Psychology doctoral internship rotations and stipend

On the third floor of the Sharp Mesa Vista Hospital CAP Building, you will find the 23-bed Child and Adolescent inpatient unit (CAP3). CAP3 is divided into two patient treatment programs: an adolescent intensive care unit, treating acutely disturbed adolescents and dual-diagnosis youth, and a program for children ages 5 through 12. CAP3 treats youth who are experiencing impairment in their family, school or health functioning as a result of psychiatric illness. Typical presenting problems include depression/suicidality, runaway/conduct disorders, substance abuse/dependence, mood disturbance/behavioral disturbance/bipolar and/or the acute phase of a psychotic disorder.

The CAP3 rotation will familiarize interns with the developmental tasks and issues facing youngsters, and with how psychopathology becomes interwoven with such developmental issues. In the context of a shorter stay and the increasing severity of patients' disturbances, interns learn how to set appropriate acute-care treatment goals and disposition planning and learn how to use the program milieu to achieve these goals. Interns help facilitate a weekly family support group for parents and family members to learn about safety planning, communication and methods to support their child or adolescent in recovery. Work is fast-paced, exciting and high demand. Interns on this rotation are expected to multitask and have balance.

Interns will gain didactic and clinical experiences in these clinical issues:

• Case management skills

• Chemical dependency treatment with dually diagnosed adolescents

• Cognitive-behavioral treatment with youth

• Crisis intervention with youth and families

• Developmental tasks of youth

• Group psychotherapy with adolescents and latency age children

• Inpatient management of acutely disturbed youth

• Multidisciplinary team approach

• Psychopathology of youth

CAP3 strongly emphasizes a team approach in which psychologists, psychiatrists, nursing staff, social workers, activity therapists, teachers, consulting staff, the patient and the patient's family work together on treatment goals. Interns become an integral part of the treatment team during the rotation. Interns serve as co-therapists in a variety of groups, serve as a liaison between staff and consulting psychologists and participate in treatment planning and treatment conferences, attend team meetings and in-service presentations and provide informal consultation to other staff.

Child and Adolescent Outpatient Programs are housed on the first floor of the CAP building at Sharp Mesa Vista (aka CAP1). The Adolescent Cognitive Intensive Outpatient Program (AC-IOP) provides treatment for mental health. Patients receive evidence-based (CBT, DBT and ACT) group therapy, individualized psychoeducational skills (e.g., anger management, assertive communication, impulse control, self-esteem, body image, etc.), family therapy, multi-family group therapy and individualized case management. Family involvement is a crucial part of treatment and includes parent education and skills as well as mandatory weekly participation in multi-family group therapy and monthly family therapy meetings. The program provides a safe alternative to hospitalization and serves as a step-up from traditional outpatient therapy or a step-down from inpatient, RTC or PHP levels of care. Typical course of treatment is 3 hours per day, 3 days per week for approximately 2 months. The intern also has opportunity to gain experience in the Adolescent and Child Partial Hospitalization Programs and the Changes IOP (adolescent dual recovery) if it is in line with their training goals.

The Adolescent Cognitive IOP provides treatment for mental health and chemical dependency issues. Patients receive evidence-based (CBT, DBT and ACT) group therapy, individualized psychoeducational skills (e.g., anger management, assertive communication, impulse control, self-esteem, body image, etc.), family therapy, multi-family group therapy and individualized case management. Family involvement is a crucial part of treatment and includes parent education and skills as well as mandatory weekly participation in multi-family group therapy and monthly family therapy meetings. The program provides a safe alternative to hospitalization and serves as a step-up from traditional outpatient therapy or a step-down from inpatient, RTC or PHP levels of care. Typical course of treatment is 3 hours per day, 3 days per week for approximately 2 months.

Outpatient CAP psychology interns participate in a wide variety of activities to learn about adolescent development, the nature of adolescent psychopathology and the interaction between the two. Interns conduct individual, group, family and multi-family therapy as well as intake evaluations, suicide risk assessment and safety planning. Group is often delivered using a co-therapy model (i.e., two therapists in the room), and there are opportunities to shadow supervisors and receive periodic live supervision in all clinical activities. Additionally, interns participate in department-wide measurement-based-care initiatives to evaluate IOP’s effectiveness for individuals and across patients and demographics. Findings allow for guidance and enhancements in IOP structure, curriculum and other program improvements efforts, which interns participate in alongside program staff.

