Clinical Rotation

Major rotations (each 6 months)

Center for Traumatic Stress for Children & Adolescents

Supervisors: Anthony Mannarino, Ph.D. and Alvaro Q. Barriga, Ph.D.

The Center for Traumatic Stress for Children and Adolescents (CTSCA) is a specialty clinical-research program for children, adolescents, and their families who have experienced traumatic life events. Interns completing a major rotation through CTSCA will receive training in evaluating traumatized children and in two treatments that have been developed at the Center: Trauma-Focused Cognitive Behavioral Therapy and CBT for Children with Traumatic Grief.

Interns that choose a major rotation through CTSCA will be given the opportunity to provide therapy to patients between the ages of 3 and 18 who have experienced some type of trauma, including, but not limited to, sexual abuse, physical abuse, the traumatic and/or unexpected death of a loved one, natural disaster, and/or serious medical conditions. The intern will ideally carry a caseload of 8-9 clients and will receive one hour of scheduled supervision per week with additional supervision as needed. The CTSCA is extensively engaged in the scientific and empirical development and evaluation of culturally sensitive assessments and intervention with children who have experienced traumatic stress. Faculty provide modeling in the scientist-practitioner approach to clinical activity and interns are encouraged to participate in research, as appropriate based upon their level of experience and career interest.

Special Prerequisites: Prior to being allowed to complete a major CTSCA rotation, interested interns are required to have completed a graduate-level course in developmental psychopathology, complete a rotation specific interview with the training faculty and also the online, free TF-CBT training at www.musc.edu/tfcbt.

CTSCA Goals:

• Learn the basic components of assessment with children and adolescents exposed to trauma, including the use of objective instruments to assess trauma symptoms
• Implement Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) with 8 -9 cases per week
• Complete TF-CBT, including the trauma narration and processing component, with at least four families
• Use objective instruments to assess treatment outcomes, particularly in regard to PTSD and other trauma symptoms

Adult Intensive Psychiatric Day Treatment Program

Supervisor: Nancy Kennedy, Psy.D.

As part of the adult rotation, interns obtain experience in the Adult Intensive Psychiatric Day Treatment Program where they will work with a comprehensive treatment team, including a licensed psychologist, attending psychiatrist, psychiatric residents, psychiatric nurses, and possible psychology graduate practicum students. This team works with acutely psychiatrically ill adults, often referred by providers to circumvent an inpatient admission. The program treats a variety of patients with different ethnic backgrounds and constituting diagnostic groups, most frequently affective, anxiety and personality disorders. The intern will gain experience in the conduct of comprehensive biopsychosocial evaluations and group psychotherapy in a culturally sensitive manner. In addition, interns will experience participation with a multi-disciplinary treatment team and gain an understanding of the interplay between intensive group psychotherapy and assertive medication management of the acutely ill psychiatric patient. As part of the developmental perspective on training, interns will participate in a three stage supervision plan, beginning with observation of the supervisor, co-leading with the supervisor and progression to the supervisor moving to observation of the intern with supervision feedback immediately following the group.

Adult Intensive Psychiatric Day Treatment Program Goals:

• Observe minimum 3 process psychotherapy groups
• Co-lead minimum 8 process psychotherapy groups
• Plan and lead minimum 16 process psychotherapy groups
• Identify and implement minimum of 4 distinct group interventions from CBT, DBT, interpersonal, psychodynamic or other theoretical perspective

Neuropsychology

Supervisors: Hollie Dean-Hill, Psy.D., Michael D. Franzen, Ph.D., Matthew Page, Ph.D., Victoria-Maria Sekunda, Psy.D.

The 6-month major rotation in neuropsychology is for interns who are pursuing board-eligibility in clinical neuropsychology in order to meet APA Div. 40 Houston Guidelines. This track is for interns with extensive training in neuropsychology prior to internship. Interns who want some exposure to clinical neuropsychology in order to become more well-rounded practitioners are able to complete a year-long minor rotation in neuropsychology. This major rotation will prepare interns for competitive candidacy for neuropsychology post-doctoral fellowship programs. Interns on the advanced track will see a wider variety of clinical cases through both the medical inpatient consult and liaison (C&L) service at Allegheny General Hospital and through the outpatient Dept. of Psychiatry. Advanced neuropsychology trainees will also be expected to take a more in-depth role with the clinical interview process, test selection, test administration, and report writing consummate with their experience.

