespan Health System provides a broad range of training experiences in behavioral medicine. The rotation emphasizes training in assessment, consultation, and intervention skills for psychologists in medical settings. Training provides exposure to individual, as well as group modalities of intervention within a variety of patient populations. The clinical psychology resident can engage with dynamic, multidisciplinary teams that may include colleagues with backgrounds in psychology, psychiatry, a variety of medical specialties, clinical social work, and nursing. Rotation components include:

Patients seen through the Behavioral Medicine Clinical Services located at The Miriam Hospital are assessed and treated for a broad range of concerns such as chronic pain, obesity-related conditions, smoking cessation, difficulty managing chronic medical conditions (e.g., arthritis, chronic fatigue, gastrointestinal disorders, endocrine disorders, HIV) and co-morbid sleep, anxiety, and mood disorders. Patients are typically treated using cognitive-behavioral and acceptance-based interventions. Dr. Jennings provides supervision and support in this service, offering general behavioral medicine options as well as specialty services. Dr. Pinkston-Camp also provides on-site support to residents in Behavioral Medicine.

At Open Door Health, the first community-based primary care center in RI for the LGBTQ+ community, clinical psychology residents will have the opportunity to provide gender affirming care, trans* surgery assessments and support, mental health, substance use, and behavioral medicine therapy for clinic patients. The integrated mental health program is continuing to evolve, and residents can support the growth of the program by being involved in program development processes. Dr. Pinkston-Camp provides supervision to residents at Open Door Health. Treatment approaches are grounded in trauma-informed, resilience-based foundations with social justice and intersectionality lenses, and include, but are not limited to, cognitive behavioral therapy, dialectical behavioral therapy, acceptance and commitment therapy, motivational interviewing, and narrative therapy. For gender affirming surgery assessments, the WPATH guidance is followed.

The Pediatric Sleep Disorders Clinic is an integrated multidisciplinary program providing comprehensive assessment and treatment of child and adolescent sleep problems. The staff of the Sleep Disorders Center includes psychologists, pulmonologists and sleep technicians. Typical presenting concerns include bedtime refusal, insomnia, difficulty maintaining sleep, delayed sleep phase, sleepwalking, sleep terrors, nighttime fears, excessive daytime sleepiness, difficulty adhering to PAP therapy for snoring/breathing difficulties, and sleep problems comorbid with medical, developmental, and psychiatric disorders​.  Clinical psychology residents will conduct both new patient evaluations and follow-up treatment visits in conjunction with supervisor, Dr. Boergers each week.  Treatment approaches include, but are not limited to, cognitive behavioral therapy for insomnia, parent training, graduated exposure techniques, and psychoeducation.

The Rhode Island Hospital Comprehensive Spine Center​, Behavioral Pain Management Experience emphasizes training in assessment, treatment and consultation skills for patients presenting with chronic pain and co-occurring psychological concerns which may be a result of or exacerbating the chronic pain. The experience is within the Rhode Island Hospital Spine Center which offers spine-specific physical evaluations, interventional procedures, minimally invasive and complex spine surgeries, as well as physical and occupational therapy. The clinical psychology resident functions as part of an integrated care, multidisciplinary team that includes physicians, nurses, physical therapy, massage therapy, and psychology. Individual psycho-diagnostic evaluations for both pre-surgical and non-surgical patients are conducted collaboratively with supervisor, Dr. Quinones. Clinical psychology residents may engage in multiple training opportunities including the provision of therapy and education to patients, participating in warm-handoffs, and providing consultation and post-evaluation follow-up recommendations/care. Patients are treated in a group psychotherapy format co-led by Dr. Quinones and the clinical psychology resident using a cognitive-behavioral framework (ACT combined with CBT) that includes evidence-based components as well as lifestyle modification, skills training for management of medical symptoms, self-regulation, and relapse prevention skills.

Behavioral Medicine Rotation B: Cardiopulmonary, Behavioral Medicine, and Inpatient Consultation Care - The Miriam Hospital

Faculty Supervisor(s): Anna Schierberl Scherr, PhD (primary), Maria Buckley, PhD, Barbara Jandasek, PhD, & Jeffrey Burock, MD

The Miriam Hospital's Behavioral Medicine Rotation B provides broad training in behavioral medicine by providing experience in assessment, individual and group treatment, and activities that promote chronic disease risk reduction and treatment. The clinical psychology resident functions on multidisciplinary teams that include psychologists, psychiatrists, physicians, clinical social workers, nurses, dietitians, pharmacists, respiratory and physical therapists, and exercise physiologists.  