Interns receive gain didactic training, supervision and direct experience with these clinical areas:

• CBT, DBT and ACT

• Suicide risk assessment

• Safety planning and means restriction

• Developmental tasks of adolescents

• Psychopathology of adolescents

• Chemical dependency treatment with dually diagnosed adolescents

• Family systems theory

• Family therapy

• Group psychotherapy with adolescents

• Multi-family group therapy

• Intake evaluations and triage

• Measurement-based care

• Program development

• Program evaluation and improvements

• Curriculum development

The A-IOP is an afternoon/evening program. The intern will spend at least three days per week working from 11 am to 7:30 pm.

The ICU and South Rotunda (SR) are two adult locked psychiatric units designed for individuals experiencing an acute phase of a psychiatric disorder. The ICU/SR  rotation provides clinical experience in the evidence-based treatment of patients across a broad spectrum of age and diagnoses, including psychiatric and substance abuse disorders. Working alongside the unit psychologist, interns provide evidence-based psychoeducation, group therapy, individual therapy and brief screening assessments.

This rotation will develop the intern's ability to effectively and quickly conceptualize and treat a challenging caseload of individuals who have multiple presenting problems. Additionally, interns will be actively engaged in program development, as ICU/SR psychology programming expands to meet the needs of this dynamic population.

Given short hospital length-of-stay, interns are faced with rapid patient assessments and formulate effective interventions to stabilize disequilibrium. By the end of the rotation, interns should be able to efficiently assess a patient with regard to differential diagnosis and with regard to particular strengths and weaknesses. Interns will learn to effectively communicate about these assessments with other interdisciplinary team members. Interdisciplinary collaboration is heavily emphasized in this rotation, and side-by-side work with social work, nursing, recreation therapy, psychiatry and peer support is encouraged and expected.

During the rotation, interns will be offered educational and clinical experiences in the following areas:

• Adult psychopathology assessment/diagnosis and treatment

• Evidence-based approaches (ACT, DBT, CBT) that are trauma-informed and person-centered

• Brief screenings to inform treatment

• Behavior modification

• Brief crisis treatment

• 72-hour and 14-day holds, hearings and conservatorships

• Electroconvulsive treatment (ECT)

• Group, individual and milieu based therapy

• Program development

• Interdisciplinary treatment team approach

• Seclusion and restraint issues

Our Mid-City Satellite Outpatient clinic houses the Trauma and PTSD Recovery Intensive Outpatient Program, which offers evidence-based outpatient therapies to adults. Therapies aim to help patients build skills in relation to coping with trauma and PTSD symptoms. The 8-week group treatment addresses topics such as the impact of trauma on the brain and on the body, distress tolerance skills, increasing emotional intelligence, goal setting and motivational interviewing for change, self-compassion to cope with shame and guilt, increasing values, meaning making and safety. In addition to facilitating and co-facilitating process and skills groups, interns will also assume a caseload of individual patients for brief, weekly sessions to facilitate the skill building and progress of patients while in program.

The goals of this rotation are to familiarize interns with the principles of evidence-based trauma therapies and gain related skills, such that they can apply them to a wide range of PTSD presentations. The program uses an integrative approach to trauma treatment, including modalities such as CBT, DBT, ACT and Somatic therapies. The learning for the intern is achieved through participation in group and individual therapy, clinical team meetings and supervision. Interns will be part of a multidisciplinary team that includes psychologists, psychiatrists, psychiatric nurses, social workers, and marriage and family therapists. Upon completion of the Trauma-IOP rotation, interns are expected to be able to conceptualize trauma and its impact, co-facilitate group therapy, manage a small caseload of individual patients, and clearly present educational material on a variety of topics related to trauma and PTSD.