The initial stage of the rotation involves careful consideration of the intern’s prior coursework and practicum experiences with standardized assessment more broadly and neuropsychology specifically. Based on the intern’s prior experiences and his/her career objectives for what populations and practice setting he/she desires, an individualized training plan is developed in order to shape the rotation. At different points in training, interns are provided live observation during their training either by neuropsychology post-doctoral fellows and/or faculty members, depending on the supervisor. Interns receive extensive feedback on all aspects of the evaluation process toward preparing the intern for future independent practice.

Hospital Inpatient C&L: Depending on the specific supervisor and the intern’s individual training plan, interns are able to assist with conducting neuropsychological evaluations as part of a consult and liaison (C&L) service for medical inpatients in a level-1 trauma hospital. Approximately 60% of the patients present with traumatic brain injuries, while the remaining cases involve cerebrovascular accidents, hydrocephalus, seizure disorders, pre-/post-surgical evaluations, pre-/post-organ transplant evaluations, medical decision making capacity evaluations, and other acute medical events. These are brief (< 60”) bedside evaluations for acutely ill patients and trains interns in the rapid consult model within an interdisciplinary medical setting.

Outpatient Neuropsychology: All interns will assist with completing comprehensive outpatient neuropsychological evaluations who are referred to the department for a wide-variety of psychiatric and neurocognitive problems, including, but not limited to, traumatic brain injuries (TBIs), cerebrovascular accidents (CVAs), seizure disorders, genetic disorders, progressive neurocognitive disorders, and intellectual disabilities, pervasive developmental disabilities. Depending on the supervisor, interns may gain experience assessing individuals across the lifespan from approximately 6 years of age to 100+ years of age.

Tiered-Supervision: After the intern has demonstrated foundational knowledge and skill in neuropsychological assessment, each intern will provide tiered assessment supervision to graduate practicum students or interns completing the minor rotation in neuropsychology under the ultimate supervision of the intern’s faculty supervisor. This opportunity allows the advanced intern to begin developing and honing his/her own supervisory style in preparing for future independent practice. The intern’s supervision will include a discussion of different supervision theoretical models, the opportunity for role-playing, live observation of the tiered-supervision provided by the intern, and discussion regarding common ethical challenges that can occur in supervisory relationships.

Neuropsychology Rotation Goals:

• The intern will be able to accurately administer and score multiple commonly used, standardized, objective measures from each of the following domains: intellectual functioning, attention, visuospatial and visual-motor construction, language, memory, executive functioning, behavioral and personality functioning.
• The intern will demonstrate a more advanced level of knowledge regarding psychometric theory, including how different normative samples are biased according based sample characteristics, the limits of interpreting data due to either floor or ceiling effects, and the interpretation of a test’s sensitivity and specificity and the relationship these metrics have with diagnostic certainty.
• The intern will be able to assemble neuropsychological test batteries that are appropriate to address common referral questions.
• The intern will be able to fully or nearly entirely complete an initial clinical interview under the direct observation of the supervising Neuropsychologist for a relatively non-complex presenting problem. For more complex referral questions, the intern will be able to conduct most of the interview, particularly the more routine sections of the interview that do not require as specialized or advanced knowledge (e.g., medical history).
• The intern will be able to write a draft of a full neuropsychological evaluation report with appropriate assistance and supervision from the Neuropsychologist.
• The intern will be able to form reasonable diagnostic hypotheses based upon the DSM-5 and ICD-10 criteria for the more straightforward and less complex presenting problems, but is likely to require significant assistance for more complex presenting problems.
• The intern will be able to identify many of the most common ethical dilemmas that arise in Neuropsychology and be able to discuss these dilemmas at a more advanced level in relationship to specific standards outlined in the APA (2002) Ethics Code. The intern should also be familiar with Bush et al.’s (2006) ethical decision making framework in Neuropsychology and demonstrate a rudimentary ability to follow this framework for discussing more complex ethical dilemmas, including being able to identify at least two reasonable courses of action he/she could follow under those hypothetical scenarios.