Behavioral Medicine Clinical Services with a focus on disordered eating and weight. Patients seen through the Behavioral Medicine Clinical Services are assessed and treated for problems such as chronic pain, obesity, weight management and disordered eating behaviors, smoking cessation, and chronic medical conditions (e.g., arthritis, chronic fatigue, gastrointestinal disorders, endocrine disorders) and co-occurring mental health concerns and stressors. Evaluations are conducted collaboratively between the clinical psychology resident and supervisor, Dr. Anna Schierberl Scherr and usually incorporate a comprehensive interview and data from self-report questionnaires. Clinical psychology residents will carry an individual caseload consisting of patients with weight management issues and disordered eating behaviors and other psychiatric conditions commonly occurring in medical settings. Patients are typically treated using cognitive-behavioral as well as acceptance based and self-compassion frameworks that can include lifestyle modification, skills training for management of medical symptoms and emotional distress, mindfulness-based self-regulation, and relapse prevention skills.

Cardiac and Pulmonary Rehabilitation. The Cardiac and Pulmonary Rehabilitation Behavioral Medicine Service with Dr. Maria Buckley provides training in conducting brief, targeted interventions for issues such as adjustment to cardiac and pulmonary disease, weight management, smoking cessation, anxiety and mood management, adherence to exercise and treatment regimens and stress management. The clinical psychology resident will receive training in presenting brief psychoeducational classes to Cardiac and Pulmonary Rehabilitation patients. The resident may also have the opportunity to co-facilitate a quarterly Heart Transplant/LVAD support group meeting. The Cardiac and Pulmonary Rehabilitation services are multidisciplinary and offer the opportunity to collaborate and consult with physicians, exercise physiologists, pharmacists, respiratory and physical therapists, dietitians, and nurses and to assist them in their delivery of patient care. 

The Miriam Hospital Inpatient Consultation-Liaison Clinic. On the inpatient Consultation-Liaison (C/L) service, the clinical psychology resident assesses and treats acute medical-surgical patients in the emergency room and during their inpatient stay at The Miriam Hospital. Consultations range from the assessment of more traditional psychiatric problems which may arise in medically ill patients (e.g., changes in mental status, depression, anxiety disorders, psychosis, suicidality) to the initiation of positive lifestyle modifications with the goal of long-term benefits. There is also an emphasis on treating psychiatric sequelae of neurological disorders and geriatric disorders, including dementia, Parkinson's disease, multiple sclerosis, and post-stroke sequelae. The clinical psychology resident will also develop basic skills in the ability to read neuroimaging including Brain CTs and Brain MRIs. This experience includes both patient-centered and consultee-centered consultation, wherein the medical and nursing staff may be assisted in managing various behavioral difficulties in patients. The consultation-liaison service is multidisciplinary, consisting of psychiatrists, a psychiatric nurse, and trainees in each of these disciplines, with Dr. Jeffrey Burock as the supervisor. This service treats a high number of patients each day and the pace of the service may be faster than other sites. There is also a special emphasis on identifying medical and neurological issues which may be playing a role in the psychiatric presentation. 

The Pediatric Cardiology Rotation. The Pediatric Cardiology Rotation provides training with the Pediatric Psychology team providing integrated behavioral health services in Hasbro’s Pediatric Heart Center. Common referral questions include individual and familial adjustment to chronic illness, problems with adherence to medical regimens, preparation for medical procedures, transition to increased responsibility for their own medical care for children and adolescents with congenital heart disease, as well as complaints of cardiac symptoms often co-occurring with depression and anxiety. Clinical psychology residents on the rotation participate as part of an interdisciplinary treatment team that includes representation from disciplines of cardiology, psychology, nursing, and social work. Treatment provided is typically CBT-based individual and family therapy, in collaboration with supervisor, Dr. Barbara Jandasek. Opportunities may also exist for didactic presentations to families, as well as consultation with the medical team.  In addition, clinical psychology residents may participate in other interdisciplinary meetings (psychosocial team meeting, camp meetings, research meetings, echo conference) depending upon resident availability and interest. 