Interns will gain didactic and clinical experiences in these clinical issues:

• PTSD and comorbid diagnoses

• Trauma informed care

• Case conceptualization through a trauma lens

• Assessment of suicide risk

• Group therapy and individual therapy

• Interpersonal processes in therapy

• Multidisciplinary team approach

• Case management for individual patients

Sharp McDonald Center provides comprehensive, evidence-based treatment to adults with chemical dependency. It is San Diego's only freestanding, fully Joint Commission-accredited Chemical Dependency Recovery hospital. All programs operate out of three buildings and include three distinct settings that have areas of integration, including medical detoxification/residential, partial hospitalization and medication-assisted intensive outpatient programming. The Sharp McDonald Center is 0.7 miles from Sharp Mesa Vista (our main behavioral health hospital where other rotations are completed). SMC interns attend group supervision and other meetings at Mesa Vista throughout the week and must have their own transportation available.

The treatments provided at the Sharp McDonald Center are evidence-based interventions for individuals with substance use disorder diagnoses. The programs treat patients who are able to function in a subacute inpatient, partial-hospital or intensive outpatient setting.

Residential, partial hospital and intensive outpatient programs utilize interventions from both abstinence-based and harm reduction model and facilitate sober living skills, requiring these adults to take responsibility for self-maintenance and maintenance of their environment. Sharp McDonald Center provides daily therapeutic programming to provide continuity of care and to maximize clinical gains. A free aftercare program is provided to all former patients of the Sharp McDonald Center, which provides continued care upon discharge from programming and maintains a strong sense of community among McDonald Center grads and staff.

Sharp McDonald Center interns will receive training and experience with the following:

• Evidence-based behavioral therapies

• CBT and ACT group and individual therapy

• Motivational interviewing

• Comprehensive psychosocial assessment and treatment planning

• Discharge planning

• Exposure to patient placement guidelines for the American Society of Addiction Medicine (ASAM) and Utilization Review

• Family therapy

• Program evaluation and development

Sharp McDonald Center interns work side by side with experienced professionals from several disciplines (e.g., psychologists, occasionally postdoctoral fellows in clinical psychology, clinical social workers, marriage and family therapists, CADAC counselors, nurses, psychiatrists, chaplains). They provide group therapy and carry a caseload of three to five patients for individual therapy, comprehensive case management, utilization review, family therapy and couples sessions. SMC interns will work one evening shift per week from 11:30 am to 8pm.

Adult Services — with both open and locked inpatient units — is designed for patients 18 years and older who are experiencing an acute phase of a psychiatric disorder and those who are receiving detox treatment for chemical dependency. All Mesa Vista programs are heavily influenced by the Recovery Model (see Guiding Principles and Elements of Recovery-Oriented Systems of Care: What Do We Know From the Research?, Hill, et al., 2010; Frese, et al. 2001; Warner, 2010). Working closely with an experienced psychologist, interns provide evidence-based (primarily CBT) psychoeducation, group therapy, one-to-one interventions and skill development for patients experiencing severe and sometimes chronic mood, thought, personality and other disorders.

The Adult Services rotation provides clinical experience in the evidence-based treatment of patients across a broad spectrum of age and diagnoses, including psychiatric and substance abuse disorders. The primary goals of this rotation are to develop the intern's ability to assess adults and establish individualized, empirically-informed treatment approaches for psychiatric inpatients. Interventions may be executed directly — as in the case with group therapy — or through indirect means — as in the case of treatment and discharge planning conferences. The intern is an active participant in team meetings and is involved in staff consultation and program development.

Given short hospital length-of-stay, interns are faced with rapid assessments of patients and formulation of effective interventions to stabilize disequilibrium. By the end of the rotation, interns should be able to efficiently assess a patient with regard to differential diagnosis and with regard to particular strengths and weaknesses. Additionally, interns should be capable of developing and leading a multi-disciplinary team approach to treatment, working in conjunction with psychiatrists, social workers, nursing staff and activity therapy specialists.

