At the beginning of the training year, interns select a sequence for involvement in three, four-month rotations including at least one inpatient, extended stay rotation at CBM and one outpatient or acute inpatient rotation at TMCBH. The third rotation will occur at CBM in either outpatient forensic assessment or inpatient treatment (forensic or extended stay). Interns will also choose a minor rotation in either Dialectical Behavior Therapy (CBM) or outpatient psychotherapy (TMCBH).
Clinical Tract: Major Rotations
CBM
Inpatient-Adult, Extended Stay Acute: Currently there is one 25-bed and one 15-bed extended stay
acute adult inpatient unit. Presenting problems may include psychoses,
suicidal behavior, affective disorders, severe personality disorders,
and co-morbid substance abuse diagnoses. On the units, the average length
of stay ranges from 90 days to one year. Each intern will complete at
least one, four month rotation on a CBM inpatient, extended stay unit.
Inpatient-Adult, Forensic/IST: There is one 25-bed inpatient, competency restoration unit. Patients on this unit are admitted under Chapter 552 of the RSMO as Incompetent to Proceed and participate in the Competency Restoration Program, where they are offered a combination of psychopharmacological treatment and competency education.
During this rotation, the intern will serve as a member of the multi-disciplinary treatment team consisting of psychiatry, psychology, social work, nursing, and rehabilitation services. The intern will assist a post-doctoral resident in providing individual psychotherapy, psychological assessment, and group therapy.
Outpatient Forensic Assessment: The Forensic Assessment four month rotation offers interns the opportunity to acquire a working knowledge of Criminal-Forensic Psychology, particularly as it applies to the issues of competency to stand trial and criminal responsibility. This rotation focuses on conducting and writing pre-trial court-ordered evaluations under the provisions of the Missouri State Statues. Psychology interns receive didactic and experiential training under supervision of post-doctoral fellows and certified forensic examiners.
TMCBH
Inpatient- Adult, Acute: There are two acute, coed inpatient psychiatric units of 25 beds each. Responsibilities include treating an underserved/uninsured inner-city population of patients primarily transferred from TMCBH's Emergency Department or TMC's Medical Emergency Department. The scope of behavioral health issues presented are depression, anxiety, substance abuse, PTSD, personality disorders, neuro/cognitive impairment, severe psychosis, and suicidal and homicidal ideation. Interventions include medication management, guardian or court-ordered psychiatric evaluations, and minimization of suicidal or homicidal ideation, social work, and discharge planning.
Access Intake Medication Services (AIMS)-Adult Outpatient: The intake and access services department at TMCBH serves adult outpatients with a wide variety of mental health difficulties, including severe and persistent mental illness. Services include brief intake assessments, psychological assessment and testing, referral, and individual & group psychotherapy. Clients are largely from an underserved population and are at or below poverty levels.
The rotating intern would complete full integrative psychological batteries, including intelligence, achievement, memory, executive functioning, and psychopathological assessments. Referrals come from a variety of sources including outpatient psychiatrists and case managers. In addition, there is the opportunity to participate in capacity evaluations ordered by medical professionals and brief assessments of individuals on the inpatient unit.
Post-Traumatic Stress Disorder Services-Adult: The Post-Traumatic Stress Disorder (PTSD) Service is a specialty clinic at TMCBH providing evidence-based treatments to individuals struggling with PTSD and co-morbid issues. During their 4-month rotation, interns will be trained to provide psychological assessment of PTSD, as well as focused PTSD interventions, including evidence-based individual & group psychotherapies. Therapeutic approaches include, but are not limited to, Prolonged Exposure, Cognitive Processing Therapy, Seeking Safety, and Dialectical Behavior Therapy. Interns will have the option of learning and implementing an evidence-based treatment package for PTSD (i.e., Prolonged Exposure or Cognitive Processing Therapy). Interns will also have the opportunity to develop new programming and provide educational presentations across TMC regarding PTSD and services offered by the PTSD service. The PTSD Service operates at both TMC's Hospital Hill & Lakewood Counseling Service campuses.