Geropsychology Rotation - Providence VA Medical Center

Faculty Supervisor(s): Pamela Steadman-Wood, PhD, ABPP (primary), Jessica Cappellano, PhD, and Ronald Smith, PhD 

Located at the Providence VA Medical Center, the Geropsychology rotation is designed to introduce the clinical psychology resident to the role of the geropsychologist in home-based and outpatient settings. The clinical psychology resident will spend 2-3 days in the General Outpatient Mental Health Clinic (CAPS) and 1-1.5 days per week in Home-Based Primary Care (HBPC) providing an array of psychological services to older Veterans. 

Providence VA General Outpatient Clinic (CAPS). The VA’s General Outpatient Mental Health Clinic—the Comprehensive Ambulatory Psychiatry Section (CAPS)-- provides Veterans with access to comprehensive, evidence-based mental health care with the goal of improving Veterans quality of life.  This training experience will focus on individual therapy with older adult Veterans coping with a variety of medical and mental health concerns. Veterans seen in this clinic present with a variety of comorbid medical (e.g., chronic illness, chronic pain), and mental health (e.g., mood, adjustment, anxiety, trauma and substance use disorders, grief, loss, relational issues,) concerns. Treatment approaches include Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), Cognitive Processing Therapy (CPT), Interpersonal Therapy (IPT), Later-Adulthood Trauma Reengagement (LATR), Motivational Interviewing (MI) and Problem-Solving Therapy (PST). Opportunities for group therapy may also be available, depending on need and interest.

The CAPS training experience will also provide clinical psychology residents with opportunities for working with Veterans (and caregivers) with neurocognitive disorders. This may include brief cognitive testing and behavioral interventions. Clinical psychology residents may receive training in Resources for Enhancing Alzheimer’s Caregivers Health (REACH VA), an evidence-based psychosocial intervention to reduce caregiver burden.  REACH VA focuses on providing psychoeducation on the disease process, enhancing stress management, and promoting problem-solving skills. In this context, residents will have the opportunity to develop non-pharmacological interventions to address problematic behaviors that may arise due to dementia.  They will also assist family members in developing and achieving goals related to the care of their loved ones and themselves.  Interventions will be conducted face-to-face and/or via telehealth. Opportunities to collaborate with geriatric psychiatry, geriatric primary care and neuropsychology may also be part of this training experience.

VA Home-Based Primary Care (HBPC). The VA is a leader in the provision of patient-centered medical home models of care, an emerging wave of service delivery. The VA HBPC program serves primarily older Veterans whose medical and psychiatric conditions serve as barriers to engagement in traditional outpatient care. As such, all primary care services are provided to them in their home by an interprofessional team of primary care providers, nurses, nutritionists, social workers, rehabilitation therapists, clinical pharmacists, and psychologists. As a part of this team, the clinical psychology resident will have the opportunity to provide brief assessments including assessment of cognitive and capacity evaluations, consultations for a variety of concerns, and evidence-based treatment for overlapping and interacting physical and mental health presenting concerns. Common presenting concerns include adjustment disorders, anxiety-related disorders, cognitive concerns, chronic pain, insomnia, mood disorders, PTSD, substance use disorders, caregiver stress, bereavement/loss, issues related to aging, life transitions, and death and dying. Common evidence-based treatment approaches include Acceptance and Commitment Therapy, Mindfulness-based interventions, Cognitive Behavioral Therapies (CBT-I, CPT, etc.), Motivational Interviewing, and Problem-Solving Therapy . Residents will have the opportunity to learn how to flexibly adapt the evidence-based treatments to adjust for any cognitive impairments, to ensure accessibility of treatments for all Veterans.

Finally, residents may have the privilege of working with Veterans within palliative and hospice care as they approach end-of -life.

Overall, residents will be able to learn how to navigate the often complex ethical and legal issues inherent to working: (1) with Veterans living with multiple medical and psychiatric comorbidities, (2) in non-traditional care settings, and (3) as part of an interprofessional team with diverse priorities, treatment targets, and demands.

Primary Care Behavioral Health (PCBH) Rotation A - Providence VA Medical Center

Faculty Supervisor(s): Tracy O'Leary Tevyaw, PhD (primary), Elizabeth Chattillion, PhD, Karen Oliver, PhD

Primary Care Behavioral Health (PCBH) Rotation B - Providence VA Medical Center

Faculty Supervisor(s): Caitlin Burditt, PhD (primary), Kevin McKay, PhD, ABPP

[Please note that clinical psychology residents would complete only one of the PCBH rotations for the training year.]