During the rotation the interns will be offered educational and clinical experiences in the following areas:

• Adult psychopathology — assessment/diagnosis and treatment

• Behavior modification

• Brief crisis treatment of individuals, couples and/or families in conjunction with their assigned case managers

• Electroconvulsive treatment (ECT)

At Sharp, we are committed to meeting the needs of the rapidly expanding older adult population in San Diego County. The SBU is a 19-bed inpatient unit that is part of that commitment. As part of that commitment, there is a strong focus on the Pikes Peak Model throughout training with interns using competencies to assess progress and set training goals. Likewise, a critical lens is applied to address issues of ageism and combating intersecting social issues that impact older adults.

Psychology, social work, recreation therapy, nutrition, pharmacy, nursing, physical therapy, music therapy, chaplaincy, internal medicine and psychiatry are members of the core team. The SBU interdisciplinary team is skilled in working together to compassionately and effectively meet the bio-psycho-social needs of older adults with severe mental health problems.

The doctoral psychology intern is an integral member of the SBU interdisciplinary team. The intern plays a leadership role on the SBU psychology team, helping to oversee and support the work of advanced doctoral students and work collaboratively with postdoctoral fellows. The psychology team leads or co-leads two groups on the unit every day. Interns typically run 3-4 groups weekly. Interns also carry an individual caseload of patients (typically 2 to 4). Interns are routinely involved in leading interdisciplinary behavioral interventions, family education/support and psychological/neurocognitive screenings and assessment. Staff training and program development activities are an important part of the intern role. There is also time to spend in the milieu, and plenty of important clinical work occurs in these more informal interactions with patients and staff.

Many SBU patients are admitted from home and others come from board and care, assisted living or skilled nursing facilities. Patients typically are discharged to the same or higher level of care. Usual length of stay is one week to one month, though some patients stay much more than a month. Most patients are hospitalized voluntarily, but some are there on a legal hold and/or under conservatorship. Many patients receive follow-up care in our Senior Intensive Outpatient Program and there is some opportunity for interns to follow their individual therapy patients into the outpatient setting. While SBU does support the needs of older adults experiencing neurocognitive impairments, the majority of the patients served on SBU are people who have experienced chronic SMI over their life course and require medication adjustments and behavioral supports as well as folks who are experiencing acute symptoms of depression and anxiety. Nearly 20% of patients served by SBU are being treated for a substance use disorder.

SBU interns can expect to develop knowledge and skill in:

• The Recovery Model and person-centered care

• Evidence-based, developmentally appropriate individual and group interventions (ACT, CBT, Behavioral Activation, Motivational Interviewing)

• Providing assessment and intervention to older adults with a strong focus on Pikes Peak Competencies

• 72-hour and 14-day holds, hearings and conservatorships

• Brief neuropsychological and psychological screenings

• Cognitive battery assessments to assess for NCI and support placement upon discharge

• Caregiver support

• Community reintegration and other strategies to reduce relapse and readmission rates

• Electroconvulsive treatment (ECT)

• Program development for gero-focused initiatives across Sharp Mesa Vista

The Senior Intensive Outpatient Program (SIOP) is one of the fastest growing programs at Sharp Mesa Vista. It has quadrupled the number of actively enrolled patients in the last several years, and continues to expand. The SIOP staff are at the forefront of helping the hospital meet the needs of a rapidly growing senior population, collaborating with other programs and agencies throughout Sharp and in the San Diego community to ensure that patients continue to thrive, even after completing our programs.

The SIOP provides behavioral and cognitive behavioral group interventions, as well as case management, individual, couples and family sessions to support group work. Patients primarily present with severe mood disorders and/or anxiety disorders. Somatoform and Axis II disorders are also represented, as are thought disorders and mild cognitive impairment. Patients are triaged into the SIOP track that is the best fit for their presenting problems and level of functioning. Length of stay ranges from six weeks to six months or more. We begin "transition" or discharge planning with patients from their first day in the program.

The intern is an active, integral member of the interdisciplinary team. Under the supervision of the staff psychologist, the intern is involved in all aspects of the program.

The SIOP intern can expect to develop skills in:

• Adult development and aging

• Application of/adaptation of evidenced-based treatments for older adults (individual, group and family)

• Community outreach (building bridges with programs that serve/support older adults in the community)

• Community reintegration and Recovery Model

• Program development and evaluation