Yearlong outpatient psychotherapy experience

Adult Outpatient Supervisors: Jordan Rood, Psy.D., Bruce Rohrs, Ph.D. Lori Siegel, Ph.D., Rebecca Weinberg, Psy.D, Richard Withers, Ph.D.

Child Outpatient Supervisors: Richard Withers, Ph.D., Alvaro Barriga, Ph.D.

As part of the training year, all interns will carry a caseload of at least 4-6 lifespan psychotherapy patients in the outpatient clinic. These cases are part of the intern’s year-long outpatient caseload requirement and serve to ensure the intern has sufficient exposure to a breadth of presenting problems and is able to develop at least basic-level competencies in providing therapy to children, adolescents, and adults.

Adult Outpatient Treatment Goals:

• Intern will identify and work through potential treatment impasses with awareness of the impact of both intern and client variables as measured by successful completion of case presentation/conference.
• Intern will successfully work through the termination process with at least two ongoing psychotherapy cases during the internship year.
• Intern will demonstrate understanding of appropriate referral for ancillary care (e.g., for medication; case management; higher level of care or more specialized care or evaluation), and will learn the processes for making these referrals as demonstrated by at least one appropriate referral during the course of the internship year.
• Intern will demonstrate the ability to develop rapport as evidenced by carrying a case for at least 5 sessions.

Child Outpatient Treatment Goals:

• Demonstrate familiarity with DSM-V/ICDM-10 diagnoses common to children and recognize developmental differences between adult and childhood presentation of common mental health diagnoses.
• Be able to articulate a general knowledge of healthy and problematic child and adolescent psychological development.
• Recognize different engagement and therapeutic communication strategies appropriate to child and adolescent work.
• Be able to articulate basic understanding of agents of change in major evidence-based approaches to child psychotherapy (e.g., Cognitive-Behavioral, Psychodynamic, Child-Centered and family focused treatments).
• Be able to articulate rudimentary knowledge of parenting skills: behavioral principles, age appropriate expectations and developmental needs of children of different ages.

Minor rotations

Children’s Hospital of Pittsburgh

In the instances of off-campus rotations, AGH and the outside institution enter into a training agreement, and a psychologist supervisor must be identified at the outside institution and approved by the Director of the internship.

Consultation & Liaison (6 or 12 months)
The role of interns completing this minor rotation within the Neurology Clinic is to provide comprehensive psychological evaluations and treatment for patients presenting with headache and tic disorders. Treatment for patients presenting with headache consists of stress management, non-pharmacological interventions for pain and cognitive behavioral therapy. Common non-pharmacological interventions include relaxation training (e.g., diaphragmatic breathing, progressive muscle relaxation, guided imagery, autogenics), mindfulness training and biofeedback training. Cognitive behavioral therapy is also incorporated to address the impact that emotional distress and negative thinking may have on one’s headaches as well as to treat any comorbid anxiety or depression. For patients presenting with tics, interns will learn to provide Comprehensive Behavioral Intervention for Tics (CBIT). CBIT is a highly structured treatment that takes place over 8-12 sessions. It involves functional based assessment, awareness training, competing response training, relaxation training and strategies to maintain therapeutic gains. Dr. Scotti-Degnan is certified in CBIT from the Tourette Syndrome Association’s Behavioral Therapy Institute and will provide supervision for all rotating interns.

Children’s Hospital C&L Minor Rotation Goals:

• Headache Treatment Specific Objectives:
  • To increase familiarity with the various types of headache disorders and those most common among the pediatric population
  • To increase familiarity with the various treatments of headache, including non-pharmacological pain management of headache
  • To begin to deliver non-pharmacological pain management of headache to patients, including relaxation techniques (diaphragmatic breathing, progressive muscle relaxation, guided imagery, autogenics), mindfulness training and biofeedback training
• Tic Treatment Specific Objectives:
  • To increase familiarity with the various types of tic disorders and be able to diagnosis the proper type of disorder based on clinical presentation
  • To increase familiarity with the various treatments of tic disorders, including Comprehensive Behavioral Intervention for Tic (CBIT)
  • To begin to deliver CBIT to patients