The PCBH rotations are designed to introduce the trainee to the role of the psychologist in primary care-mental health integration within an outpatient primary care setting. Clinical psychology residents serve as a member of an interprofessional treatment team comprised of primary care providers, psychologists, psychiatrists, social workers, clinical pharmacists, nurses, nurse practitioners, nutritionists, and physical therapists. 

In the outpatient setting, the clinical psychology resident will develop a working knowledge of the function and role of a psychologist within a complex medical system. The development of assessment skills required to determine when brief treatment in primary care or referral to more comprehensive treatment in the mental health service will be emphasized in the context of an open access model, depression care management program, and disease specific consultation and treatment. Brief treatment, risk assessment, and early identification of mental health and substance use problems will be a focus. Residents will have the opportunity to provide open access, receive “warm handoffs” directly from primary care providers, and provide brief, evidence-based treatment to a caseload of veterans in primary care.

The clinical psychology resident will also be exposed to a variety of presenting problems. The Veteran population is diverse, and Veterans often present in primary care with complicated medical and psychological issues. Common presenting problems include depression and other mood disorders, PTSD and stress reactions, substance abuse, adjustment disorders, chronic pain, diabetes and other metabolic conditions, obesity, caregiver stress, cognitive impairment, coping with medical illness, and bereavement and loss. Common treatment approaches include cognitive behavioral therapy, motivational interviewing, coping skills training, problem solving, and acceptance-based approaches.

VA Primary Care Behavioral Health Rotation A

Training experiences in Primary Care Rotation A include:

Metabolic Clinic. The clinical psychology resident will participate in a weekly interprofessional shared medical appointment for veterans with diabetes in the Primary Care Metabolic Clinic along with members of pharmacy, nutrition, and diabetes education. The clinical psychology resident will also conduct individual motivational enhancement sessions for diabetic nonadherence and obesity management as part of the Metabolic Clinic experience. 

Heart Failure Clinic. The Heart Failure (HF) Clinic is a weekly shared medical appointment that provides assistance for Veterans with HF who have recently been discharged from a hospital admission. Veterans with HF and their caregivers may attend four distinct sessions that are offered by a clinical pharmacist, a registered nurse, a behavioral psychologist, and a nutritionist. Sessions address stress management, disease coping, nutrition, and medication-related topics, and provide the Veteran with the necessary tools for HF self-management.  The psychology resident will facilitate the behavioral health sessions of the HF Clinic. These sessions include psychoeducational didactics addressing strategies for coping with HF and stress management. The resident will assist the Veterans with individualized symptom management as well.

MOVE! Weight Maintenance Group. The clinical psychology resident will co-facilitate a weekly weight maintenance group as part of the VA’s MOVE! Weight Management program. The resident will be the primary group facilitator and will lead the group in behaviorally focused didactic presentations related to weight loss and maintenance, as well as in monitoring group progress, setting goals, and conducting weekly weigh-ins. 

Sexual Health Clinic. The clinical psychology resident will participate in the Sexual Health Clinic, which is an assessment and treatment program for sexual issues. The MHBSS Service, along with Urology and Endocrinology Service, provide a comprehensive approach to medical and psychological assessment and treatment of erectile dysfunction and other sexual issues in the Veteran population.  There will be an opportunity for the assessment/treatment of veterans in the Sexual Health Clinic on an intermittent, as-needed basis (typically ranges 4-10 assessments per rotation).  In addition, one veteran may be selected for brief treatment. 

Bariatric Surgery Psychosocial Evaluations. The clinical psychology resident will have the opportunity on an intermittent, as-needed basis to conduct psychosocial evaluations for Veterans who have been referred for bariatric surgery. The resident will learn to conduct a comprehensive evaluation of Veterans’ mental health, weight and eating behaviors, substance abuse history, home environment, and social support system, to determine if a Veteran is an appropriate candidate for bariatric surgery. Evaluations will be co-facilitated with the supervisor and recommendations for behavioral or psychosocial changes will be discussed with the Veteran in the evaluation session. The resident will share findings with the bariatric surgery team and may also have the opportunity to follow individual patients who would benefit from brief treatment to help facilitate behavioral changes necessary to achieve bariatric surgery eligibility.

VA Primary Care Behavioral Health Rotation B

Core description is the same as Primary Care A. However, supplemental experiences differ. Training experiences in Primary Care Rotation B include:

Metabolic Clinic. The clinical psychology resident will participate in a weekly interprofessional shared medical appointment for patients with diabetes in the Primary Care Metabolic Clinic along with members of pharmacy, nutrition, and diabetes education. The clinical psychology resident will also conduct individual motivational enhancement sessions for diabetic nonadherence and obesity management as part of the Metabolic Clinic experience. 

