Behavioral Medicine Rotation A: Specialty Care and Partnership Programs in Behavioral Medicine - The Miriam Hospital

Faculty Supervisor(s): Micheline Anderson, PhD, Ernestine Jennings, PhD, Amanda Phillips, PhD, Megan Pinkston-Camp, MA, PhD (primary), Meghan Sharp, PhD, Chrystal Vergara-Lopez, PhD

The Specialty Care and Partnership Programs in Behavioral Medicine rotation within the Lifespan/Brown University 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- and community-based 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, including specialization in smoking cessation.

The Center for Behavioral and Preventive Medicine (CBPM) at The Miriam Hospital is launching a new program to promote physical and mental health at scale in Rhode Island. The focus of this experience will be working with Drs. Vergara-Lopez and Jennings on developing, adapting, and delivering innovative brief scalable consultation, intervention, educational and skill-based workshops in partnership with community organizations. This experience will offer the clinical psychology resident the opportunity to engage in program development, community-engaged need and acceptability assessments, and delivery of evidence-based consultation, intervention, and workshop services. To better serve the large Latine community in Providence, RI, and surrounding cities, there will be opportunities to develop services and programs in Spanish and English.

Clinical psychology residents will spend one day a week at the Lifespan Recovery Center (LRC), which is a multidisciplinary outpatient clinic focused on the provision of care to individuals with substance and alcohol use concerns with intersecting concerns of psychiatric illness, stigma, minoritized stress, and behavioral medicine concerns. Providers in the clinic include psychologists, masters-level substance use counselors, social workers, addiction psychiatrists, family medicine physicians, and addiction medicine physicians. Residents will have the opportunity to provide evidence-based care for individuals with co-occurring substance use and mental health disorders. Additionally, in line with the recovery model of care, residents will have the opportunity to develop and implement clinical health psychology (e.g., chronic pain, weight, body image, sleep concerns, HIV, HCV) screening, brief interventions, and programs in the center. Opportunities may also be present for group interventions and shared medical visits. Dr. Pinkston-Camp is the supervisor for this experience. If residents have an interest in and there are clinical opportunities at the time of the rotation, Dr. Pinkston-Camp can also provide specialized training in methamphetamine/stimulant use, sexual health, LGBTQ+ care and HIV.

At the Lifespan Cancer Institute (LCI) located in Rhode Island Hospital, residents will gain valuable experience in providing psychological support and interventions to adults facing the challenges of cancer diagnosis, treatment, and survivorship. Residents will work with Dr. Amanda Phillips and the multi-disciplinary team at LCI to offer comprehensive care that addresses the biopsychosocial aspects of living with cancer and end-of-life concerns. Typical treatment modalities include meaning-centered psychotherapy, cognitive-behavioral therapy, and acceptance-based interventions.

Clinical psychology residents will have a half-day experience in specialty integrated behavioral health (IBH), embedded within Lifespan Obstetrics and Gynecology (OBGYN) outpatient clinic. The IBH service is part of a multidisciplinary team caring for people assigned female sex at birth seeking care for reproductive physical health concerns including but not limited to pregnancy, pelvic pain, medical trauma, and sexual dysfunction. Residents will work with Drs. Meghan Sharp and Micheline Anderson to gain experience in brief assessment and treatment of mental health concerns as they relate to female reproductive health. Residents will participate in peer-to-peer education with OBGYN providers, warm handoffs during OBGYN medical visits, assessment and treatment planning, and brief psychotherapy (CBT, ACT, DBT, and IPT).

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): Ronald Smith, PhD  (primary) and Pamela Steadman-Wood, PhD, ABPP

Located at the Providence VA Medical Center, the Geropsychology rotation is designed to introduce the trainee to the role of the Geropsychologist in an outpatient medical center setting. The clinical psychology intern will spend 3 full days and two half days in the General Outpatient Mental Health Clinic – Comprehensive Outpatient Mental Health Services (COMHS), providing an array of psychological services to older Veterans. The rotation aims to provide specialized training in the assessment, intervention, and consultation with older adults, their families, and related care systems. The training opportunities unique to those of a member of an interprofessional geriatric care team within the medical center setting provide  diversity of experience with older adults, demonstrate the complex ethical dilemmas that can arise in geriatric care, and highlight the importance of advocacy for clients’ needs.

Providence VA General Outpatient Clinic (COMHS). The VA’s General Outpatient Mental Health Clinic—the Comprehensive Outpatient Mental Health Service (COMHS)-- 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 illnesses, 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), Interpersonal Therapy (IPT), Late-Adulthood Trauma Reengagement (LATR), and Motivational Interviewing (MI). Opportunities for group therapy may also be available, depending on need and interest.

The COMHS training experience will also provide interns with opportunities for working with Veterans with neurocognitive disorders and their caregivers. This may include brief cognitive testing, psychoeducation, and behavioral management interventions. 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.

Overall, clinical psychology 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 an outpatient medical center setting, 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),  Karen Oliver, PhD

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

Faculty Supervisor(s): Zoe Mushkat, PhD (primary), Caitlin Burditt, PhD, Janet Phillips, PhD, 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 complex 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:

MOVE! Weight Management Program. The clinical psychology resident will co-facilitate behavioral health focused sessions within the MOVE! Program, which is a 16-week manualized group program for Veterans pursuing weight loss. The resident will also 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.  The clinical psychology resident will gain experience in conducting presurgical psychological evaluations for Veterans pursuing implant surgery (typically ranges from 8-10 assessments per rotation).  There will be an opportunity for the treatment of veterans in the Sexual Health Clinic on an intermittent, as-needed basis.  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.

Tobacco Cessation. The clinical psychology resident will have the opportunity to provide evidence-based treatment for Veterans looking to stop using tobacco or related products. The resident will carry approximately two tobacco cessation cases per rotation and will conduct assessment and individual intervention with them based on a standardized approach. The resident will also have the opportunity to learn about pharmacological intervention for tobacco cessation.

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:

Interdisciplinary Pain Clinic: The Interdisciplinary Pain Clinic (IDPC) includes clinicians from multiple disciplines, including rehabilitation, mental health, pharmacy, anesthesiology, and medicine. IDPC members complete thorough chart reviews of Veterans with complex chronic pain conditions and then assesses these Veterans during an appointment that includes all disciplines. Following evaluation with the IDPC, team members see Veterans in follow-up with the goal of reducing pain, improving functioning, and enhancing quality of life. The clinical psychology resident will have the opportunity to complete thorough chart reviews and participate in the assessment visit. They may also have the opportunity to see Veterans in follow-up, if appropriate.

Empowered Relief: Empowered Relief compresses elements of pain neuroscience education, mindfulness principles, and 3 key cognitive-behavioral skills into a single two hour class that is delivered in-person or online by a certified clinician. Participants gain effective self-regulatory skills that help them steer their nervous system toward lasting relief. Participants complete a personalized plan for empowered relief and receive a free binaural app for daily use. Four randomized controlled clinical trials have consistently demonstrated feasibility, accessibility, patient satisfaction, and clinical efficacy for Empowered Relief in people with chronic pain and in patients undergoing surgery. The clinical psychology resident will have the opportunity to observe up to four Empowered Relief Workshops during the rotation and discuss how this workshop potentially responds to individual and system-level needs during clinical supervision meetings.

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).