Primary Care Integrated Services-Adult: The Health Psychology rotation offers interns the opportunity to work within various specialty medical clinics at TMC, hospital hill, including Pulmonary Clinics (such as Sleep and Asthma), Infectious Disease, Bariatric, Sickle Cell, Oncology, and Primary Care. Responsibilities include individual and group psychotherapy as well as assessments including pre-surgery bariatric evaluations, capacity to make medical decisions, and clearance for treatment of Hepatitis C. The program offers biofeedback for chronic pain, anxiety, and other medical related issues. An intern with a particular interest in relaxation training will have the opportunity to work towards self regulation mastery in thermal biofeedback and co-facilitate a relaxation training group. Interns also have the opportunity to rotate with Consult & Liaison Services that provides psychiatric evaluations for medical patients.
Clinical Tract: Minor Rotations
Throughout the year and regardless of rotation, clinical tract interns will spend two, one-half days per week providing psychotherapy interventions either at TMCBH (adult or child & family clinic) or by participating in the DBT program at CBM.
Dialectical Behavior Therapy: The DBT program at CBM serves an ethnically diverse inpatient population who present with emotional dysregulation issues and diagnoses such as Borderline Personality Disorder, Bipolar Disorder, and various developmental disorders. As part of the DBT program, interns will facilitate DBT skills groups, provide individual therapy and coaching for one or two inpatients, and attend the weekly consultation team meeting throughout the year.
Outpatient Psychotherapy: Interns may choose to provide individual psychotherapy at TMCBH's outpatient clinics (Adult/AIMS and/or Child & Family). An intern will manage a caseload of at least five individual clients and attend one hour of supervision. Interns are encouraged to pursue to group therapy opportunities according to clinic and patient need.
Forensic Tract
Training experiences include working with the Department of Mental Health in activities involving restoration to competency and clinical treatment of individuals who have been found Incompetent to Proceed and Not Guilty by Reason of Mental Disease or Defect. In addition, there will be opportunities to evaluate Defendants on issues including competency to stand trial, sanity at the time of offense, and risk assessment.
Interns in the forensic tract will spend two, six-month rotations providing treatment and evaluative services to inpatients at NMPRC according to unit assignment. Unit populations are generally organized according to clinical presentation: cognitive disorders, chronic and persistent mental illness, and dual diagnoses. Interns will also complete a minor rotation in forensic assessment.
Forensic Tract: Major Rotations
Twain Unit-Cognitive Disabilities: 20-bed unit; patient population primarily composed of individuals with developmental disabilities, dementias, and head traumas. Treatment interventions include Illness Management and Recovery (IMR), New Outlook, substance abuse, and competency restoration education.
During this six-month rotation, interns will participate in multidisciplinary team meetings, perform psychological assessments, and provide individual and group therapy.
Carver Unit-Chronic Mental Illness: 20-bed unit; patient population includes individuals with chronic and persistent mental illness such as schizophrenia, severe mood disorders, and other refractory psychiatric conditions. Treatment interventions include social learning, DBT, substance abuse, and competency restoration education.
Lincoln Unit-Dual Diagnoses: 20-bed unit; patient population includes individuals in the forensic system with co-occuring clinical and personality disorders. Treatment interventions include New Outlook, DBT, substance abuse, and competency restoration education.
During this six-month rotation, interns will provide services on both units dividing their time according to unit needs. Interns will participate in multidisciplinary team meetings, perform psychological testing and assessments, and provide individual and group therapy.
Forensic Tract: Minor Rotation
Forensic Evaluations: Interns will spend a minimum of eight hours per week working closely with a certified forensic examiner to develop understanding and skills in forensic interviewing, assessment, and report writing. Interns will experience the integration of psychology and law through interaction with the legal system and performing competency and criminal responsibility evaluations and risk assessments. Opportunities to observe court proceedings and provide expert testimony are likely.