Pain School. The clinical psychology resident will learn how to conduct a pre-intervention pain-specific evaluation for the Primary Care Behavioral Health Pain School.  The resident will also learn to administer both individual and group Cognitive Behavior Therapy for Chronic Pain for Veterans living with chronic pain.  Finally, the resident will collaborate with members of primary care, pharmacy, physical therapy, and nutrition services to present the Primary Care Behavioral Health Pain School “Pain Panel.”

Smoking Cessation Clinic. The clinical psychology resident will have the opportunity to learn how to provide “open access” support to Veterans who are stopping smoking.  He or she will co-facilitate (with the Pharmacy service and PCBH Post-Doctoral Fellow) an evidence-based, standardized, group smoking cessation intervention that is short-term (i.e., four sessions) and aligned with motivational and cognitive-behavioral precepts.

The Primary Care Interprofessional Learning Clinic. The clinical psychology resident will participate in a weekly interprofessional shared medical appointment for Veterans presenting with complex medical, psychological, and/or psychosocial concerns.  The resident will learn how to conduct a comprehensive chart review and offer hypotheses, relevant information, and suggestions to the team during team precepting/rounding.  During the visit, the resident will contribute to the interview, offer to complete brief assessments of cognitive, behavioral, and other psychosocial issues, complete safety assessments, and develop appropriate safety plans.  Following the interview, the resident will offer suggestions to the Veteran, his or her treatment team, and other healthcare providers regarding their impressions and recommendations for appropriate referrals and follow-up care. 

Pre-Transplant Psychosocial Evaluation. The clinical psychology resident will have the opportunity to conduct pre-surgical evaluations for Veterans being considered for heart, lung, liver, or kidney transplants. The resident will learn to conduct a comprehensive evaluation of Veterans’ mental health and substance use histories, current adherence patterns, and social support resources as well as their understanding of their medical situation and transplantation procedures. Evaluations will be co-facilitated with the supervisor and recommendations for behavioral or psychosocial changes will be discussed with the Veteran and his or her support person in the evaluation session. The resident will share findings with the transplant team and may also have the opportunity to follow individual patients who would benefit from brief treatment to help facilitate behavioral changes necessary to achieve surgical eligibility.

Clinical-Research Focused 12 Month Experience

Unlike the four-month rotations described above, the Clinical-Research rotations are 12- month long experiences providing concentrated clinical-research training in a specialty area. During the first eight months of training, time is spent as follows: 50% time research, 20% behavioral medicine clinical experience, and 10% didactics. In the last 4 months of training, time is spent as follows: 60% research, 40% out-of-track clinical experience. The clinical-research rotations are designed for clinical psychology residents with prior experience and training within the specialty areas offered, and who are planning a research-oriented career in the specialty area.

Obesity Clinical-Research Rotation - The Miriam Hospital

Faculty Supervisor: Rena Wing, PhD and J. Graham Thomas, PhD 

The Obesity clinical-research rotation is a focused 12-month long experience providing concentrated clinical-research training in the specialty area of obesity. During the first eight months of training, time is spent as follows: 50% obesity clinical-research, 20% inpatient hospital consultation-liaison service, 20% outpatient behavioral medicine clinical work, and 10% didactics. In the last four months of training, time is spent as follows: 60% obesity clinical-research, and 40% out-of-track clinical experience.

This research- focused rotation takes place primarily at The Miriam Hospital’s Weight Control and Diabetes Research Center. The aims of the research within the Center are to expand knowledge of the causes and consequences of obesity, develop innovative and effective treatments for weight loss and weight maintenance, and offer quality obesity treatment to the community through ongoing clinical trials. The clinical psychology resident will participate in ongoing studies related to these areas, the development of grants and manuscripts and the facilitation of clinical research weight management groups.

Clinical psychology residents on this rotation will also receive clinical training in behavioral medicine through assessment, treatment and consultation activities. The clinical activities on this rotation are designed to provide training that can complement the resident’s research in obesity while also enhancing the clinical psychology resident’s exposure to broad based behavioral medicine training. Clinical experiences typically include training in integrated primary care and inpatient consultation-liaison settings, and/or specialized behavioral medicine settings (e.g., behavioral sleep medicine, smoking cessation, cardiac rehabilitation).