Allegheny Health Network

Child Integrative Therapy (12 months)
Provides a more in-depth experience in child psychotherapy with a wider exposure to different psychopathology and treatment needs for children, adolescents and their parents. Developmentally informed case-conceptualization and integration of psychodynamic, cognitive-behavioral and child-centered treatment approaches will be encouraged. The minor will include training in evidence-based therapeutic uses of play and art with children and adolescents. Interns will teach behavior-management strategies to parents for challenging behaviors associated with impulse control, mood and anxiety disorders. Interns will also become familiar with more specialized treatment approaches, such as Parent-Child Interaction Therapy for younger children with behavioral disorders, behavioral treatments for anxiety disorders and OCD, and treatment approaches for Autistic Spectrum Disorders. Exposure to and training in these treatments will be provided as cases arise. Interns will also have opportunities to learn about children with severe medical difficulties through the Children’s Institute of Pittsburgh, and potentially to work with these children as cases arise.

Interns will be expected to develop facility in working with educators and others involved with children, and helping families to access community resources relevant to treatment needs. They will become familiar with child psychopharmacology practices and gain experience in coordinating treatment with psychiatrists and other physicians.

Child Integrative Therapy Minor Rotation Goals:
In addition to general child outpatient therapy goals, interns would be expected to:

• Demonstrate capacity in therapeutic communication with children and adolescents of different ages and developmental levels (be able to converse with children who indicate that they feel understood and understand the clinician).
• Demonstrate capacity in at least one evidence-based therapeutic approach to children and adolescents, including:
  • Completion of a thorough psychosocial intake.
  • Demonstration of ability to engage both children and their parents collaboratively in treatment planning, while maintaining appropriate boundaries and respecting confidentiality.
  • Ability to set specific and measurable goals in the form of a treatment plan, appropriate to diagnoses and individual child and family needs.
  • Ability to carry out the basic treatment strategies consistent with one or more evidence-based approaches in a manner appropriate to individual children and their families.
• Demonstrate ability to effectively and appropriately communicate with other child service providers, including physicians, educators, social workers and service coordinators.
• Demonstrate a basic understanding of child abuse reporting laws and procedures for handling child and adolescent emergencies.

Women’s Behavioral Health Program (6 or 12 months)
The Women’s Behavioral Health program at AHN’s West Penn Hospital is an integrative behavioral health clinic for women presenting with mood and anxiety disorders in pregnancy or the postpartum period as well as women struggling with distress related to infertility, pregnancy loss and other reproductive problems. Interns that choose a minor rotation at Women’s Behavioral Health will be given the opportunity to evaluate and provide therapy to patients between the ages of 16 and 45 who present with depressive, anxiety and /or bipolar disorders who are currently pregnant, postpartum, engaged in fertility treatment or who have experienced pregnancy loss. The intern will learn about providing behavioral health services in a medical setting and will ideally carry a caseload of approximately 4-6 clients and will receive on hour of scheduled supervision per week and additional supervision as needed. This minor is under the direction of Rebecca Weinberg, Psy.D.

Women’s Behavioral Health Minor Rotation Goals:

• Develop an understanding of psychiatric symptoms in a perinatal population
• Develop the ability to complete a thorough psychiatric assessment with perinatal patients
• Develop an understanding of empirically supported psychotherapies for perinatal patients including, cognitive behavioral therapy, interpersonal psychotherapy, and behavioral activation and competence in utilizing these treatments to treat these women.
• Develop an understanding of departmental issues related to beginning a new department project.
• Contribute to program development and management of data.

Adult Clinical Health Psychology: Minor Rotation

This rotation is primarily located at West Penn Hospital (WPH) within the AHN Psychiatric and Behavioral Health Institute, although there may be an infrequent need to travel to off-site locations for some clinical experiences (e.g., heart transplant evaluations at AGH). The primary goal of the rotation is to provide clinical health psychology training within an academic medical setting. Clinical Health Psychology is a specialty that is dedicated to the development of knowledge regarding the interface between behavior and health, and to the delivery of high quality services based on that knowledge to individuals, families, and health care systems. Interns choosing this minor rotation will have flexibility to choose among the listed training opportunities to find a combination that provides the best fit with their training experiences and career goals.

Training Opportunities

• Behavioral health consultation and liaison services to WPH medical-surgical care units, including Burn, Acute Rehabilitation, Cardiothoracic ICU, Med-Surg ICU, Progressive Care Unit, Hematology and Cellular Therapy, and Medical Oncology
• Integrated Primary Care with West Penn Medical Associates and Integrated Specialty Care with the Esophageal and Lung Institute
  • Serve as a consultant on a multidisciplinary team which may include physicians, nurses, pharmacists, and allied health staff
  • Provide brief evidence-based interventions to patients and their families
  • Co-lead group therapy for clinical populations (e.g., CBT, ACT, mindfulness)
  • Participate in medical student, resident, and fellow education
• Pre-surgical psychological evaluations for bone marrow/cell transplant and heart transplant candidates
• Interested interns may have the opportunity to participate in ongoing research projects, program development, and/or quality assurance projects

Supervisor:

Kimberly Fleming, PhD

Neuropsychological Assessment in either Dept. of Psychiatry or Neurology (12 months)
The internship offers a minor rotation in neuropsychology through either the Dept. of Psychiatry or through the Dept. of Neurology for interns seeking a career in neuropsychology (which also requires the intern to complete a major rotation in Neuropsychology): The training through the Department of Psychiatry is well-suited for interns who want to become well-rounded general clinical psychologists. In this setting, interns will be exposed to a wide-variety of presenting problems that frequently involve both neurological and psychiatric conditions. At the completion of the training year, interns will have greater skills in completing an initial diagnostic interview, administering objective, standardized assessments, and will gain an appreciation for the cultural and ethical considerations involved in general cognitive assessment

Interns who are planning a career in Neuropsychology are encouraged to consider completing a minor rotation with Dr. Carol Schramke through the Dept. of Neurology. In that capacity, interns will gain significant exposure to providing evaluations for patients presenting with complex epilepsy, psychogenic non-epileptic seizures, motor disorders (e.g., Parkinson’s disease), Multiple Sclerosis, and will also participate in pre- post-surgical evaluations.

Neuropsychology Minor Rotation Goals:

• The intern will be able to accurately administer and score at least one commonly used, standardized, objective measure from each of the following domains: intellectual functioning, attention, memory, executive functioning, and personality functioning.
• The intern will demonstrate a foundational level of knowledge regarding psychometric theory, including how to derive normative scores from raw scores and how to translate between T-score, Z-scores, Standard Scores, Scaled Scores, and percentiles.
• The intern will be able to assist the supervising Neuropsychologist with completing an initial clinical interview and demonstrate how foundational interviewing skills, such as establishing rapport and gathering accurate data, can be applied to patients with complex psychiatric and co-morbid medical histories.
• The intern will be able to write portions of the neuropsychological report (e.g., parts of the background section and behavioral observations), but is likely to require significant assistance and feedback on the following sections: test summary, diagnostic impressions, and the conclusions and recommendations.
• The intern will demonstrate that ability to broadly conceptualize a neuropsychological assessment case by integrating data from the clinical interview, test data, and behavioral rating scales, and to offer some relevant recommendations.
• The intern will be able to identify some of the common ethical dilemmas that most frequently arise in Neuropsychology and be able to discuss these dilemmas at an introductory level in relationship to specific standards outlined in the APA (2002) Ethics Code.
• The intern will be able to demonstrate a working knowledge of cultural considerations related to neuropsychological assessment, including recognition of cultural influences of self and others in the assessment process and strengths and limitations of the assessment process as they related to diversity.

Example intern training programs

The example training programs below are provided for illustrative purposes only and represent just a few of the major and minor rotation combinations available to give the prospective applicant a sense of the wide variety of unique training programs the intern is able to craft.

Lifespan treatment

This is a sample training program for an intern interested in gaining a full range of child, adolescent and adult therapy experiences.

Integrative care treatment

This is a sample training program for an intern who is interested in providing evidenced-based treatment within a medical system, emphasizing providing therapy within an intensive outpatient program designed for perinatal women experiencing psychiatry difficulties.

Child Neuropsychology & Treatment Focused

This sample training program would be ideal for the intern who wants in-depth training in child neuropsychological assessment to meet Div. 40 Houston Guidelines, while obtaining additional competencies in CBT therapy children and adolescents and gaining exposure to pediatric consultations within a children’s hospital. 

Adult Neuropsychology & Treatment Focused

This sample training plan is designed for the intern who wants advanced training in adult neuropsychological assessment across multiple settings in addition to developing competencies for providing adult psychotherapy within acutely ill psychiatric patients.